Today junior doctors have gone on strike for the first time in 40 years. Like the last strike in 1975 this one is all about the doctors, not patients. By making those hours most practical for patients normal working hours for doctors, Jeremy Hunt has hit on the hidden hypocrisy – this strike isn’t about patients, it’s about money and politics. Patients are left to deal with the consequences.
In 1975, the last time doctors went on strike, the issue was a new contract imposed by the late Barbara Castle. It stipulated that doctors employed by the NHS could no longer continue with private practice. Junior doctors went on strike later that year angry over a new contract reducing overtime pay.
Very little has changed in 40 years. The current proposed action consisting of 2 days of “emergency only” coverage and 1 of – shockingly – a complete walk out has little to do with patient care and everything to do with junior doctors pay. Far from being martyrs for the public cause, they are professionals looking out for themselves.
Patients are already suffering. Across England, 4,000 procedures have been cancelled and thousands more postponed adding to the pain of those unfortunate enough to need a hip operation or similar routine procedures.
This is on top of the already lower quality of care should you be admitted to hospital on a weekend – the reason for the contract change in the first place. This is beyond doubt and a scandal that has for too long gone unchallenged. The Royal Society of Medicine found in 2012:
Admission on weekend days was associated with a considerable increase in risk of subsequent death compared with admission on weekdays
The study calculates the additional risk as approximately 16%, a shockingly high number. Now, before going too far, this analysis has been criticised, most importantly for not taking into consideration the underlying health of those being admitted on weekends, the implication being they tend to be in a worse state to begin with and are expected to have higher mortality rates.
This is confounded however by analysis of maternity services which doesn’t have this limitation. There too we find poorer services on a weekend noted by the NHS as “both significant and an obvious cause for concern”.
Before considering the practical advantages for the public in being able to use NHS services outside working hours, the case for standardising levels of treatment across the week is compelling.
Save our weekends, not the NHS
It is the status of anti-social hours, those at weekends and in the evenings, is the central stumbling blocks to negotiations. The BMA reject Jeremy Hunt’s contention that there is agreement on 15 of the 16 areas of concern raised during the last round of ACAS talks, but it is the issue of weekend working that is of greatest concern to the junior doctors and the reason is simple – money.
Today, a junior doctor’s basic salary is £22,636, admittedly not a great return on 5-6 years of training. However, supplements for working anti-social hours can boost this to nearer £40,000. The truth is, it is this extra money that makes being a junior doctor worth it.
At first, this was the issue. The BMA screamed of a “30% pay cut” due to the changes. In response, the Government bent over backwards to meet the BMA’s concerns. The fact is that junior doctors like anti-social hours because they get paid better for it. It doesn’t matter that during these hours more people die.
They want anti-social hours premium to remain meaning keeping the NHS a working day only service. It is more important to manage their own lives than those of their patients. Their words may say one thing, but their actions say the opposite.
The offer of an 11% pay rise, protection of pay until 2019 and an assertion that less than 1% of doctors will lose out (due to working illegally long hours) is greeted with scorn. Apparently, this constitutes “smoke and mirrors” and “fudging the figures” despite there being a straight forward pay calculator available for anyone.
So if pay is protected, hours are reduced from a weekly maximum of 90 to 72 hours and weekend provision is brought up to standard – saving lives – what is the issue?
If the money’s been fixed, what’s the issue?
So first it was the money and saving the weekend, even if this means putting patients at risk. Now though it’s subtly changed. To read the banners of the strikers, it makes little mention of patient safety. One reads;
“The NHS should be yours, let’s keep it yours. Your lives are what we stand for. So let’s keep it yours.”
Littered among the banners are messages of “save our NHS” and – a little ironically given they’ve left their patients – “first do no harm”. Instead of arguments on the substance of the offer to junior contracts or substantive, constructive suggestions as to how we can move towards a 24/7 NHS while dealing with their concerns, the doctors are broadcasting political messages on NHS privatisation and austerity.
In truth, a fellow of the BMA, Dr Russell Hopkins hit the nail on the head when he wrote in a letter to the Telegraph:
“The BMA has morphed into a militant, Left-wing political body seemingly interested in attacking the Government, while pressing the financial needs of the profession, giving little thought to patient care, ethical practice or the need for out-of-hours care.”
The strike has morphed from genuine concern for patient care and doctors pay and conditions into a political attack on the government. Now the government is the enemy, the offer is irrelevant, the issue now is the government’s apparent “cack-handed” approach to negotiations. This may be, but it is no reason to put patients’ health at risk. After all, “first do no harm”.
This should not be a surprise. As Boris Johnson has pointed out, the BMA is full of closet Corbynites who is inevitably wholly behind the doctors not for any reason of substance but just for apparently being “smeared”.
Like Corbyn, the BMA are wedded to good old fashioned socialism, complete with crippling strikes.
One BMA council member tweeted his support for the bearded messiah “we can now all vote Labour again”. Another said “we can beat the Tories and make this country great again”. One member of the BMA junior doctors’ committee, Yannis Gourtsoyannis, said “a victory for the junior doctors would signify the first real crack in the entire edifice of austerity in the UK”
This is a politically motivated strike as much as it is about money and public won’t stand for it.
Patients will lose patience
Currently, two thirds of the public support the strike but this could change quickly. It is easy to support industrial action when it is just a question of backing the “little guy” against a monolithic bullying government.
And what better cause is there than young, aspiring doctors? As we know and as I’ve written about previously we in this country have a religious fascination with the NHS, believing it to be far better than it actually is. In fact, we seem to think it somehow miraculous merely for doing what it is designed to do.
However, no-one’s patience is inexhaustible.
It will take one unnecessary death, one harrowing story of a patient left in pain waiting for a postponed or cancelled operation to make the public think again. If this comes to pass, the BMA’s arguments of patient safety will melt away into insignificance and the hypocrisy of the doctors will be laid bare.
This was never about the patients, this strike is about money and politics – as always.