Winning the battle and losing the war


I can recall the exact moment I first heard about the new junior doctor contract.

I barely believed what I was hearing. Pay cuts, after years of pay falling behind inflation. Barriers to unsafe working hours removed, after they had proved so successful. Discrimination against women, from one of the few UK employers that offered equal opportunities. Could it really be true?

If that same person had told me that the dispute would lead to the first all-out strike in NHS history, I would not have believed it. I would not have expected the Government to push a flawed contract so hard. And, if they did, I would not have believed an apolitical bunch of junior doctors could be so united.

But, here we are, after the all-out strike. To the surprise of the Daily Mail, and the Health Secretary, the NHS is still standing.  Our NHS colleagues covered expertly.

The unanswered question on everyone’s lips is – what next?

Here are some things that could happen now…

  1. More strikes

The last two days have proved the concept – an all-out strike by junior doctors can be achieved, without endangering patients on those days. So, why not have more?

Here’s the downside. For each strike, lots of planned operations, tests, appointments and scans have been cancelled, to focus on covering for the striking doctors. This disruption is necessary to keep emergency patients safe, and of course, a strike has to cause disruption to be effective. But the more strikes there are, the more people this will affect. What about the person with cancer who needs to see a doctor and start urgent treatment? What about the man with critical coronary artery disease whose heart bypass is cancelled?

If the junior contract as it stands is dangerous for patients, then  some temporary inconvenience to them now can be justified by their long term gain when the contract is fixed. But an all-out strike has already failed once to generate a reaction from Government, so why would a second one help?

And doing the same thing again risks losing the attention of the public. Top Gear gets fewer viewers when it’s repeated on Dave, and it was clear from the previous set of strikes that the Government (and the media) was less interested in repeats.

  1. Escalation

The all-out strike didn’t persuade the Government to back down. Another all-out strike probably won’t either. So, is there an argument for doing something bigger?

Some doctors think so. One junior doctor resigned live on television recently, and others have published their resignation letters on facebook and twitter. Mass resignations have been talked about. Not everyone will resign, but even a small proportion of resignations could make services very difficult to run properly.

There are other ways action could be escalated. An all-out strike that included nights and evenings would be much harder to cross cover with consultants. There has been talk about an indefinite strike.

But escalation comes with a downside too. The higher the impact of the action, the more damaging it is likely to be for patients. So far, the public support doctors. Raising the stakes further is a gamble, and the goodwill, once lost, will be hard to get back.

  1. Ceasefire

What will another strike achieve? It doesn’t seem likely to force the Government back to the negotiating table. There is no “nuclear option” that wouldn’t harm patients, which we won’t do.

In that case, perhaps further strikes would have no great benefit and the logical thing to do is to cease hostilities. But a temporary ceasefire doesn’t clearly lead to a resolution.


Winning the battle, losing the war


Looking into the Abrainia crystal ball, I see a drawn-out series of strikes, perhaps supported by the public and other NHS workers, but steadfastly ignored by the Government.

I see doctors refusing to back down, but refusing to escalate to any action that actually will harm patients.

I see a Government closing their ears, humming loudly, and pretending that they can’t hear. I see politicians who regard backtracking after a strike in the same way they regard negotiating with terrorists. Give an inch, and suddenly the whole public sector will be on strike. Better to make an example of the junior doctors, even if it drives them away from the NHS.

I see significant numbers of doctors leaving training, or declining to take up training posts. I see applications to medical school falling. I see the understaffing on all of our rotas getting steadily worse.

I see the Government triumphantly winning the battle and losing the war, imposing the contract while significant numbers of doctors walk away to look for a job where they are more highly valued. I see the chronically underfunded Health Service losing the goodwill of the people who hold it together, while the politicians celebrate in Westminster.

I see a generation of doctors profoundly disillusioned and disengaged from helping the Government build what we all want, which is a first-class health service.


“Your future is whatever you make it”


It doesn’t have to be this way.

Jeremy Hunt himself has claimed that the two sides were “90% agreed” (although he is not famed for his judicious use of statistics). The BMA representatives have repeatedly asked for more talks.

There must be a solution that is acceptable to both sides. But that solution can’t be found without more negotiation.

Someone needs to stop acting like a politician, and start acting like a leader. Someone needs to step forward from this mess and break the impasse. Mr Hunt? Mr Cameron? My hopes aren’t high, but please prove me wrong.

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