Collective Abrainia


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It’s been a pretty strange few weeks in the world of politics. Theresa May is about to become Prime Minsiter of the UK, and her key virtue seems to be that she hasn’t said or done anything stupid in the last month. All she needed to do was keep quiet and wait for her rivals to come down with politically fatal collective abrainia* and sabotage each other and themselves.

Amidst the huge publicity around the EU referendum and Brexit, there has been another referendum and another resignation that has largely slipped through unnoticed. Unless, that is, you are a junior doctor.

The achievements of junior doctors during the last year have been remarkable. Without giving up their (quite demanding) day jobs, they have organised and fought a campaign including unprecedented strike action. They have maintained public support while up against a Government spin machine working at full tilt, helped by a compliant majority of the media. Doctors have attended marches, written blogs and made videos, appeared on TV and written articles in newspapers. They set up a table outside the department of health and manned it for weeks waiting for Jeremy Hunt to appear for negotiations. During strike action, they set up free classes to teach CPR to grateful members of the public. And doctors everywhere have engaged the public in this debate and helped to educate them about the issues.

After months of political to-ing and fro-ing, of strikes and marches, of the Government sitting down to negotiate, walking away, then returning, it was finally announced that a compromise had been reached. And then, the shiny new improved version of the contract, which was agreed between the government and the BMA junior doctors’ council, was put to the vote among junior doctors…and was rejected by 58% to 42%.

Johann Malawana, the chair of the BMA junior doctors’ council, who led a moderate and reasonable fight against the original unfair contract, has followed David Cameron’s example and resigned. He had supported the new contract as a reasonable compromise, but he couldn’t persuade his electorate to agree. The metaphorical removal vans are drawing up outside BMA House as I type.

Some no-voters have genuine concerns (for example that the new contract will discriminate against women, and that limits to working hours will be poorly policed), but many were fuelled by non-specific anger. “Is this really what we’ve been fighting for?” was the collective response to a contract that seems underwhelming, and similar in many ways to the original hated proposal.

What next?

nobody knows

Much like the vote for Brexit, doctors who have voted “no” have voted for the unknown over the known. They have not voted for any particular alternative, because none has been presented.

Hunt has said he will impose the contract. There is still the question of whether this is legal, and a group of doctors are mounting a crowd-funded legal challenge. The new chair of the BMA junior doctors’ council has said that strikes are back on the table.

A separate question is whether Hunt will stay in charge of the NHS under a new PM. Doctors will be hoping that the answer is no. If he goes, his replacement will inherit a mess.

A new person in charge of the Department of Health, with a new Prime Minister above them, could go some way to repairing the huge breakdown in trust between doctors and the Government. Rebuilding some of the bridges between medics and politicians that Hunt has napalmed in his tenure as Health Secretary should be their first priority. Once that is addressed, they could move on to dealing with the more trivial issues such as the ongoing financial meltdown in the NHS and understaffing in many hospitals.

I hope that the contract dispute can be resolved, and junior doctors can all get back to doing what we signed up for. But after the month we’ve just had, it would take a braver person than me to make any predictions.


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* Abrainia: an illness in which the sufferer, usually a healthcare professional politician, behaves as if lacking a brain