Herding Cats

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If you take a group of doctors and ask them all the same question, you can expect to hear more than one opinion. Even a single specialist, when faced with a tricky treatment or diagnostic decision, might offer more than one answer. We are trained to think hard and independently, to take difficult decisions seriously, and to communicate our thoughts clearly. We’re also trained not to force our views on others.

Until recently, there had been remarkable unity among the ranks of junior doctors in their contract dispute with the department of health. The original contract proposal seemed disastrous in every way – safety, pay and equality all suffered. Government allegations of the British Medical Association misleading its junior doctor members were, well, misleading. We read the plans ourselves and we were horrified. And if the facts alone were not enough to unite us, there was Jeremy Hunt, centre stage, conducting an orchestra of spin-doctors, calculated press releases and herd-following tabloids, firing out dubious statistics and allegations, trumpeting his imaginary plans for a “truly 7-day NHS”.

The story today is rather different. A year has passed. Several strikes, and many weeks of negotiations later, we have a contract that a sizeable minority of junior doctors feel they could live with (42% voted to accept it, 58% to reject it). Jeremy Hunt appears to have realised that his unifying effect is working against him, and has kept uncharacteristically quiet. And the BMA Junior Doctors Committee has been busy tying itself in knots, changing personnel like disposable gloves, and announcing strikes that then get abandoned within days.

And while the BMA vacillate, the NHS is in crisis. Nursing bursaries have been cut. Senior doctors are again being attacked via the media. Junior doctors are increasingly taking time out, or emigrating, even before the new contract has been brought in. Waiting times are reaching record highs, hospital are bursting at the seams with patients, and some departments have been unable to find enough doctors to stay open safely. Increasing numbers of senior NHS and even government figures are publicly admitting that the current trajectory of funding is going to lead to a train wreck.

There’s an excellent reason why the BMA appear uncertain what to do. It’s because it really isn’t clear what they should do. We were all prepared to strike against a contract that everyone could see would be a disaster. But what about a contract that nearly half of us think might be ok? Perhaps a series of rolling 5-day strikes in that context seems a bit – radical? But after fighting so hard for so long, should we really roll over and accept a contract that a majority of junior doctors voted against?

It’s important to remember the achievements of junior doctors during the last year. Without giving up our (quite demanding) day jobs, we have organised and fought a campaign including unprecedented strike action. We have maintained public support while up against a Government spin machine working at full tilt, helped by a compliant majority of the media. During strike action, doctors set up free classes to teach CPR to grateful members of the public. Doctors have attended marches, written blogs and made videos, appeared on TV, written articles in newspapers, set up a table outside the department of health and manned it for weeks waiting for Jeremy Hunt to appear for negotiations. But the most significant achievement was forcing the Government to return to negotiations, and getting a better deal for our contract. Not perfect. But better. Think 42% satisfaction, compared to 2% satisfaction with the original.

With the appetite for strikes fading, perhaps the junior doctor contract battle is over. A year ago, it felt like this dispute was at the centre of the crisis in the NHS. Now, with an improved contract, and worsening problems elsewhere, it feels peripheral.

 

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The future of the NHS feels less certain than at any time since it came into being in 1948. A debate is needed about how health care in the UK will be funded in the future. Junior doctors need to rediscover that elusive sense of unity, and make our voices heard.

 

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