Dr Johann Malawana addressed the BMA’s junior doctor annual conference in London over the weekend. Here is his speech as last ditch talks continue with the government over the juniors’ contract:
A year ago, and it’s sometimes hard to believe it was only a year, we were waiting for the DDRB to make recommendations on our contract and we were setting out the values that would underpin our negotiations. We had already experienced disappointment and delay.
I take no pleasure from the long and painful journey that has brought us here.
There have been times when we may have asked ourselves why we became doctors. On the third night shift in a row, on a winter’s morning on a picket line. Or when the world of politics from which we thought ourselves sheltered came and found us and demanded a response.
It has been a year when our profession has been put under the harshest possible spotlight. Where every one of our motives, actions and values has been questioned, by those who do not always wish to hear the answers.
Junior doctors have been tested. It will never be forgotten how they rose to that test.
When I’m old, and am asked how we measured up, I’ll tell people they can watch any interview, read any article, look at any picture, and they’ll ask: ‘Who was that?’
They’ll see people who had only been doctors for a few months speaking with passion, experience and eloquence. They’ll see doctors who met every media-fuelled misapprehension with a ready explanation. They’ll see members of the public bringing cake and leaving with life-saving skills.
They’ll see a profession that wasn’t radicalised but vitalised by a natural sense of justice that we share with the great majority of the British people.
They’ll see a profession famous for its friendly and not so friendly rivalries united as never before. GPs, consultants, SAS doctors, we thank you from the bottom of our hearts. Nothing would have been possible without your support.
We didn’t want the year to follow the course it did. But we can’t fail to be inspired by what it revealed about our profession.
What a paradox we have uncovered. A generation of junior doctors so ground down by political diktats that many have been driven to move overseas. And yet a generation with such energy and commitment to patient care that if only it can be freed to work in a safe and fair NHS, the future can still be bright.
It has been 300 days since the DDRB very sadly seemed to place expedience ahead of independence with its recommendations for the contract. We began the year not with a list of issues but hampered by a list of misapprehensions. We wanted a contract that was better, but had to start with a vision of one that was immeasurably worse. As you might answer someone looking for directions – I really wouldn’t have started from here.
We have been arguing for 300 days about issues which have damaged junior doctors’ morale and the quality of patient care for much longer than that, and would continue to do so.
It’s not the 300 days, but these days that matter now. We’re talking. They’re listening. We’re listening too. If this were a movie, I’d now pull out a large envelope with the word ‘deal’ written on it. We’re not there, and I can’t even add the word ‘yet’ to the end of that sentence.
But I can tell you this.
Our attitude in these negotiations has been not to trade grievances but to resolve them. Our aim has been to rediscover the common ground that is so great but so easily neglected: the shared interest of everyone in the health service to improve care for our patients. The temptation has been to relive the resentments, which are many, but instead we have tried to rediscover the opportunities.
It’s all too easy to say I wouldn’t start from here. Our patients need us to say, where do we go now?
Just let me be optimistic a little longer – I’ve always enjoyed trying a new language – and say the spirit of constructive engagement of which we have seen more than a hint in recent days might just be a good way of conducting business in the wider NHS.
When the government speaks of seven-day services, and we say ‘great – we want patients to have the care they need when they need it’, we’re not opposing them.
When the government speaks of more seven-day services, and we say ‘great – but how are they going to be staffed and funded?’, it’s a reasonable question. It’s not a coup d’etat.
When the government leaves the impression that an under-staffed, under-resourced NHS will simply be stretched from five days to seven, it’s our job to warn that wouldn’t be safe.
And that should be the start of a conversation, not the end of one.
For too long we’ve had a health service where the issues that we most need to talk about are the least likely to be addressed.
The chancellor talks about a ‘fully-funded’ NHS. I think he’s too smart to believe that. The other day, we heard the NHS England plan for tackling the £22 billion black hole in finances. More cuts to tariffs that have left hospitals with a huge deficit. More cuts to the real-terms pay of doctors. More failed ideas.
I’m not so arrogant as to pretend we have all the answers. We don’t do magic bullets in medicine. There may be no easy answers, but we can embolden and inform any government who genuinely wants to find the right ones.
Now that we’re talking, let’s keep talking.
The government will find they’re talking to leaders. If they want leaders, they don’t just have to phone up someone with a knighthood in a royal college – love them though we do after all their support this year. There are leaders on every ward in every hospital in the country. And they’re called junior doctors.
Like with sausages, we won’t ask the government to dwell on how those leaders were made. The uncomfortable truth is that months of state-sponsored adversity has done more for our profession than a thousand MBAs.
But now they have been discovered, we have the young and inspiring leaders that the Francis report exhorted us to become. This government has at times created a problem, deliberately. But it may have also created the solution, accidentally.
There is much on which we and the government differ, but we can surely agree on this: That this generation of junior doctors doesn’t do apathy, it doesn’t shrug its shoulders, it doesn’t fall into the corrosive trap of giving up.
This generation has proved beyond doubt that it will go to extraordinary lengths to protect and improve the care of patients. And that is something for us all to celebrate.
Finally, I want to thank you. I knew what I was getting into when I took this job, but I couldn’t have lasted a day without your support. The BMA staff, and my negotiating team and committee are amazing. And this was the year when I think the BMA went beyond simply representing its members, and became its members.
There were times this year when we were accused of exerting some kind of dark force, marching innocent doctors to the BMA tune. Fat chance of that. It’s the energy, decency and creativity of our members – and yes, will you please save those placards – that has set the direction of our action from start to finish.
I’ve never felt more proud to be a junior doctor. I’ve never valued more what we do, or felt more valued by the people we serve. I’ll never forget this year, and whatever we face next year, I’ve never felt more sure that we’ll face it together.
One profession, standing together. It’s everyone’s future.