In my last blog I stated that I had concluded that the BMA were heading to defeat on the issue of the junior doctor’s contract.
My primary reason was that as August approaches the vast majority will swallow the bitter pill and capitulate (the mortgage still has to be paid and the children fed). I think that both the BMA and the Secretary of State share the responsibility for having totally failed to reach a satisfactory conclusion.
I received only one response to this from a junior, and while I strongly sympathise with his predicament I was worried by his comment, “We are the last line of defence. No one else is fighting for the NHS”. Really? I don’t think that is the case – there are many who care deeply about the service and who are doing their best to shape a sensible and deliverable agenda (as I did for many years).
But what concerns me most about his comment it that it suggests a total blurring of the reasons behind these damaging strikes.
Obviously I am not party to all the nuances of the negotiations but my understanding is that considerable agreement had been reached on most issues. The contract contains a significant reduction in hours and many built in protections with a 13% pay increase, perversely to make up for reduced overtime payments!
The sticking points are the level of overtime pay for Saturdays (most other services work Saturdays for standard rates of pay), and the proposals for penalties on trusts who produce non-contractual rotas. If this is the case then there is, in my view, minimal grounds for continuing the industrial action.
Emotive placards stating, “tired doctors make mistakes” is a sentiment with which no one could disagree. However the evidence that the new rotas generated by the contract would be unsafe is shaky.
On February 1st Sir David Dalton, the government chief negotiator, stated that the government had reached agreement with the BMA on measures to protect juniors from unsafe hours.
Any trust which tried to implement dangerous rotas would be in deep trouble. The BMA seem to have forgotten that trust boards are legally accountable for the quality and safety of the service they provide and regulatory authorities would come down like a ton of bricks on offenders.
But this is where the blurring comes in this dispute because the ground now seems to have shifted from the nit-picking details of a contract to “saving the NHS” as my previous respondent stated. The BMA seem to have moved away from fears of “unsafe working hours” and moved on to – well I am not quite sure!
Clearly at the heart of the debate is the issue of full seven day NHS working but with the same resource. Everyone, including I suspect the SoS, knows that this is just nonsense. NHS England has refrained from publishing a report from Deloitte commissioned in 2015 into this matter, but leaks suggest that there will be an additional £900m p.a. required to make this work.
Juniors largely already work rotas which cover seven days, as do nurses, ambulance crews, radiographers and many others in the NHS. The real target of the government is consultants, and even more specifically acute medical physicians (surgeons and radiologists are already well down this road).
The definition of seven day working in the NHS is vague, but all wish to see fully staffed and adequately resourced acute services which is probably what Joe Public both understands and wants, and it would seem sensible to put time and effort into delivering this (I doubt anyone wants to attend an outpatient clinic on a Sunday afternoon).
I have lived through numerous NHS dis-organisations in my time. But the NHS is a massive behemoth and will lumber on despite the best worst efforts of the politicians, and I can find no reason for the continuing series of BMA strikes which were initially merely inconvenient but which will become more damaging and possibly dangerous.
I suspect that many of my generation of doctors will be increasingly uncomfortable with this.
I believe that the BMA were itching for a fight with the Government if only to recover their reputation following the drubbing they got from the juniors as a result of the “Modernising Medical Careers” debacle when in 2007 they sat in the High Court alongside the Department of Health against a cohort of junior doctors (Remedy UK).
They have led their troops to the top of the hill, but seem unclear as to where to go next and I suspect will have no alternative but to march them down again. Or, to change the metaphor, “when in a hole stop digging!”
Dear junior doctors, for whom I have huge respect and indeed affection, please put away your placards and turn up for work on April 6th.