Jeremy Hunt has won a battle against junior doctors, but not the war

Junior doctors are used to managing crisis situations. Lifesaving treatments, long hours, dealing with dying patients, and coping with poor resources are all situations they would expect to wrestle with during their training. These young men and women want to cure the world – this is ingrained in their excellent and rigorous training, which might take anything up to 15 years.

So why is this important? You don’t have to live on Mars to know that the British Medical Association (BMA) – specifically, the junior doctors’ arm of it – and the government, namely health secretary Jeremy Hunt, are at odds.

It has become increasingly clear that Hunt has won the battle. Negotiations with the BMA have not just stalled, they have broken down because they failed to deliver the contract junior doctors felt was right for them and safe for patient care.

Hunt has a different view – not only does he think it is safe for patients, but he believes that it doesn’t discriminate against female doctors (over 60% of doctors are women), it offers a good work-life balance, and crucially it will deliver a seven-day service. His case is enhanced by the fact that junior doctors’ leaders endorsed the contract before consulting committee members. To some this is a matter of pay and conditions, while to others (not just within the BMA) it is a broader issue involving the current state of the NHS.

So is all well in the Hunt camp? Probably, insofar as the imposition of the contract is concerned. On the other hand, the BMA came to a rather desperate juncture. Its highest body, the council, backed the junior doctors’ committee’s demand to run an unprecedented series of five-day strikes. There was frustration, anger and even desperation at the inability of the government to see their viewpoint, fuelled no doubt by Hunt’s reappointment as health secretary.

In the cold light of day, the BMA realised that it would fall foul of the very reasons it was against the contract imposition – it had given trusts very little time to put together a contingency plan to safely cover the five days of the September strikes. It risked harm to patients, the very issue its 170,000 members feel is sacrosanct. The General Medical Council waded in, as did some of the medical royal colleges, ensuring the divisions in the senior medical fraternity were played out in the public and the media. A rapid climbdown by the BMA was inevitable, leading to an announcement that the September five-day strikes were off, further playing into Hunt’s hands.

To his credit, Hunt has not been gloating in this victory. He has adopted a dignified approach, welcoming the decision by the BMA but remaining steadfastly rooted in his conviction that the contract imposition would remain regardless. Last week, at Expo 2016 in Manchester he was very cordial, courteous and in consolatory mood. He expressed his wish to move forward.

Even BMA stalwarts might reluctantly agree that he is winning the battle. The imposition will proceed, without any further changes, unless he softens his approach.

However, Hunt should have no illusions. This is a hollow victory. Juniors are now a disaffected, angry, disillusioned and frustrated lot. These are the consultants and GPs of tomorrow, the very doctors the government needs to fulfil its plans for a round-the-clock, stellar NHS. Many feel that their professionalism and dreams have been thwarted by the government, and those who are really hacked off have emigrated.

The dispute is being played out against a background of an escalating funding crisis, trusts being unable to meet increasing demand and a warning that the health service will experience “pockets of meltdown” this winter. We could go on.

In the face of such adversity, the NHS is hardly able to deliver a five-day service, let alone the seven-day NHS Hunt dreams about. He has wrongly aligned his aspirations for a seven-day service to delivering the junior doctors’ contract. The BMA has repeatedly asked him to define his vision to enable a constructive dialogue on what is evidence-based, and what is achievable. What is clear is that both the BMA and Hunt require a highly motivated, energetic and engaged medical workforce to deliver the high-quality care needed to manage complex illnesses and meet rising demand.

The government is responsible for creating the conditions for safe working of our juniors and for providing and delivering safe services. Hunt must work hard to win the hearts and minds of junior doctors to achieve the ultimate goal of providing safe, high-quality services seven days a week. Theresa May should conduct her own appraisal of the state of the NHS and the problems it faces, and make her priority settling this dispute and finding more money for the health service.

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Jeremy Hunt has won a battle against junior doctors, but not the war