2 Eylül 2016 Cuma

So, junior doctors, what exactly is it you’re striking for? | Deborah Orr

It’s hard to believe that the British Medical Association really intends to stage four five-day junior doctors’ strikes before the end of the year, one of them in just a couple of weeks’ time. BMA members, after all, are the people who warn that the NHS is already under intolerable pressure. How can they therefore believe that such huge, continuing disruption can simply be absorbed by their colleagues, bringing no harm to patients? It doesn’t make sense.


Nor does the BMA’s own position quite make sense. The strikes earlier in the year resulted in a renegotiation and new contract for junior doctors, which the BMA committee declared satisfactory. Yes, it was rejected by members. Nevertheless, the fact remains that the new contract did largely address the particular problems with weekend remuneration that junior doctors had initially identified.


Supporters of action will argue that the dispute is about much more than junior doctors’ contracts. But there has to be a worry, surely, that if the specific detail acting as a catalyst for industrial action isn’t perceived by the public as impeccably clear and strong then the wider message is also undermined.


Many people are concerned about the future of the NHS. And many people were dumbfounded that Theresa May opted to keep Jeremy Hunt as health secretary. But, to me, it’s beginning to look as if the junior doctor’s dispute isn’t really solid enough to carry the weight of such hefty concerns.


I have sympathy with the argument that the move to a seven-day NHS, without a proportionate increase in funding, is a dangerous one. It can certainly be interpreted as a way for politicians to actually cut funding while claiming to be increasing it, as they regularly do.


People have every right to be suspicious. In the 1980s and 1990s, public services were starved of funding by governments which then cited the mess that they were in as prima facie evidence that they were hopeless and had to be privatised. Not everyone has forgotten such cynical strategies, or persuaded themselves that they could never be employed again. They most certainly could.



Jeremy Hunt


‘Unless what they want is something that can be written into their contracts – rather than, say, the resignation of Jeremy Hunt – then they have few grounds for complaint when others question whether this latest stance is sensible, admirable or honest.’ Photograph: Carl Court/Getty Images

Yet there is also some sense in the thought that expensive buildings and expensive equipment are greatly under-utilised for two days in every seven.


There’s a sensible idea in there, for increased NHS capacity – a greater number of available beds at night, a greater number of appointments for patients. The question is really about whether the government is willing to pay for the kind of rise in payroll costs that increased use of facilities would entail. That’s an incredibly important debate to have – but it seems at the moment that the tight focus on the BMA and junior doctors is serving to dilute that focus rather than concentrate it.


There’s a sense in which junior doctors are the stalking horse of more senior medical professionals, who naturally enough would like to be generously compensated if they start being asked to turn out for weekend shifts themselves. Junior doctors, of course, are the ones who are already working at weekends anyway – which is the reason why they’re on the frontline of the resistance to seven-day working. Wise and venerable consultants, offering sympathy for those hot-headed kids, do actually have a horse in the race themselves.


Yet there’s a real chance that junior doctors would bear the brunt of public revulsion if such big strikes took place and things went wrong. I don’t much like the idea of passionate young people full of vim and political commitment waking up one morning to headlines asserting that they were instead dogmatic provocateurs who killed innocent patients with their militancy. Who doubts such headlines are possible? Or that the personal pain and disillusionment such headlines could visit on individual junior doctors is not significant?


I understand that it’s awkward, bringing up the idea that what the mainstream media might do is worth bearing in mind. I know the established media is seen as “part of the problem”. But I also know that the BMA’s latest threat is not onelikely to fare well within that climate, which for better or worse is a climate it cannot blithely ignore.


Maybe the threat alone will get the junior doctors what they want. But unless they can make it clear to the public that what they really want is something that can be written into their contracts – rather than, say, the resignation of Jeremy Hunt – they can’t complain when reasonable people question whether this latest stance is sensible, admirable or honest.



So, junior doctors, what exactly is it you’re striking for? | Deborah Orr

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