The knives are out for the junior doctors as they threaten five-day strikes, starting on 12 September. They can expect both barrels from the Tory press: “How dare the doctors barter lives for cash” asks the Mail. “It will be only a matter of time before the body-count begins.”
The BMA says it will call off the strikes if the government abandons imposing a tougher new contract in October, but the health secretary, Jeremy Hunt, was in a no-turning-back mood on the BBC’s Today programme this morning. The junior doctors’ leader, Ellen McCourt, says appeals to re-open talks have met a “deafening silence”.
Let’s remember where all this began – and it wasn’t with the junior doctors, ploughing on night and day through ever-worsening conditions in the NHS.
This is another of David Cameron’s disastrous legacies. Looking for bright ideas for his 2015 manifesto, he plucked “a seven-day NHS” out of thin air. He used a set of figures purporting to show high weekend death-rates that have since been resoundingly rubbished by health statisticians. Senior figures in the health department warned that squeezing yet more work out of an already stretched NHS was unrealistic and unwise. It was an election slogan, not a worked-out policy.
And why now, of all times? The NHS has never seen such a deep financial crisis, receiving an average 0.8% funding increase over the years since 2010, compared with an average 4% uplift since 1948. The department of health press office dutifully puts out near-mendacious factoids, such as “funding is at record levels, with the highest number of doctors employed in the history of the NHS.” But with the population rising, and especially soaring numbers of elderly people and people with diabetes, Britain still has many fewer doctors, nurses and beds per head of the population, and less money to spend than comparable countries.
What started as a stunt has turned into a confrontation from which the government now feels it cannot retreat
As the DoH knows well, the shortage of doctors and nurses leaves many rotas unfilled, putting extra pressure on staff, especially in A&E. The risk is doctors will flee abroad and to Scotland, while the Brexit vote could mean EU doctors and nurses decide to go home. Is this the time to provoke the precious doctors we have?
Let’s remember who these “juniors” are. They are not rebellious reckless youth, but 50,000 of the cleverest and most hardworking adults of their generation; the cream of their school science classes, serious-minded grown-ups in their 20s and 30s. Doctors are not known for political radicalism, either, so the health department’s statement that they are “playing politics” is well off the mark. They are angry, very angry, that the most dedicated workhorses of the NHS have been picked on at random to have their weekend pay and working conditions worsened. Why? It isn’t even going to save money for the NHS.
What started as an electioneering stunt has turned into a full-on confrontation from which the government now feels it cannot retreat. Theresa May had a long talk with Hunt before reappointing him, arguing for the need to see off these strikers as a matter of her authority. That was a bad mistake. What she needed was a fresh, open mind, someone whose pride was not at stake.
The BMA did all it could: the previous junior doctors’ leader, Johann Malawana, reluctantly agreed a deal which he told his members was the best he thought he could get, and he tried hard to sell it to them. But 58% rejected it in a ballot, he had to stand down and McCourt has taken over. When I interviewed her in April, she was just about to begin her 13-hour Saturday shift in a North Yorkshire hospital, to be followed by 13 hours on Sunday. The new contract will make her work every other weekend and cut her pay. She said “I love what I do in emergency, the variety of cases, working with the sickest patients when you can help them most.” So how did the government manage to provoke such people to this?
On this issue, as with Brexit, May has stamped her political identity. Retreat is unlikely. In a lifetime of covering hundreds of strikes, in my view they rarely begin for good reasons or end well, especially for strikers, however justified. The public has staunchly backed the junior doctors so far, and maybe still will support this most trusted of professions, with the NHS near the top of public concerns. But since many people die every day in hospital, you can bet the rightwing press will find a good case or two where they can claim, however spuriously, that it was the strikers’ fault. That’s the risk the doctors take.
But the risk May and Hunt take is greater. The NHS is paralysed with debt, as hospitals put out bogus plans pretending they will balance their books. The public is rumbling that major re-organisations are planned locally without anyone telling them, under the 44 new STPs, local sustainability and transformation plans. Persuading people that often good plans for joining up health and social care and reconfiguring local services, are not just cuts – when they are happening at a time, in effect, of cuts – would be a Herculean task for a trusted health secretary, but how is Hunt to do that?
These noisy strikes will add to local objections to any changes on the ground. Forcing doctors into this new contract is virtually irrelevant to the current state of the NHS.
The public think they were promised £350m a week more for the NHS as a Brexit bonus, but instead will come to hear of unpopular amalgamations of some A&Es and maternity units. Anyone sensible looking at the current state of the NHS and the problems it faces, would clear the decks of all extraneous trouble – and settling with the doctors would come first.
The NHS is in trouble. Jeremy Hunt can’t afford this junior doctors’ strike | Polly Toynbee
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