Let me make a few things clear. I bow to no-one in my commitment to the NHS. Competitive NHS-devotion is a tiresome sport, but I’ll play it if necessary.
I think that Jeremy Hunt is out of his depth as health secretary, and has handled the junior contract poorly. More broadly, I abhor the fragmentation and privatisation visited upon us by the health and social care act. Still more broadly, I reject the discredited economics of austerity, and the mantra that adequately funding the NHS is unaffordable.
I also think the current tabled offer from the DH is crap for junior doctors, and for the profession as a whole. It’s quite right to say that this is part of a process of demoralisation that is aimed at reducing doctors to functionaries within a factory-like health service. The new contract, introduced as it stands, is bad for doctors.
But…. Is it bad for the NHS as a whole? There are reasons to think it might be, but think about it from the DH perspective: you can’t spend any more money, but you’re committed, partly by manifesto and partly by belief that more doctors around at the weekend might make things safer, to make out of hours cover cheaper.
I’m not saying the DH has got it right, it hasn’t, but we need to understand the aims and constraints under which they have to operate. An argument is put forward by DH et al that the new contract would be better for the NHS as a whole, and though we may disagree, we cannot assume we are right. The truth is, we can’t know for sure what effect the new contract would have on patients.
So, enter the BMA. As the doctors’ trade union, the BMA are quite within their rights to fight this proposed contact on behalf of their members. They seem awfully certain that the new contract is a clear and present danger to patients, but presumably they have a vault of evidence for this stored under BMA house. Let’s leave that aside for now.
They also claim, repeatedly, that the government are preventing negotiation in two ways: by threatening contract imposition, and by restricting what is negotiable to 1 out of 22 aspects of the contract. The latter is easily dealt with-it just isn’t true. The government want the DDRB recommendations to be the basis for negotiation. That’s it. The BMA want to go back to the drawing board. Which brings me to contract imposition.
Say the government allow the BMA a veto over any deal, which is essentially the demand being made when people say ‘drop the preconditions’. The BMA know that no possible new contract will be better for doctors than the current one, given the funding situation. Why wouldn’t they stall, and delay, until 2020 when hopefully there will be a new government? You may welcome this prospect but I hope you can see why the DH are less enamoured.
Think that’s a ridiculous timeline? The DDRB made their recommendations in 2012. The BMA walked out of negotiations over a year ago. Four years doesn’t seem like such a long time if you take that perspective.
In any industrial dispute, both sides have a nuclear option. The employers have imposition, the workers have strikes.
There’s always a weird bit in a industrial dispute, when both sides make bold claims to be on the side of the public, and throw allegations of unreasonable behaviour at each other. The union needs a mandate from its members, and public sympathy, to maximise its strength when, inevitably, the talking starts. Apocalyptic claims made under these conditions tend to wilt once the deal is done.
I’m a bit surprised that more doctors haven’t recognised that this is what is happening now. I’m not sure what the BMA game plan is, but I suspect they’d be very happy to sit down in a few weeks opposite the DH, armed with a thumping strike mandate, broadly supportive public opinion, and no actual strike action having happened. So….
In the interests of doctors, they have exaggerated the intransigence of the government, and taken a polarised, unbalanced view on the service impact of the proposed contract. I’m not blaming them for it, it’s their job as a trade union. I just wish that more doctors recognised what is happening for what it is.
This is not a fight for the future of the NHS.
This is a fight for the status and independence of the medical profession. As such, it is worth having, but not, in my view, worth an all-out strike. Especially as negotiation could begin tomorrow if both parties genuinely wanted it to.