Over the last nine months or so I’ve written a few things about junior doctors and their strikes that have provoked quite strong feelings among some members of the medical profession. I fear what I’m about to write will cause even more pained outbursts of disbelieving outrage.
Never mind. Here goes:
Many doctors are sensible, moderate, thoughtful people who have genuine and reasonable concerns about the employment contract that the Government is seeking to impose on them, and about the management of the NHS as a whole.
Those doctors should be listened to more.
How many is many? I don’t know, but I suspect it’s quite a lot. I suspect that the description I’ve offered above could fairly be applied to the majority of junior doctors.
Not that you’d ever know that, of course, because you don’t get to hear from those doctors much, if at all. They stay quiet while a smaller but much noisier group of medics dominate public and political debate here.
Unfortunately for the profession and the country as a whole, that small, noisy group also largely controls the junior doctors’ committee of the British Medical Association. As a result of that control, the BMA is racing headlong into a series of five-day strikes across the NHS that could well kill patients.
Cue howls of outrage from the JDC Facebook mob. Yes, kill people. I think it’s perfectly possible (but not certain) that the absence of thousands of highly-skilled medics for such a period will lead to deaths that might not otherwise have happened. I don’t say that as a simple matter of belief. I say it because I’ve spoken to doctors who think it’s a possibility.
Don’t NHS staff shortages kill people too and won’t the contract worsen those shortages? That’s the point often made by the JDC tendency when the impact of strikes comes up. It’s a legitimate question, but follow the logic through and it leaves you arguing that it’s necessary to kill some people now in the hope of preventing other deaths later.
That sort of approach might be justifiable in times of war, but it doesn’t strike me as a valid way to debate the management of public service. I suspect most people, doctors and non-medics alike, would consider it unacceptable too.
That being so, it seems worth asking: how can those strikes be stopped? What can stop the BMA charging off this cliff and taking its members and NHS patients with it?
Here, the JDC mob has a simple answer: drop the contract, sack Jeremy Hunt and give the NHS zillions more in funding every year.
There’s only one teeny problem with that: It’s. Not. Going. To. Happen.
If there was ever a prospect of Mr Hunt and his contract being removed by No 10, it evaporated when the BMA went thermonuclear by calling five-day strikes over a contract it had previously endorsed. Politically, there is no chance of Theresa May handing victory to a union that behaves in that manner. Zero.
By contrast, there is a real possibility of her deciding on a nuclear-grade counter-strike: the talk among Tory MPs is of removing doctors’ legal right to strike, or derecognising the BMA as an interlocutor for contract talks.
Besides, even if ministers were prepared to pay the significant political price of compromising with the BMA now (and thus emboldening every other public sector union), how would they do it? Where’s the starting point for talks? What exactly does the BMA want? Its earlier objections to the contract were addressed in a revision agreed in May, or so the BMA said.
What is its detailed objection to the contract now? No-one seems to know. The trade union that may drive the NHS into its greatest acute crisis of care is doing so without a clearly stated objective for that action. It really is that bad, and anyone currently involved with the JDC should wear the fact of their woeful and dangerous incompetence as a badge of shame for the rest of their days.
Then there are the more nebulous issues raised by many pro-strike doctors, about staff numbers, NHS funding and Mr Hunt’s honesty in making the case for his seven-day NHS.
Those may well be legitimate issues. But they’re certainly not ones that can be written into an employment contract or addressed in talks between a trade union and an employer. If you’re a junior doctor and you’re going on strike because you think the NHS will get more money and be “saved” as a result of your actions , you really, really don’t understand what you’re doing.
So what can be done? Who can avert this disaster?
Not the current JDC, obviously. These dangerous idiots have lashed themselves to the mast and must go down with the ship.
What about the actual leader of the BMA? Isn’t it about time that Mark Porter spoke up here? Probably, but he lacks the confidence of too many junior doctors. And why should anyone on the employer side deal with a man who has, ultimately, overseen the JDC’s scandalous antics?
Perhaps the Royal Colleges can get involved? Maybe, but again, there’s a credibility issue with parts of the profession. Besides, the colleges aren’t really set up for industrial negotiation, and their disparate leaderships’ differing agendas and approaches mean they couldn’t offer a single coherent voice.
A savvy Opposition might try to broker a deal, but Jeremy Corbyn’s Labour is taking sides and will be on the picket lines if the strike comes. We’ll be able to ponder the politics of that decision if the strikes do indeed kill patients.
Right now, I can only see one way out of the current mess, and it involves at least one organisation that doesn’t currently exist. I’ll get to that in a second.
First though, doctors have to start doing things differently. If you’re a junior (or senior) doctor who thinks that, whatever the Government’s sins, the BMA has also got this one wrong, then you need to say so. Loudly and often and soon.
Right now, a lot of doctors who hold that view are staying quiet. That’s understandable, given that those who dare to question the JDC group-think are at risk of some properly nasty vitriol from colleagues, both online and otherwise.
But you know what? That’s not going to change unless doctors challenge the Manichaean Twitter-mob that has turned this into a puerile binary debate in which you’re either 100 per cent for the wicked Government or entirely behind the noble BMA.
It’s no use relying on nasty journalists to fight them: no-one likes us and we’re never going to change enough people’s minds.
Nor can you bank on the courts. Some doctors seem to believe that the Justice for Health bid for judicial review of contract imposition will lead to a deus ex machina intervention from wise and benign judges who order Mr Hunt to stop being so horrid, listen to the lovely doctors on all things and give the NHS lots of magic new money, meaning the strikes won’t actually have to happen and everyone gets a kitten. Presumably when that doesn’t happen, Justice for Health will appeal to Santa Claus and the Tooth Fairy.
Back in the real world, there’s only one way to stop the strikes, and there’s only one group of people who can do it. The only thing that’s going to trump a group of doctors yelling madly about something is a larger group of doctors talking sensibly about the same thing. Speak up, and if you get abuse as result, name and shame the abusers. I know at least one major media outlet that’s quite happy to publicise, in the public interest, the vile conduct of a small number of medics.
Maybe, just maybe, this might give the profession a more reasonable voice and face, either through a new JDC (elections this month, remember) or simply because it becomes evident to others (media and politicians alike) that people other than the JDC idiots are actually representative of the profession. I can think of a few candidates for this, but the last thing I’m going to do is name them.
However they’re found and whatever posts they occupy, those people should make clear that strikes are suspended until a proper negotiating position on the contract is agreed. Then they should sit down with Mr Hunt or NHS employers and start again, with no preconditions save one.
That condition is the creation of a new commission to examine all those non-contractual issues that have been raised in the dispute: funding, safety, staffing, even Department of Health communications on the seven-day service and the fitness of the BMA as a union: should it be replaced? If not, how can it be given more professional and representative leadership?
It should be jointly chaired by a senior doctor and a politician; again I can think of people but my suggesting them wouldn’t be helpful.
That commission would then look at the non-contractual issues raised in the dispute and publish its recommendations to ministers and the BMA alike. Let them reject or accept those proposals and answer to the public for their responses.
Who knows what that commission would recommend or conclude? It might demolish the BMA in its current form. It might help Mr Hunt persuade the PM and the Treasury to spend even more on the NHS. Whatever it came up with, it would be a far better basis for a sensible conversation about healthcare than the current depressing and potentially fatal shouting match.
Speak up, doctors. You are better than the people who currently claim to speak for you. You swore to protect your patients from harm. You may well define that obligation so widely as to encompass objecting to Government health policies and a new contract, and that’s fair enough. But if so, your oath also binds you to protect patients from the dangerous mistakes of your colleagues.
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