With my sister beginning medical school this year, in my house we have been closely watching the semi-constant stream of updates about the ongoing conflict between Junior Doctors and the Government over a new contract over the past year. This has resulted in the first all-out strike of Junior Doctors in NHS history (two in April), and the BMA to call for five days of consecutive stoppages with less than two weeks’ notice (which have now been postponed). This begs the question of who is to blame, if anyone, for this continual disruption of the day to day running of the National Health Service?
It is very easy to point the finger at the Government and Health Sectary, Jeremy Hunt, who appears to have lost the support of the health service. This can be indicated by areas of the contract highlighted in the initial dispute such as changing one 30 min break from every 4 hours to one in the first 5 hours. Furthermore, there were “proposals to scrap fines for NHS trusts who forced doctors to work unsafe hours.” These are reflected in slogans used by junior Doctors at marches such as “Tired Doctors risk lives”. Added to this the Government’s initial contract included Saturdays, 7am-5pm, as ‘plain time’ and thus in the same pay bracket as Monday-Friday 7am-7pm. This could be argued as justified due to Jeremy Hunts election pledge of a 7 Day NHS and hence by reducing extra pay for Junior Doctors at weekends Hospitals are more likely to increase staff numbers, which in the Governments eyes should reduce the increased death rate at weekends. However, what the figures used by the Government have failed to take into account is that at weekends routine operations do not happen as they do during the week, thus at weekends a larger proportion of the surgery that occurs is emergency surgery, which by its very nature has a higher mortality rate. Therefore, it could be argued, as it often is by the BMA, that the Government are spinning figures to their own advantage to make changes that are not completely required, and may possibly put patient safety at risk.
Despite this, it could be argued that the newly negotiated contract has quite a good deal for Junior Doctors with basic pay increasing by 10-11%. Aspects such as this addressed in the new contract caused 42%, of the 68% BMA members that voted, to be in favour of the new contract, a stark contrast to the nearly 80% of Junior Doctors going on strike in April (not all Junior Doctors are members of the BMA). This therefore suggests that Junior Doctors were ‘coming around’ to the new contract, so where did the idea for the biggest strike for Junior Doctors in NHS history come from? A possible suggestion is the change in BMA leadership which occurred after the newly negotiated contract was rejected by a vote of BMA members. This caused BMA Junior Doctors committee chair Johann Malawana to resign with him saying that “the vote was a ‘demonstration of just how appallingly frontline staff have been treated and undermined’ and accused the Government of overseeing a ‘fundamental breakdown in trust’” (from the BMA website). He has since been replaced by Ellen McCourt. However, Ellen McCourt cannot be solely blamed for what the press describes as “militant” tendencies within the BMA, with the telegraph as early as January 2016 claiming Dr Kailash Chand, a leading BMA figure, had “likened Conservative policies to Nazi propaganda”. The article went on to mention he is “among several supporters of Labour and Jeremy Corbyn on the British Medical Association’s council” begging the question as to whether the BMA has been ‘playing politics’. This idea was raised by Andrea Jenkyns, a Conservative member of the health select committee, who said “the disclosures raised questions about whether the actions of some BMA leaders were ‘politically motivated’”. Thus it appears that the Government is not entirely to blame.
Perhaps therefore the blame lies with both parties involved? A recent email that the BMA sent out to its members may indicate this, with it stating “For the first time in this dispute NHS England have told us that a service under such pressure cannot cope with the notice period for industrial action given. Our hospitals are chronically under staffed. Our NHS is desperately underfunded. We have to listen to our colleagues when they tell us that they need more time to keep patients safe”. This proposes that whilst the BMA wish to make an impact with their opinions they do not wish to compromise patient safety, unlike the removal of some safeguards by the Government in the proposed contract (although it could also be argued that by making suggestions such as pointing out the underfunding in the NHS could also have political leanings against Conservative austerity policies). Militant language is used later in the email with the lines “This does not absolve the Secretary of State. He continues to ignore the BMA’s request to stop the imposition. He continues to force upon junior doctors a contract that discriminates against carers, parents, doctors with disabilities and women, a contract that devalues our time and a contract that disincentives careers in our most struggling specialties. He continues to strive towards an uncosted, unfunded, unstaffed extended seven day service. He continues to disregard the concerns junior doctors have about staffing shortages and patient safety” particularly suggesting that the BMA are not in much mood to negotiate. Thus it could be argued that the BMA are just as at fault, if not more so, then the Government for a lack of compromise in this new contract.
To conclude, it appears that no side in this contract dispute is blame free with the Government attempting to increase the amount of unsocial hours worked by Junior Doctors, many of whom feel undervalued by this, and removing some important safeguards. Added to this the BMA appear to have some political leanings and could be accused of being militant and influencing members against the Tory Government. One side will ultimately have to back down with the Government imposing the contract and the BMA threatening five strike days a month if they do. The British Medical Association have given the Government until October to stop the imposition of the contract or the strikes will occur. What will finally decide this depute is if strikes do occur and the numbers of junior Doctors that take part. If a large majority (as they did in April) went on strike, the Government would be undermined and forced to negotiate, if less than or around 50% walk out, then the BMA would have been massively undermined and thus the new contract would go ahead.