AT EIGHT this morning young doctors in England began a 24-hour strike where they are only providing emergency cover, the same as the one provided on Christmas Day. Patients have been advised to avoid hospitals if possible, referring themselves to local clinics and pharmacies instead. The first industrial action by doctors for four decades, the strike has resulted in the cancellation of around 4,000 operations.
The medics (some of whom, despite the term “youth”, are quite loud) are angry with Jeremy Hunt, the health secretary, about his proposal for a new contract, which he has threatened to impose on them if an agreement is not reached . . Picket lines are expected to go up at hospitals again on January 26 and in February (when a full walkout is planned leaving consultants, nurses and temporary staff alone to deal with emergency). The details of the dispute are factual, in terms of working hours, basic and additional rates of pay and working time regulations. But there are two main disagreements, which are quite simple.
The first is about how much the NHS should be reducing hospitals on doctors’ working time. After pulling out of talks last summer the BMA, their trade union, returned to the table in December. The result was a memorandum of understanding in which the BMA, the Department of Health and NHS Employers agreed a series of rules on the length of shifts, the frequency of long shifts and rest periods between shifts, and the creation of an independent ” “custodian” responsible for enforcing these rules at each NHS trust. But the BMA maintains that this is not enough; that in a busy hospital environment it can be all too easy to work dangerously long hours, especially as some penalties are waived for hospitals that exceed these limits. He argues that the rules should go further (for example, he wants long continuous movements to be limited to three rather than the five offered) and wants the person to have more teeth -keeping
The second is about whether evening and weekend work should have a higher value than between 7.00 and 19.00, Monday to Friday. If you think the answer to that is “no”, it’s hard to disagree with Mr Hunt when he says his reforms will leave 99% of junior doctors better off, or worse, paid than they are now. If “yes”, the decision is less certain: although the basic pay for doctors will increase, partly to compensate for the end of automatic increases for seniority, payment will not plus to pay extra non-social hours for Saturday or weekday evenings. between 19.00 and 22.00. In addition, since this will make it cheaper for hospitals to schedule doctors during these hours, there will be more working time for which they were previously paid a premium. If the value of their work during this period is indeed higher than during the “normal” work week, it is fair to say that more than 1% may lose out.
That the dispute is difficult to resolve indicates that the factors in dispute – the number of hours a doctor can safely work and the strictures required to apply them; the value of time at different times of the day and week – they all have a large qualitative component (although each side has a series of quantitative studies saying different things). The health service is flesh and human. Like the body, it runs on a series of delicate balances, not binary switches. Hence the uncertainty and lack of understanding that surrounds the dispute and has made a solution, until now, impossible.
Therefore, the blame for the strike is very different. Mr Hunt’s aim for a seven-day NHS is commendable but it took far too long to realize that the way he was presenting it meant doctors were not working hard enough. Already at breaking point (many young British doctors leaving for the Australian and New Zealand health systems), many doctors immediately turned against him. The simplistic clinical research that underpinned the case for the reform was an uncritical error, documenting higher death rates in the system on weekends. So a seed of disgust has been sown which has been nurtured perhaps too keenly by the leadership of the BMA, whose rallies respond to baseless claims that Mr Hunt wants to privatize the NHS and abuse the health secretary. which – the doctors ignore – he has a manifesto promise to fulfill. The doctors have the right to strike (accepting punishing daily hours and thankless conditions at an hourly rate of pay that would disgust many in less skilled jobs), but the co- their decision to do so strangely after discussions where even the BMA admitted, progress. was done. That the rhetoric surrounding the strike suggests that the NHS itself is at risk, and not just the pay and protections of some of its staff, perhaps admits that the details of the case are not, unadorned, fitting the scale of the action.
However, it is difficult not to sympathize a little with both sides. Doctors have a lot of hard work and deserve better pay and conditions, not an unequivocal promise of thin improvements. Mr Hunt, far from wanting to kill the NHS, rightly admits that the system only has a future as long as taxpayers are willing to fund it – and so it is heavily focused on improving patient experiences (allegedly inspired by reformer Eric Topol’s “The Patient Can See You Now” quote on the future of medicine).
No, if there is one party in the Hunt-doctors controversy that deserves the most criticism, it is the British public. This is the electorate who deeply respects the NHS, puts a brutal song by health workers to the top of the Christmas charts, happily accepts false claims from the left that the one alternative is an American-style private health care model, voting just as happily. Tory politicians promise to extend services to weekends and despite all this, they show little willingness to pay more in tax towards a system that is still in its infancy good cheap If the BMA really wanted to change things, it would try to dispel this argument by polling voters to find out where to cut spending, or raise taxes, to pay for the seven-day NHS they voted for.
Otherwise, to remain viable at a time when the average citizen is becoming more and more marginalized, “our NHS” will need to tighten its belt by £30 billion by 2020, less than a third of which is cover with additional expenditure. It is in this context that Mr Hunt is trying to extend services to evenings and weekends. If he is struggling to convince doctors that they should be paid the same for working these hours as they are during normal hours, it is because they are not he has a pot of money to smooth the process. So pity the well-meaning health secretary, pity the hard-working doctors – and blame the sentimental but gullible British public.
