The junior doctors’ dispute has induced a mood of apocalyptic gloom everywhere that the medical profession gathers. Moaning has always been part of medical culture, but none of us have ever seen anything remotely like this before. The entire profession is very apprehensive about the forthcoming strike, despite extraordinary levels of support for Dr Malawana and his colleagues. Even the Royal Colleges, surely the most conservative of all medical institutions, have called for the withdrawal of contract imposition.
I last blogged about the junior doctors’ dispute back in January. Since then, everything has got worse. Sincere efforts to compromise and to move away from the brink have been peremptorily rejected by the Secretary of State for Health. It has all turned a bit nasty.
The Government’s stance is hard to understand, because it is impossible to see what ‘winning’ now looks like. Politicians employ spin-doctors, and you would think that they would be advising Mr Hunt that ‘strutting machismo’ and ‘strong Government’ are not synonyms. Repeating fallacious arguments over and again does not persuade anyone with any ability to understand evidence. At the end of all this we are likely to have a seriously damaged NHS, even in parts of the country where there is no dispute. No wonder the junior doctors are so angry. I am pretty fed up myself, although I am a non-combatant (as I work in Wales).
It is hard to know what will happen to public opinion from here. In the long run, the aftermath of the dispute is bound to be extremely difficult, and blame for that will fall on Cameron and Hunt. In the short run, public opinion may turn against the junior doctors and the BMA. Although the arrangements for senior cover during the strike look solid, we can assume that Tory-supporting tabloids will attribute deaths to the action without troubling with issues of causality.
Today, the BBC report that a Government spokesperson has said that the BMA are trying to bring down the Government and that they have ‘radicalised’ a generation of junior doctors. I have to say that if I thought that was true, I would be happier about having paid subscriptions to the BMA for 36 years. We have moved on a bit since the Zinoviev letter, and I doubt if this kind of ‘enemy within’ rhetoric will convince anyone. It is a decade of alienation and abuse of junior doctors that has brought us to this. Although New Labour played a significant role, it took a man of Mr Hunt’s special abilities to mobilise a group of middle class professionals who have children, mortgages and car loans to worry about. I do not believe that subliminal Bolshevik messages in the careers pages of the BMJ had any significant effect.
Just in case anyone has missed the point, the new contract is, according to the Government’s own advisers, discriminatory against women. 70% of newly qualified doctors are women. A single parent, living far from family, would not be able to work as a junior doctor under the new contract, because child-care at weekends comes with a premium charge but, under the new contract, doctors will get weekday rates. No one can work at a loss. It is hard to think of anything more inflammatory than the statement that this is a price worth paying for the advantages of the new contract.
The nature of the ‘seven-day’ NHS under the new contract is far from clear. There is no credibility to claims that the imposition of a discriminatory and badly thought-through contract will somehow save the lives of people who are admitted at weekends. If the Government ‘wins’, the existing recruitment problems of the NHS will worsen and patients will suffer. The dispute is pointless as nothing good can come from the Government winning.
I suppose that the Government may believe that their intransigence will break the power of organised medicine. Perhaps they see that as an essential first step to eliminate resistance to change in the rest of the NHS workforce and in the public sector trade unions in general. I think that we can guarantee that something is being broken here. I cannot help but feel that it will prove to be something more precious and irreparable than the alleged power of doctors.