The BMA’s reasons for promising to take industrial action on 13th and 28th January, as well as 10th February, betray the crux of the conflict between itself and the Government. It’s really about pay and working conditions; patients are of secondary concern.
In the BMA’s summary of its position as of 4th January, the ‘areas of disagreement’ between itself and the Government include: safety; pay progression; and pay for all work done. Dr Johaan Malawana, Chair of the BMA junior doctors’ committee, contests they have ‘consistently been clear that we want to reach a negotiated agreement to achieve a contract that is safe for patients, fair for junior doctors and sustainable for the NHS’, and yet all the areas of disagreement listed by the BMA concern first and foremost doctors’ interests.
The disagreement over safety is a question of hours, with the Government proposing to abolish the financial penalty for hospitals that overwork doctors. However, Jeremy Hunt plans to limit the number of hours junior doctors can legally work to 72 per week. He maintains that the current limit is 90.
Quite reasonably junior doctors argue that ‘tired doctors make mistakes’, although it is misleading to argue that patients will be directly affected by Government proposals. If doctors were to be overworked, it would be their own health and social lives that would take the hit. Only as a consequence of their tiredness, leading to impaired concentration and judgement, would patients be affected.
Unequivocally the remaining four areas of disagreement appertain to pay. They are the last to be resolved, thus presumably the most contentious and critical. Nonetheless, as is manifest in Dr Malawana’s statement, the BMA has deliberately misled the Government and public by not listing its grievances in order of importance.
By continuously placing patient care first in their list of concerns, they have sought to distract from the fact that their own pay is of primary importance. Another example of this spin comes from Dr Mark Porter; he claims that the BMA seeks a contract that is ‘good for patients, junior doctors and the NHS’. It would be disingenuous to allege that these three issues are of equal weight in their dispute with the Government. The BMA have accused the Government, in particular Jeremy Hunt, of resorting to ‘political spin’, yet they have flagrantly been at it themselves.
Likewise, protesting junior doctors, with their ‘not safe, not fair’ placards, create a smokescreen to conceal their true concerns. Hysterical claims that the NHS is in mortal danger (‘Save the NHS’) also distract scrutiny from the doctors’ own interests and deceitfully elevate their protests to the category of brave and selfless struggles. This self-righteous tone is encapsulated by the BMA’s statement that ‘the proposed contract represents an existential danger to the NHS as an institution.’ It would be more honest to state that the proposed contract is unfair on junior doctors, but the BMA and its members have not missed an opportunity to ennoble their cause.
If patient safety were truly their primary concern, why would they be so resistant to the Government’s laudable intention to reduce the weekend mortality rate in NHS hospitals? Why would they decide to strike if, as Dr Mark Porter put it in a letter to Jeremy Hunt, industrial action will ‘cause disruption to patient services’?
With breath-taking arrogance some members of the medical community have tried and failed to refute convincing evidence of a ‘weekend effect’ in NHS hospitals. Unfortunately for them, the BMJ itself conducted one of many studies that pointed to this ‘weekend effect’ of higher mortality rates. While Jeremy Hunt was rightly criticised for his erroneous suggestion that the 11,000 extra deaths at weekends were avoidable, attempts from some of the medical community to spin what Sir Bruce Keogh, National Medical Director of NHS England, termed the ‘inconvenient truth’ of higher weekend mortality rates are deplorable.
While I feel the BMA and its members have campaigned misleadingly, the Government has come out just as badly. Although its intention to reduce weekend mortality rates is admirable, its approach and method are misguided. A full seven-day NHS service may not be cost effective if it unnecessarily stretches resources. How, without employing more doctors and consultants, would there be enough of them to cover more hours? Moreover, it would be a waste of money to have non-urgent services such as dentists’ surgeries open on the weekend. Thus, it could be preferable to extend only essential services to the weekends.
Were there a more competent opposition in place, the Government would not have got off so lightly with its foolhardy confrontation of the medical industry. As our population ages and requires increasingly levels of care, the NHS has never been more important. In pursuit of his goal of reform Jeremy Hunt has surely broken most of the rules in the diplomat’s guide to negotiating. The approach of the Government and the content of its proposals could well cause the next generation of doctors to have second thoughts about a medical career. At a time when fewer doctors are qualifying and being retained by the NHS, this is extremely reckless.
The BMA and juniors doctors may be concealing their true motives in this conflict with the Government, yet I am firmly on their side and respect their right to reject the proposed contract. They have a strong hand; they are skilled, in-demand specialists, so why shouldn’t they fight to be properly treated by their employers? There is no shame in them explicitly demanding not to have their pay cut. Nonetheless, they have so often concealed this primary concern under the pretence of a moral crusade that they appear ashamed of it. Their lack of transparency undermines their cause and impairs their chances of success; they have obfuscated their message and these attempts to mislead may diminish public sympathy.
I dismiss the argument of commentators like Dominic Lawson that the BMA are concealing their financial motivations because they’re some sort of Marxist cabal. Indeed some prominent BMA members have expressed sympathies for the Labour party, but this is not about political affiliation; it’s about privilege.
The fact remains that junior doctors are privileged in relation to the rest of the population. Many, but not all, will have enjoyed comfortable upbringings before cementing their middle class status upon qualifying as doctors. It is understandable that their favourable position in life might cause them to shy away from publically fighting for money in the aftermath of a recession during which the living standards of millions worsened. Despite the economic recovery, average pay is not expected return to pre-crisis levels until 2017, so they may well consider it churlish to complain while the majority of people would envy their career prospects and earning potential. The way in which they have positioned pay as a secondary concern is therefore understandable, yet it is unnecessary and unhelpful.
The time has come for junior doctors to stop playing righteous charades. I support their right to a fairer deal, but I’d be more endeared to their cause if they’d stop trying to con us and come clean about their true intentions.