Strike action being taken by junior doctors has been endlessly reported on since the first whisperings of its possibility, and staff across the country are poised to walk out for the second time next week, accompanied by a flurry of opinions. It’s easy to get caught up in the media snowstorm, with profound declarations left and right that the NHS makes us proud to be British, and touching personal anecdotes of how it’s helped us and our families in our most difficult moments. But why do we really need to support junior doctors in their strike, and what might it mean if we don’t?
In a nutshell, the proposed contract for junior doctors – that is, a doctor anywhere between graduation and consultancy – entails a number of changes to their terms of employment. The current “standard time” hours are from 7am – 7pm Monday to Friday, in which doctors are paid at their usual rate; any work outside these hours is paid a premium wage according to a banding system in which staff are compensated for unsocial hours. The new contract would see these standard hours extended to 10pm everyday except Sunday, resulting in a pay reduction. There are also plans to make exhaustingly long days standard, with only a 20-minute break allowed per shift of up to 11 hours.
While the Department of Health advertised an increase of 11% to basic salary, many junior doctors stand to take a salary decrease of around 25% because of these small-print changes. The British Medical Association took issue with the changes when they were first negotiated in 2013. As a result of the government’s refusal to budge on 22 of the contract’s 23 points, the BMA felt the only option at this stage was to take industrial action.
Initially there were plans laid out by the BMA for three spells of strikes, the first of which went ahead on 12th January for 24 hours. Following hopes that progress was being made, the second strike was called off. Despite this, one step forward led to two steps back and industrial action will resume on 10th February, with only emergency care available. This follows a statement from Dr Johann Malawana, chair of the BMA’s junior doctors’ committee, in which he accused the government’s position of being “based on ideology rather than reason”.
The doctors’ reasons for striking have been crystal clear from the onset. In exchange for working safe, fair hours, they don’t necessarily want more money; they just don’t want any less. Meanwhile, the government’s intentions are somewhat less explicit. Health Secretary Jeremy Hunt and his team seem to have taken a masterclass in public deception, and have presented an apparently innocent new contract on the premise of a need for a seven-day NHS with a generous salary bump to go with it.
Despite fairly regular negative propaganda, for example claims by certain publications that junior doctors mostly spend their time and money jetting off on luxurious holidays, the first strike generated a largely supportive response from the public. However, the fact that these articles garnered such outrage while the £410,000 payoff given to Hunt’s adviser last year was swept under the carpet shows how easily the government can paint the doctors as the bad cops.
The point of view of many is that taking industrial action will do nothing to change the outcome of the contract. Hunt himself has of course claimed the strikes to be “very unnecessary”, and has pandered to doubts by accusing doctors of “putting patients at risk” through going on strike. Insisting that there is no need to strike vastly over simplifies the reasons for doing so - the terms of the contract have not even been addressed for change since the late 1990s, and now that they have been in such a flippant manner, maybe walking out is the only way to make the government see that medical professionals won't take this sitting down.
In the long term, suspicions of plans to eventually privatise the NHS can seem far-fetched, but are they really that distant? When comparing these new terms of employment with the attractive career prospects offered to medics working in Australia and Canada, it’s easy to see why many NHS-trained doctors are tempted to move abroad. Ensuring cheap staffing of weekend health care by extending standard hours makes the introduction of a better-paid, privately-owned health service seem fairly self explanatory.
This, together with the fact that Hunt has long supported the idea of a “personal payment” scheme akin to US health insurance make this potential reality of privatisation all the closer to home. According to a book co-authored by Hunt back during his tenure as Shadow Secretary of State for Culture, individuals would pay into their own personal health accounts and those who couldn’t afford this would be state-funded. It’s not clear exactly what “state-funded” would entail, but the implication is a tiered health care system which ensures the best for the wealthiest. As a country whose health service is built on the fundamental belief that everyone is entitled to free health care at the point of need, we must maintain fair terms of employment for its doctors, and if temporary strike action is the way to do that, then so be it.
Putting more trust in a politician who has never worked within the NHS - with no concept of its day-to-day reality - than those in charge of that operation is frankly naïve, blinkered and, at best, wildly optimistic. Supporting industrial action is vital for those of us who don’t want to be treated by a health service ridden with not only inherent distrust between medical staff and government, and for those of us who don’t wish to be treated by exhausted junior doctors.