Much has been said about the HSJ roundtable discussion last week, indeed the HSJ's piece relating to this discussion is due in the next few days. So I hear you asking, why am I asking so many questions and probing the exact context to this roundtable event? Firstly this tweet aroused my suspicions, this was tweeted at the end of last week by the HSJ's editor Alastair McLellan:
It was interesting that the HSJ were so keen to publicise the fact that the BMA did not send a rep to their roundtable event. It is even more interesting when one considers that the HSJ didn't provide a fair or full context to the BMA's decision. I also wonder if any other big organisations were invited and didn't attend, it has subsequently become clear that several major trainee organisations were not invited. Obviously the BMA didn't want to comment directly as it would simply draw attention to an event which they did not want to send a rep to for whatever reason.
Three junior doctors attended the roundtable event as they had every right to do. Despite the somewhat rambling hypocritical hyperbole from some quarters, it really doesn't help to make this personal, so sorry to disappoint by sticking to the facts. The key to this whole affair remains the HSJ's conduct and the exact terms of their roundtable debate, not the fact that three junior doctors gave their opinions as a roundtable discussion. I found it fascinating that the chair of the debate, the HSJ's Shaun Lintern tweeted:
This delivered the hint that the HSJ, whether consciously or subconsciously, had set things up to hear what it wanted to hear. It seems that the majority view of the profession is not 'constructive', junior doctors should just accept that Trusts are imposing and accept this silently. To his great credit Chris Kane, one of the junior doctors who took part, has very kindly sent me the invite letter, which appears to show more of the same:
Interestingly no one from the HSJ responded to my polite requests for a copy of the invite letter, I can't imagine why. Now go back to the HSJ Editor's tweet in which he states that the roundtable was on the 'junior doctors dispute', given the above terms of the discussion this seems a rather twisted take on events. Alastair McLellan has repeated this misleading 'dispute' line, while his use of the word 'imagine' to describe the specific terms that were contained within a letter that he signed is revealing:
The above invite letter makes it very clear that it imposition/implementation has been taken as 'a priori'. I find it strange that such a debate on the 'dispute' has effectively assumed that Trusts have to impose the contract, as this is simply not the case, as recently made clear in Justice4Health's recent court case.
Trusts are eminently free not to impose the contract, and given the inevitable massive harm of imposing a contract upon a workforce rather than insisting on further negotiation, it appears a rather strange 'a priori' to have assumed. Not only is it strange but it leads to the propagation of the dangerous impression that Trusts have no choice in this matter. Shaun Lintern chaired the roundtable and the lack of neutrality of his comments about the BMA need seeing to be believed:
Hence the title of the blog. It would be a tad suspicious if a tobacco company organised a roundtable discussion on the best and most healthy way to smoke a cigarette, in a way that did not allow for a discussion as to whether smoking was really an effective or sensible strategy in the first place. The HSJ's terms ("how can one maintain good workforce relations" while imposing a contract) meant the discussion was a bit like asking how can one stay healthy while smoking cigarettes, not a particularly sensible question and we all know what one gets if one asks a silly question. Not to forget the fact that the HSJ seems to have assumed that Trusts have 'good workforce relations' with junior doctors, something I think has become increasingly obviously not to be the case in recent months given the numerous calls from independent bodies for a review. The talk of 'healing wounds' while accepting the harmful imposition as 'a priori' is at best misguided.
Therefore in conclusion, I'll leave you to ponder the HSJ's actions: the spin of of a discussion of how to impose as one about the 'dispute', the selection of those based on who the HSJ felt would be 'constructive' and the terms of debate which took the most effective strategy for Trusts off the table of discussion. The eventual HSJ needs to be judged in this appropriate context. Imposition doesn't make any sense for employers, it can only harm workforce relations overall and this is why I am rather frustrated at the somewhat stilted approach. It soon becomes pretty obvious why the BMA didn't attend and the way in which this was publicised by the HSJ Editor only confirms that this approach was likely to have been correct.
It looks to me as if junior doctors are united in one key way, we all see imposition is the worst option for everyone including our patients and there remains no coherent argument against this sad fact. If we are going to be 'constructive' then the most constructive thing to do would be to continue to emphasise that Trusts are entirely free not to impose, and it is in all our interests to first, do no harm. Imposition can only mean overall net harm and taking this option off the discussion table isn't 'constructive', it smacks more of a head in the sand and deep denial. The harm of imposition will take generations to undo, mark my words.
