Sadly despite our common goal of improving NHS care, talks
between our union, the BMA, and government broke down many months ago due for
reasons which have yet to become fully clear.
Recently the overtly hostile and aggressive mode of the government’s ongoing
threat of unilateral contract imposition upon junior doctors has been
particularly morale sapping and depressing to endure. After all, I am rightly expected to be
totally honest with my patients, so how can it be fair or right that the
government and Jeremy Hunt treat me and my colleagues with such a total lack of
dignity and respect? The details of the
contract are complex but the key flaws within the government’s argument can be
summarised fairly succinctly.
Jeremy Hunt and the government claim contract reform is
essential to create a ‘truly 7 day NHS’.
There are two critical problems with this as what is meant by a ‘truly 7
day NHS’ has yet to be defined, while many NHS services have already been
reformed to become high quality fully 7 day services and this has been done
within current contracts and well before Mr Hunt’s reign began. Notably this has only been managed because
ground breaking reforms in areas such as cardiology and trauma were clinically
driven and the views of those who would have to deliver these very reforms on
the frontline were honestly sought. Therefore
the government’s argument is a weak straw man; existing contracts are perfectly
compatible with improving services, while pretending to reinvent the wheel of
‘7 day services’ does not magically create a new wheel.
If Jeremy Hunt and government wanted to incentivise better
care at weekends, then surely the new contract to achieve this aim would have
to increase the reward for antisocial working?
One would think so, which makes it particularly strange that the new
contract imposition rewards antisocial hours less than the current deal. This is particularly problematic in terms of
the recruitment and retention of doctors, which are already in pretty dire
straits in several areas including General Practice, A&E, Paediatrics and
Psychiatry. Jeremy Hunt’s ‘11% pay rise’
is a disingenuous sleight of hand, the deckchairs have simply been rearranged,
the overall pay package is unchanged, money has simply been moved away from
rewarding antisocial hours and into the basic pay pot. Given that recruitment and retention is
particularly dire in many of the specialties with a lot of antisocial hours,
this makes the contract particularly regressive and potentially unsafe in terms
of creating more dangerous gaps in rotas.
Jeremy Hunt has claimed that junior doctors will work fewer hours
under the new contract but has actually removed the only robust contractual
safeguard against excessive hours from the contract, the financial penalties
for employers who breached hour limits.
At the same time he has introduced nothing credible with teeth which
could possibly ensure that his vision could become a reality. Many of us already work many extra overtime
hours which are currently unpaid by the current system, despite Hunt’s
ignorantly offensive claims that doctors lack ‘professionalism and a sense of
vocation’, the system is still very reliant on this professional goodwill. Again Hunt’s claims do not fit with the
objective reality of the new contract, there will be no more doctors, and with
the removal of our only robust hours safeguard, it is highly likely that junior
doctors will be left unprotected from dangerous excessive hours. This inevitably means that patients will be
needlessly put at risk of harm; as there is a plethora of solid evidence
showing that tired doctors make considerably more mistakes.
There are many more significant flaws in Hunt’s contract
including the negative effect on both research and gender equality, but the recurring
themes remain the same: there is a gaping chasm between the government’s rhetoric
and the likely reality of the contract they aggressively threaten to
impose. It is no coincidence that both
representatives of the Department of Health and Jeremy Hunt routinely refuse to
appear in public or in front of the media to take open questions on this
mismanaged dog’s dinner, while junior doctors are more than happy to be
questioned live and to speak to members of the public on the street to inform
them of the reality of this toxic contract imposition. If the government had such a great
progressive contract on the table, why do they hide from public discussion and why
have 98% of highly educated professionals voted in favour of industrial action? The stressful dilemma facing us now is that
none of us want to strike, what we want is a safe contract which is compatible
with a sustainable 7 day NHS. However
the government has not given us a good option, we have the option of industrial
action or a regressive dangerous contract which will destroy any hope of a safe
sustainable 7 day NHS in the longer term.
With heavy hearts we have opted for the least bad option of industrial
action, knowing not where it will lead, but at least knowing we are doing the
right thing for what we hope will be our many future patients in the NHS. We want negotiation but we welcome the recent
move from Jeremy Hunt to engage in conciliatory talks with the BMA via ACAS, however
while the government refuses to withdraw its threat of contract imposition
meaningful negotiation cannot happen and a strike remains inevitable.
I am honestly not sure what I am meant to feel anymore, the
emotional rollercoaster has still to run its course. Since I graduated from medical school over
ten years ago life has certainly had its up and downs, the biggest ups were
getting married and having a wonderful daughter, the downs have included
failing several exams along the way and the incessant shifting of the goal
posts in medical training. On the whole
medicine has been a wonderful career, being a doctor is a great privilege in
ways I had not imagined before embarking upon this journey; simply being in a
position to meet and learn from so many fascinating diverse characters is a
great privilege. It says a lot given how
rewarding I find the day to day job, that I doubt that I would encourage my daughter
into medicine these days. It is a pretty
sad indictment on the mismanagement of this situation by the government and
Jeremy Hunt that they are bullying through the creation of an environment in
which I would not want to see my own child work, consequently they are
sculpting an NHS in which I would not want to be a patient, and that is the
most damning indictment of them all. The
continued creation of a high quality 7 day NHS can only be done with
collaborative and cooperative working, bullying misguided flawed policy from on
high will only create more problems, not solve them.
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