1. The maximum hours doctors can be made to work is actually decreasing. The British Medical Association is claiming that today’s strikes, in part, are about delivering safeguards to protect patients against the consequences that can arise from tired, over-worked doctors. While there is evidence that intervention into medical working hours can have mixed - and sometimes even negative - results, let's agree that no one wants a tired doctor attending to them. But maximum hours doctors are allowed to work are actually decreasing under the new contract. From the Telegraph:
The Government says the new deal would have an absolute limit of 72 hours in any week, lower than the 91 hours that the current arrangements allow. Doctors will not have to work for more than 48 hours on average due to the European Working Time Directive (ETWD), but they can opt out and work more hours - up to 56 - if they wish.
It appears EU law has limited the number of hours doctors can work per week, quite significantly. Furthermore, the BMA has already come to an agreement with the government regarding "safety issues" around "maximum working hours". The issue has been sorted.
2. This strike is over pay; not patient safety. Point one leads us nicely into point two; this strike is not about overworked doctors, and it’s not about patient safety. It is openly about pay.
Specifically, it is about how much doctors will get paid for working on the weekends. Both the BMA and government reps came to an agreement on 15 of the 16 points of contention the BMA had with the new contracts, but the discussions were ended over this last point on weekend pay.
The BMA should be honest about this. It might well be the case that junior doctors deserve higher salaries; but the money to fund that pay raise comes from the public’s purse. If the BMA wants to secure higher salaries for those in the profession, it needs to ask the taxpayer to foot the bill.
(Update, 10 February 2016: the "key sticking point" of today's strike "appears to be payments for working on Saturdays.)
3. The NHS is the only healthcare most Brits can access. The NHS in not unique in its delivery of universal healthcare. As Kristian Niemietz has noted, almost every developed country (apart from the United States) provides comprehensive healthcare services for its citizens.
What is unique about the NHS is that is provides care through one system that is both publicly funded and publicly run. There is no real market for healthcare in the UK, which keeps the cost of private healthcare sky-high.
It is simply not the case that when NHS doctors go on strike, Brits can turn to private provisions; most people have been regulated out of the market, and for them this has been made financially impossible.
4. Patient safety is at risk. Some folks out there are claiming that strikes are beneficial for patient safety because mortality rates actually decrease during strikes.
If this sounds wildly misleading, that is because it is wildly misleading.
On the one hand, studies have found that, in some cases, mortality rates do decrease during a strike; but this is only because risky operations and elective surgeries, which bump up mortality rates, are cancelled.
Putting off these kinds of operations can have very dangerous medium-term effects. Making patients wait for important surgeries is not simply an inconvenience; it can hurt their health.
On the other hand, there is evidence that health strikes can seriously increase mortality rates. Over at the Telegraph, Asa Bennett has highlighted a study from the States, where a nurse strike in New York increased morality rates at the hospital by almost 20%:
US academics Jonathan Gruber and Samuel Kleiner recently looked at what happened when nurses went on strike in New York in what they billed as the "first analytical evidence on the effects of health care strikes on patients". The professors, from MIT and Cornell University respectively, discovered in their paper – "Do Strikes Kill? Evidence from New York State" – that the rate of in-hospital mortality rose by 19.4 per cent among the 38,228 patients admitted during a strike, and the rate of patient readmissions increased by 6.5 per cent.
Only the aftermath will reveal how today’s strike has impacted on mortality rates; but one is certainly within their right to ask if the potential for increased death tolls at hospitals is ever worth the risk.
5. The British Medical Association is not a neutral body; it is a pressure group. The BMA is not an impartial medical association; it is a union for doctors, and their job is to negotiate the best deal for their members that they can get.
But the BMA isn’t negotiating. Despite coming to agreement on 15/16 issues with the government, they have still decided to hold the public to ransom over one issue, jeopardizing the quality and quantity of services the only healthcare provider in the country can perform.
When a country operates under a healthcare monopoly, its citizens are fundamentally at the mercy of the provider. That provider has an ethical responsibility to show up to work every day and look after its patients; if they don’t, no one else will
One final point: British patients are becoming increasingly aware that the NHS isn't all it's cracked up to be; some are starting to look look fondly across the channel to Europe, where patients are getting better treatment and experiencing better outcomes.
What is often neglected from these discussions is how doctors are treated by the NHS. Indeed, there is good reason to believe it is both patients and doctors who are getting the short end of the stick. Jeremy Hunt's new contract doesn't solve this issue, but neither do the BMA's demands. If the BMA is truly intent on bettering the working environment for doctors, it should look to reforming a system that only allows them to negotiate with one provider: a highly bureaucratic, government body.