Rumour has it that, after the controversy surrounding Andrew Lansley’s NHS reforms, his successor Jeremy Hunt was instructed to do one thing: keep his head down. Instead, it’s wanted on a plate. As talks between the Government and junior doctors again break down once more, one of this Parliament’s most persistent political stories just won’t go away. The health secretary hasn’t helped himself: he came under fire over his misrepresentation of the “weekend effect” (the link between weekend hospital admissions and poorer patient outcomes including higher rates of mortality). He has been rightly criticised for his subtle suggestion that the increase in basic pay is an 11 per cent increase in overall earnings, when in reality most doctors’ salaries are substantially reliant on additional money from working evenings and weekends – which will be cut.
Nonetheless, you may start to feel some pity for Hunt – after all, he’s inherited a ticking time bomb, an obsolete behemoth that works neither for its consumers nor its staff. As Kate Andrews has suggested, the successes of market-based systems in Europe can’t be ignored much longer, as the NHS staggers towards its breaking point.
And doctors have long used collective protest to shape the NHS and their role within it. In 1947, doctors contested plans for the new NHS, looking to retain their independent contractor status rather than becoming salaried employees. In 1975, both consultants and junior doctors engaged in partial strikes over hours and overtime. This ties in neatly with Peter Hoskins’ blog this week. In it, he examines all disputes going back to the 1930s.
Time lost to strikes, he finds, was much higher in the 1970s and 1980s than previously or since. The overall peak came in April 1980, when around 32 million working days were lost to industrial action in the 12 months up to and including that date. He says:
“Industrial action is consistently low, nowadays. In fact, the average 12-month total for the Labour years is about 613,000. For the Cameron years, so far, it is 658,000. This suggests not just that incidences of industrial action are much lower than they were before the 1990s, but also that they have remained consistently low. The unions have been defused by a combination of Margaret Thatcher’s reforms and wider, historical forces. The industrial strikes of the 1980s are unlikely to be repeated in a de-industrialised nation.
“None of this is to downplay or excuse the industrial action that’s being planned by the British Medical Association and junior doctors. Each strike must be judged according to its own facts.” Are doctors paid enough? It depends on whether you believe anyone “deserves” a particular salary. But junior doctors must resist the urge to back a strike, one that would compromise the safety and wellbeing of NHS patients.
Since the resumption of talks in November, there has been significant movement on almost all outstanding issues on the contract. As Sir Robert Francis QC pointed out yesterday, continued negotiations must proceed: both sides have a duty to continue exploring all avenues, including conciliation and meditation.