John Lister reports:
The stunning scale of the turnout and vote for strike action by 30,000 junior doctors, mobilised into action to oppose the new contract which Jeremy Hunt has threatened to impose on them, should be an inspiration to all.
Their case is clear: they are not, as Hunt tried to spin the dispute, seeking a pay rise – although they would have a case for demanding more. Given their many years of training, long hours of work and study, and hefty debts hanging over newly qualified doctors from University fees, junior doctors are far from overpaid, with current basic pay levels as low as £22,000 and a top basic rate of just £47,000 for the most senior registrars.
Nor have they been offered a pay rise, since the “11% increase” which Hunt offered in the basic rate would in most cases be more than offset by proposed cuts in payments for working unsocial hours, and a removal of the guarantee against them working even longer hours. In addition the contract includes the designation of working 7-7 on Saturdays as regular working hours, changes to pay progression and loss of pay protection, all of which would leave many junior doctors worse off – with estimated pay cuts of up to 25%.
After all, who would you believe on junior doctors’ pay: a millionaire Health Secretary, who has quite deliberately and cynically misrepresented the facts to suggest that 11,000 people a year die as a result of poor staffing of hospitals at weekends? – or junior doctors who save lives every day?
An official complaint has been raised by doctors to the Cabinet Office and the Parliamentary Commissioner for Standards, arguing that Hunt’s claim over excess deaths deliberately misled the Commons by selectively quoting figures from a BMJ article to justify his claim that the deaths were “avoidable”.
Hunt is desperate to give the impression that his only interest in the row over the junior doctors’ contracts is to “save” thousands of lives, and by implication make it look as if the junior doctors want more money and don’t care about patient safety.
But experts including NHS England’s Medical Director Sir Bruce Keogh keep pointing out that there is no evidence to prove that the excess levels of deaths are actually caused by a “weekend effect” of lower levels of staffing. They argue that the people admitted to hospital over weekends are almost invariably emergencies and sicker, with fewer alternative options for treatment, than the intake during the week. And anyway emergency departments already run 7 days a week.
Hunt’s crocodile tears over weekend numbers of medical staff ignore the massive problems of staff shortages that impact on patient care all week long.
A recent Nuffield Trust and Health Foundation ‘Quality Watch’ report notes the impact of the 5-year real terms freeze on NHS funding: “People working in the NHS want to deliver high-quality care, but they are increasingly battling against the odds to do so. With waiting times and staffing issues so closely linked to funding, it is likely that care quality will continue to decline in relation to these two areas.”
Junior doctors don’t want an increase, but neither are they willing to accept a contract they see as unfair to them and unsafe for patients.
So their new militancy is over a defensive fight, seeking to prevent the imposition of a contract that would erode the terms and conditions of junior doctors, and drive an even more rapid exodus of many from the NHS to work in Australia and elsewhere.
They are defending the NHS.
But they are also in the first fight to defend over a million more NHS staff
Hunt’s objective is two-fold. The first is to remove pay supplements for working unsocial hours, initially for doctors and then for all 1 million-plus NHS staff, so that Cameron’s cynical promise of “7-day working in the NHS” (itself an absurd proposal since pilot projects have shown that few patients wish to access services on Sundays) can appear to be achieved with minimal extra cost.
So the fight with the junior doctors is just an early trial of strength before Hunt embarks on a full-scale onslaught on the Agenda for Change pay agreement and the hard-won terms and conditions which cover most NHS staff, many of whose livelihoods depend upon the additional payments they receive for out of hours or on-call working.
The second objective is to further embed the notion in the media that the NHS as we know it is “unsustainable” – on both financial and clinical grounds – thus opening up a new debate on what has to be done instead. Hunt is trying to make “unthinkable” plans to break up the NHS thinkable – and doable.
From that standpoint strike action from junior doctors which disrupts services can help to underline the instability: there is no doubt that to a large extent the strike has been provoked. But when the BMA’s bluff was called like this they had no option but to respond. It’s likely that Hunt and co expected a much greater division in the ranks of the junior doctors, offering more scope to split them and weaken their resolve.
One of the main drivers of these attacks is the steady reduction of real terms health spending as the population and pressure for services increases. UK spending on health as a share of national wealth is also below the OECD average, and set to fall back to 1997 levels as a result of Osborne’s 10-year freeze. TUC research shows that real terms health spending per head has fallen since 2010 – despite Cameron’s promises of year-on-year increases in NHS spending.
This has consequences. Britain now has among the worst survival rates for breast, bowel and cervical cancers, stroke and heart attack, not least because we have some of the lowest numbers of nurses, doctors and health professionals per head of population, and extremely low investment in MRI and other diagnostic imaging.
As we head into winter, despite the unseasonal warm weather, nursing directors are warning that most hospitals are already running at winter peak levels, with occasional ‘black alerts’ when no beds are available. The financial squeeze means that most trusts are in deficit, and facing even bigger deficits by the end of the financial year.
One, Princess Alexandra Hospital in Harlow, has announced that since it is not being properly funded to take a full caseload, and it is unable to afford the increased numbers of agency staff to ensure patients are cared for safely. So they will begin closing beds to match services to their income. If others follow suit, it would cause chaos throughout the NHS.
Christopher Smallwood, the chair of the giant St George’s University Hospitals Foundation Trust has also broken cover to insist that ministers are “in denial” on the scale of the crisis their spending freeze has unleashed and that: “The NHS is heading for a real smash, and practically everyone running a hospital knows it. Hospitals are at 100% capacity at the moment – and the onset of winter could be a nightmare. But beyond this, an accelerating financial disaster is in progress.”
Support for the junior doctors’ fight to defend against a worsening of their terms and conditions has to be linked with and followed by much wider campaigning against the whole Tory agenda of cuts, privatisation and dismantling the NHS. The TUC and a growing number of trade unions also recognise this with clear declarations of support for the doctors and their strikes.
Whatever the immediate outcome of the strikes, the issues will be with us throughout 2016. A united fightback is needed, bringing together the panoply of campaigns with the health unions and even possibly the Corbyn-led labour Party.
To drive this campaigning forward, a one day conference on January 30 in London that has been called by Health Campaigns Together (firstname.lastname@example.org), the new alliance of local and national campaigns and trade unions.
Its purpose is to update campaign and trade union activists, and encourage them wherever possible work together on the broadest possible basis in defence of the NHS – and make 2016 the year in which a coordinated fight back begins. The Health Campaigns Together website is already beginning to offer information and links to all the supporting campaigns, and hopefully soon a calendar of activities for campaigners and health unions to support.