Andrew Brown is Conservative health and adult social care spokesman on Hammersmith & Fulham Council. He has a medical background and works in strategic healthcare consulting.
I have been following the dispute over the junior contract for several months now. For the record, if I hadn’t chosen to change career paths, I would probably now be a junior doctor or recently qualified consultant.
I probably am more sympathetic towards their cause than other industrial action. It is, however, becoming more and more frustrating that there has been such lack of progress in even getting the BMA and the government to the negotiating table.
Thursday’s announcement that junior doctors have voted to strike, whilst not surprising, is regrettable. What we should not do is underestimate their strength of feeling: with 76 per cent of junior doctors voting, and an overwhelming 98 per cent supporting strike action.
It is now important that everything that can be done to avert a strike is done before the first industrial action on the 1st December.
For those that haven’t been following the story, summarised well here, there are two key threads to the dispute.
The first is the contract itself, which junior doctors believe will lead to less safe working conditions for them and patients, and will be unfair to doctors who take time out of their training progression for childcare or to take up an academic role.
There is also concern that the contract will penalise specialties that are more difficult to attract applicants to, and by their nature require more out of hours cover, such as A&E.
Whilst I do not share all of these concerns, I respect doctors as a group, their intelligence, hard work and dedication, so it is right that their concerns are addressed.
Jeremy Hunt has written to all junior doctors several times to reassure them, as well as writing on this site. I think that Jeremy Hunt has been a very good Secretary of State in one of the most challenging departments.
The fact that Ed Miliband failed to “weaponise” the NHS at the last election is mainly down to Jeremy Hunt’s calm handling of the NHS and his right and proper focus on what really matters, patients and their outcomes.
I unsurprisingly therefore trust the Secretary of State, but it is clear from the strike ballot, that junior doctors collectively do not.
The second thread to this dispute is far less important, but has probably dominated far too much of the discussion. That being the arguments over the negotiations itself, and all the he said she said nonsense that surrounds this.
For example, the BMA and doctors quite skilfully using the media to argue their position, refusing to return to the negotiating table, and then criticising Jeremy Hunt when he uses the media to make guarantees and talk to the profession as a whole.
The BMA sadly withdrew from negotiations over a year ago, and since then have been refusing to negotiate without preconditions being removed along, with the threat of imposition. But imposition was threatened because the BMA withdrew from talks.
This has become a rather circular argument. Jeremy Hunt has confirmed that there are no preconditions, reiterating that again this week. Since the ballot result has been announced, the BMA has changed its stance, saying that it will only renegotiate with ACAS.
Why demand this now, rather than months ago? I am not against ACAS being involved, but suspect that they might get in the way of negotiations between the two sides.
One of the biggest areas of disagreement in this whole saga has been over seven day working. Less good outcomes for those admitted at the weekend is a real issue that the NHS must face up to.
Despite the denials by some doctors, and the quibbling over statistics used and papers cited, patient outcomes and safety is something the Secretary of State is right to address.
We know this is an issue because many doctors groups have been campaigning about this for some time.
All Conservatives and clinicians should support the aim of improving emergency care at the weekends. Hugh Byrne has written very persuasively about seven day working on this site.
But where I have some sympathy with junior doctors is that their new contract is not the magic bullet for improving seven day working. Both sides have conflated seven day working with the junior contract.
Another term for this is idea is seven day present care, coined by the Academy of Medical Royal Colleges in their paper I refer to above. I believe this is more accurate, because it addresses the real crux of the problem around less good outcomes at weekends.
Their proposal promotes better consultant coverage at weekends, and this is bound to be an issue of the future consultant contract renegotiation.
Junior doctors already work on rotas, and the vast majority of them work nights and weekends. Some in fact work shift patterns that under the new contract they are now labelling as unsafe.
Whilst not right, it is understandable that new injustices and safety issues are unacceptable but examples in the status quo are not an issue.
Many doctors also work more hours than they are contracted to do, because they are dedicated to their patients.
Whilst some doctors will have too much work to do in their allotted hours, if junior doctors are honest with themselves, I expect many would admit that this is due to issues relating to not being able to find notes or test results or equipment, or not being able to discharge patients due to lack of joined up working with social care and other issues.
These problems have to be priorities for NHS managers and the government, as well as local councillors involved in social care.
The bigger issue that this contract should seek to address is, in my opinion, not seven day working specifically, but NHS trusts’ over reliance on very expensive locum cover.
This issue has faced the NHS for years, but has become more acute recently because of the growing demand for NHS services, and the greater focus on safe staffing levels following the Francis report.
By reducing the difference between daytime pay and evening pay, and weekday pay and weekend pay, this should make it easier for Trusts to recruit more junior doctors to cover the rotas they need, and rely less on locum staff. Not only would that save money, but it should also improve care.
But, with junior doctor morale now low, and tensions between them and government/senior NHS management getting worse, there is a risk that some will decide to move abroad.
This won’t be in the region of numbers threatened, but any doctors lost to other healthcare systems is still a huge loss of the investment made in doctors’ training and skills. As a country we should want to avoid this.
As Conservatives we should also want to avoid this strike. Junior doctors are not making outrageous demands for significant increases in pay, like some industrial disputes.
Whilst some comments in the media and online, and some banners on their marches have been unpleasant, the vast majority of doctors are not in any way militant. The BMA have been far too stubborn, in my opinion, but they would probably say the same of NHS employers, the Department of Health and Government.
A strike will be damaging for patients. It will also be damaging to the junior doctors’ reputations, as well as our Government.
Jeremy Hunt needs to do whatever he can to regain junior doctors trust. Both sides need to diffuse the tension, return to the negotiating table, with ACAS if absolutely necessary, ideally without, and come to an agreement that junior doctors, the government and most importantly patients can be happy with.