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 junior doctor contract dispute closely for some time now, and wrote a piece for this site last November hoping that strikes could be avoided. With hindsight, that was clearly optimistic, and unfortunately we have seen several strikes already this year. Each of these I have strongly opposed since, like most readers of this site, I don’t believe that striking is the best way to resolve industrial disputes.
That the dispute ever got so far shows how badly the negotiations were handled by both sides, in particular by the BMA and by NHS Employers. None the less, the BMA, especially the former chair of its Junior Doctor Committee (JDC), Johann Malawana, as well as NHS Employers and Jeremy Hunt deserve credit for managing to put aside the hostility that had built up over the dispute, ironing out their differences and agreeing on a contract that protects junior doctors as well as patients.
The BMA’s support for the new contract was clear, with Dr Malawana saying in May that “I believe that what has been agreed today delivers…is a good deal for junior doctors and will ensure that they can continue to deliver high-quality care for patients. This represents the best and final way of resolving the dispute and this is what I will be saying to junior doctors in the weeks leading up to the referendum on the new contract.”
When junior doctors voted by 58 per cent to 42 per cent against the new contract, Dr Malawana, who had campaigned for a Yes vote, understandably resigned, and was replaced by Ellen McCourt as JDC Chair with a mandate to oppose the new contract which, only months before, the BMA had agreed to and welcomed.
The announcement yesterday of five consecutive days of strikes starting on the 12th September and repeated every month until the end of the year is the unfortunate consequence of the mess the BMA has now found itself in.
This strike will include A&E and, whilst the NHS managed to cover the previous strikes earlier in the year with consultants and other staff, it is difficult to see how patients won’t come to harm if the strikes go ahead later this month. Thousands of patients will certainly see their operations and outpatient appointments cancelled and delayed. For some, this will result in significant suffering, and delays in diagnosis could mean that their outcomes are worse than they might have been.
It is for these reasons that many junior doctors, senior clinicians, NHS leaders and healthcare commentators are opposing the BMA’s course of action. Jeremy Hunt has said that “people will rightly ask why the BMA, who championed this deal as a good deal for doctors in May, are now saying that it’s such a bad deal that they want to inflict the worst doctors’ strike in history.” It is difficult to argue with this view, which is perhaps why the BMA will now come under pressure from many quarters – in particular, from junior doctors themselves.
In these circumstances, I cannot see how the Government can acquiesce to the BMA’s demands. I was previously uncomfortable about the imposition of the contract on junior doctors, but now believe there is little alternative.
However, we should also be very aware of the significant feelings of mistrust and low morale within the junior doctor community that led to 58 per cent, of those who voted, rejecting the contract. Many will have voted on the terms of new deal, but many others may have done so because of issues unrelated to the contract, but none the less very important to their working lives. These include NHS trusts’ poor management of their roster; the insecurity of training schemes and having to move hospitals on a very frequent basis, often to different regions of the country, and costs associated with studying for and taking their professional qualifications, not to mention the significant pressures and workload that many of them experience during their shifts.
To ensure that the NHS, and most importantly patients, get the best out of junior doctors, we need to look after them better. The most successful businesses and organisations are usually ones that look after their employees well. The NHS’s culture needs to change to address these points, and this is something that local councillors, and MPs, can help with, by scrutinising the NHS trusts in their areas. This is something that I will certainly be doing in my borough, and I hope other readers of this site will do the same.