Be under no illusion – the BMA screwed this up.

Prior to previous set of strikes, there was an emphasis on patient safety. The contract was unsafe, argued doctors, and Jeremy Hunt’s plans were unrealistic. Chair of the Junior Doctors’ Committee (JDC), Johann Malawanna and a number of other doctors in the BMA did a superb job of appearing reasonable, measured and yet passionate. Junior doctors looked like professionals being harried and hampered by government from trying to help patients.

At relatively short notice, a ballot with a turnout of 72% gained 98% support for strikes. This is unheard of. The strikes were announced well in advanced, were each two days long and went ahead safely without incident. They had the support of the vast majority of consultants, other healthcare professionals and royal colleges. The BMA had shed its reputation for incompetence.

After further negotiations, Hunt came back to the table. The new contract with further safeguards and better conditions was put to the membership but juniors doctors rejected the contract 58% to 42%. Not EU referendum levels of close but still supported by a large minority.

Johann Malawanna stepped down, rightly stating his position was untenable given a contract he supported was rejected. Dr Ellen McCourt stepped up. Rumours suggested her mother’s history as nurse involved in unions meant she would be more radical. Jeremy Hunt announced he would impose the contract.

Out of seemingly nowhere, the BMA council on a split decision supported further strike action in protest against imposition of a contract to which over 40% of junior doctors had agreed. Monthly 5 day strikes with 8-5 full walkouts were proposed without ballot or discussion with the junior doctors who were actually doing the striking. The bizarre position that having voted for the previous strikes apparently gave the BMA a mandate for industrial action of greater severity with a different justification. They were wrong.

Criticisms from colleges, trusts and patient associations rolled in. Junior doctors (including me) themselves expressed concern that 5 days was too long to safely strike. Then on Saturday evening via BBC News and Twitter, the BMA announced the strikes had been called off. Later in the evening, members received texts when they should have heard about it before anybody.

The BMA’s mandate for the strike was shaky at best. Junior doctors oppose contract imposition (even those who voted for the contract) but should have been balloted over further strikes. The increased severity of strikes made little sense. The consultation clearly should have happened before strikes were considered, not after.

The BMA now looks weak, directionless and unsupported by its members. Ultimately, I voted for the contract but setting precedent where government imposes contracts when doctors become unruly or express concern is bad one. I envision a period of panicked dithering whilst government imposes the contract.

Good to see the BMA reaffirming its traditional relationship with doctors.

* Rajin Chowdhury is a junior doctor specialising in anaesthetics and critical care. He has been selected as Sheffield South East parliamentary candidate

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22 Comments

  • Rajin & Mark Wright

    I think you are being overly positive about Malawanna, there was an issue long before the strikes in the way the BMA engaged the media. If we start from the assumption that the contract seemed like a poorly thought through bodge job (I haven’t looked at it in detail but that is how it appears). My updates from the Guardian were churning stuff out for months getting very hypobolic very quickly. I didn’t see almost anything from other media outlets other than the occasional BBC mention (probably just picking up from the Guardian).

    Given how bad the plan looked it appeared that the BMA were doing a terrible job of getting other media interested in the issue. I’m sure there was the same stuff sent to all and the Guardian took more interest, the problem was that they were always going too. They should have put more effort in to the other media outlets interested, it looked like they were sticking to their comfort zone, as if they were still negotiating with a Labour government not a Tory one.

  • Thanks, useful. The impression this outsider comes away with is – Hunt messed up, big time. His initial intransigence and deviousness rebounded on him by driving the doctors into the militant camp, and he eventually had to make large concessions. At that point it would have been big of the doctors to declare it a reasonable settlement – but they were just too wound up by Hunt’s behaviour to do that.

    Textbook example of how not to carry on an industrial dispute, Mr Hunt. Presumably Theresa left you in post in order that you should carry the can. Same for the Brexiteers. It’s going to be government by blame culture!

  • Eddie Sammon 27th Sep '16 - 12:01pm

    I’m pleased you voted for the contract but I don’t understand complaints about the contract being “imposed”. If contracts shouldn’t be imposed then what is the alternative? Doctors writing their own contracts?

    I’ve been against the doctors strikes because I think political change should come via the ballot box and I’ve never agreed with the distinction between emergency care and non-emergency care. Routine conditions left untreated can end up as emergencies. Regards

  • Phil Boothroyd 27th Sep '16 - 12:45pm

    Eddie – the alternative to imposing a contract is negotiating a new one. And that doesn’t mean doing a Hunt and saying you are happy to negotiate, but only if the vast majority of proposed changes are accepted in advance.

    Call me crazy if you like, but I personally take the view that when a party puts something into the manifesto on which they are then elected, that puts the onus on them to have a credible plan for implementing it. It doesn’t nor should it put an onus on whichever sector of the workforce it relates to to jump to it – without consideration of the consequences. If the people who work in that sector (and understand how it actually works) recognise that there is a significant mid to long term risk to the public and indeed themselves they are absolutely right to fight it.

    My wife has left medicine already, other friends of ours have also left or gone elsewhere in the world to continue their careers. While there is a degree of regional variability, it is no lie to say that in many places the NHS really is at breaking point. Imposing the junior doctors contract, removing grants for training nurses, and now starting to pick a fight with consultants – are not a good cocktail for success when you need to get more people in (even without ‘7 day NHS’ ambitions) just to deal with an increasing and aging population. While I completely agree with the overview above, I suspect there may come a time pretty soon when everyone wishes that the BMA had fought a bit harder.

  • In general I take a very hard line that Political Parties should be neutral on Industrial disputes. There are very rare exceptions where there is some point of principle involved, this clearly wasnt one of those.
    Looking at the dispute simply as a question of who won, this was a classic case where a dull, official campaign was taken over by young enthusiasts who dragged The Union behind them. Such cases nearly always end with the Workers getting a worse deal than they would have got sticking with the Union leadership, experience trumps energy.

  • Proposing a series of 5 day strikes when so much work had been done to ensure, and convince the public of the case, that previous strikes would not harm those needing treatment on the day was clearly a mistake.

    There could also be questions raised about the “not safe, not fair” nature of the contract when so many were critical of making it more difficult for Dr’s to moonlight on their days off – if it’s so clearly not safe then why should any of you be in a position to work more for more money.

    However, imposition of contracts based on, deliberately or not, poor understanding of evidence and a position which only allowed for negotiation on one single point is completely wrong. BMA and junior Dr’s are still in credit whereas Hunt’s plan is not.

  • Lorenzo Cherin 27th Sep '16 - 1:19pm

    Rajin

    I , along with our colleague Paul Barker above, usually believe that political parties should be uninvolved in the yay or nay of strikes, but there are exceptions.Many good party activists were not keen on this action for whatever reason the junior doctors put.

    I have to say I have been against the strike from the beginning. On principle and in practice I do not believe emergency service practitioners should strike , not ever.Again,in a rare situation there are exceptions, safety , as you mention, an important one.

    Many so called routine operations and appointments were cancelled because of the strikes. Some of those were very distressing for patients. I admire Norman Lamb more than many politicians , but I want our health team to be even more admired by the patients and potential patients than by the health professionals or the party. We need both on board , as a party and as a society.

    You are to be supported in your excellent article and approach. The decisions cannot be easy. You should more widely promote the views you have in the way you do here. Our health service needs you and those like you, as do our party and our country , caught as we are between a rock , and a hard place, Hunt and the BMA strikers!

  • Little Jackie Paper 27th Sep '16 - 1:46pm

    OK – The junior doctors are right. This contract is basically taking a very thinly stretched resource and stretching it ever thinner for outcomes that are unclear at best.

    BUT

    As far as I can understand the doctors’ stance on this they do not object per se to a full-blown 7-day NHS, just the terms and conditions attached. Now as a trade union that’s reasonable but as a public policy stance it seems to me to be ducking the tough questions just as much as Hunt does.

    Do the JDs feel that there needs to be a full-blown 7-day NHS. If so how is that funded? Debt/deficits or more fiscal consolidation. If the latter then what’s cut? Do the JDs feel that the bits of the NHS that are 7-day already could be better supported? Would the JDs be willing to see some cuts to the NHS to cover that support? Are there local differences? (my time in the NHS showed me that there’s a serious body of opinion that there is scope for local determination). We could even ask about cutting the NHS per se.

    These are, of course, not nice discussions. But ultimately the NHS has had a ring-fence (albeit with efficiency savings) and that has come at the expense of deeper cuts elsewhere. This dispute is as much symptom as cause. The cause is that we are finding the limits of the NHS we can afford.

  • Eddie Sammon 27th Sep '16 - 2:30pm

    I agree Adrian but doctors strikes are life and death, unlike teachers strikes etc. Of course I support junior doctors but I don’t support telling us the strikes are about safety when even the BMA admitted the only real redline was Saturday pay.

    The NHS and the government are under huge financial pressure and reading the new contract I never saw the justification for taking this dispute out on patients.

  • Re: “The BMA screwed this up”

    I found it a little irritating the article failed to distinguish between the BMA and the BMA’s Junior Doctors’ Committee (JDC) who have been responsible for the negotiation of the junior doctor’s new contract, ballot’s and industrial action. Even though I suspect the BMA has to shoulder some of the blame for the way it has permitted the JDC to discharge its duties and the damage it has done to the BMA’s reputation; just as the BMA’s Consultants Committee negotiates revisions to the Consultants contract to support a seven-day hospital care service…

    But yes the JDC did mess this one up and continue to mess it up by confusing two very different challenges, namely: JD contracts and NHS funding.

    With respect to NHS funding the BMA has this to say:
    “The BMA has been clear in their support for more seven-day hospital services, with a focus on urgent and emergency care. Despite the publication of the DDRB (report), and the government’s response, we are still no closer to finding out how they will pay for more weekend care or how they will ensure there isn’t a reduction in mid-week services.”
    [ https://www.bma.org.uk/collective-voice/influence/key-negotiations/terms-and-conditions/junior-and-consultant-contract-home/ddrb-key-point-summary ]
    As Little Jackie Paper indicates there is much to be discussed and clarified, particularly as the government hasn’t been forthcoming on the details, other than the new JD contract…

    My understanding is that the new contract includes, among other related measures: enhanced basic pay, stricter restrictions on total hours, numbers of weekends worked etc. and so delivered against a key JD demand for shorter hours. So it is clear that the government isn’t intending to make the JD’s work for longer hours and for less pay in the 7-day NHS. In fact, they seem to be wanting to create opportunities for the recruitment of more locums and full-time JD’s!

    Which brings us to the JDC and the strikes, the only reasonable conclusion I can reach is that they have deliberately confused the issues is because firstly people in the JDC have an agenda (much as Arthur Scargill had an agenda) and secondly the cold light of day has hit them that the new contract with its restrictions will deliver a lower overall level of pay than they currently get (from working excessive hours) even though the hours will be renumerated at a higher rate…

  • Could someone explain to me why the strike was about patient safety rather than juniour doctors terms and conditions? I’m just not getting it. I proclaim a bias. I worked through the bad old days of 110 hour weekends and never went on strike. Get the violins out. Seriously though, I just don’t get it.

  • Strikes are important…They are the final and often the only action that allows the employed to have a voice against employer…..
    Those demanding that some sectors should not be permitted to strike might note how ‘essential’ workers were London Underground and Rail employees….The Tory attempts to curtail (and even remove) employees rights do not need LibDem assistance…

  • Meg Thomas questions :
    “Seriously though, I just don’t get it.”?

    If someone works what is normally a full time job, but decides (i.e. chooses), to work part time, they would expect to have a lower wage or salary proportionate with the hours they choose to work.
    My understanding from conversations I’ve had with various NHS employees, is that *part time* junior doctors had created a working practice whereby they can garner a pretty much, full time salary, by incorporating the very lucrative weekend work, plus one weekday. Now that weekend work is not going to be the well-paid ‘salary filler’ it once was,.. those junior doctors who prefer part time have a choice. They either,..continue working their chosen part time hours, but accept that their salary will be somewhat reduced (even with the 10% overall salary increase),.. or to get their salary back to where it previously was, they must do one or maybe two extra days. In other words, it’s *part time* junior doctors who are angry that their part time hours will from now on,.. only bring them part time level salaries, (which is frankly, the norm for everyone else !).
    I suspect if we dig deep, we’ll find that the JD’s waving placards, are disgruntled part timers.

  • Putting on my old HR specs, it seems to me that the NHS wants more hours and flexibility from the workforce without increasing its overall pay bill. Normal (although arguably unscrupulous) organisations can impose this, but at the cost of reduced morale and increased labour turnover.

    But the NHS is not a normal organisation. It enjoys a unique advantage: the monopoly of employment of junior doctors. Students hoping to become doctors know that unlike other graduates, they will have no choice as to their future employer. They have to trust it will respect their years of hard work and commitment; and that future changes and service improvements will be achieved in a spirit of partnership.

    In imposing his new terms and conditions of employment on what is effectively a trapped workforce, Jeremy Hunt has decided instead to exploit the NHS’ unique monopoly. This amounts to treating the contract as a form of indenture bordering on serfdom and I wonder at the legality of such an approach. At the very least, the BMA should consider advising junior doctors, upon signing the new contract, to add “signed under duress”. This may help the signatory if a court case were to arise following a contractual dispute.

    A further thought is that the Health Secretary may actually be banking on labour turnover increasing. I am told that discussions amongst junior doctors are rife about opportunities in Australia, NZ, Canada and elsewhere. They all seem to know ex-colleagues who have already moved. In the meantime, it is interesting that most of the increase in the number of doctors over the last decade has been sourced from abroad. Given that, according to the OECD, Britain still has fewer doctors per head of population than almost every other European state; that health needs are projected to continue to rise; and that the new contract will encourage locally trained doctors to leave; the NHS will have no option but substantially to increase the trend of recruiting doctors principally from countries with worse employment conditions.

    So is that Jeremy Hunt’s game plan? Reduce the number of home-grown doctors and replace them from abroad?

  • Phil Boothroyd 28th Sep '16 - 1:25pm

    J Dunn – all the people I know (and they are few and far between) that do something like that are locums – they aren’t on the imposed contracts and so it is a separate issue. They are effectively self employed and come in to cover shifts that the hospital is unable to fill with their permanent staff. Locums can be a lot more expensive, in part because they aren’t on a standard contract and don’t get all the usual benefits of a permanent contract (uncertainty income, often step in at short notice, may need to travel a lot, no sick pay, plus they often need to earn a lot just to break even due to their insurance premiums, and so on). They also (as I understand it, may be wrong here) don’t get training and can’t progress to consultant/gp status. Add to that they are in a market where the demand significantly outstrips supply, and cost is only going to go one way – hence they can earn a lot.

  • Phil Boothroyd

    I think the situation you point out is probably correct. I’m not blaming anyone here, for their desire to optimise their pay against their skills. It’s just human nature after all. Another method is being used by boomer age professionals such as State Registered Nurses. Retire with your NHS pension at age 56 (ish), then return via agency work,.. plus you can often choose your own part time hours and the rate of pay is very favourable, and being semi retired with a pension coming in you’re not too bothered about such things as sick pay, holiday entitlement etc.? In theory, (I believe), once you take your NHS pension, you are not supposed to work for the NHS again,… but it doesn’t stop you working agency for a private company who, in turn, is supplying a contracted service to the NHS.?
    I guess the bottom line, is that if we need skills, we have to pay for those skills, but we’re finding that with an aging population, we’re shovelling more and more money into the NHS but without a corresponding output in health care.

    Solutions..? We often worry about Artificial Intelligence and robotics, taking peoples jobs, but in this instance (NHS), I think money put into the development of AI in diagnostics and patient health management would be a godsend, and ultimately, money well spent.?

  • Putting on my old HR specs, it seems to me that the NHS wants more hours and flexibility from the workforce without increasing its overall pay bill.

    A viewpoint not supported by either the text of the disputed contract or the grievances of the JD’s. The new contract tries to enforce shorter working hours on JD’s, which given the government is keen on a “7-day NHS” would seem to imply they are creating an opportunity for more JD’s; whether these are UK graduates and residents or from overseas is another question.

  • Helpful discussion thanks
    Can’t help thinking about Hippocrates here

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