The junior doctors’ strike is about the existence and future of the NHS

I’d like to clarify a few points raised in the LDV comments thread related to the Doctors strike and Tim Farron’s remarks about it. First, I will state my potential conflict of interest: I’m a doctor (retired) a life-long member of the BMA (yes, I do still pay my union subscription) and my daughter is also a junior doctor.

The strike is happening because Jeremy Hunt has stated that he will impose a new contract on juniors against their will in August 2016. Negotiations, which have been conducted over the last three years with the BMA, have broken without any agreement and, thus, junior doctors are withdrawing their labour, as a last resort.

There has been a complete breakdown of trust between the profession and the government, which has been simmering for some time. That breakdown stems in part from the imposition of the Health and Social Care Act 2012 on the NHS against the almost unanimous views of doctors and, indeed, most of the healthcare sector. This was not in the Conservative 2010 manifesto, the evidence base for the Act was non-existent, yet doctors have been forced to implement this Act against their better judgement and at great expense in both time and money. This has happened against a backdrop of serious budget cuts within the service, the so-called Nicholson challenge to save £5 billion a year, each year from 2010-2015, which was largely achieved. The service and the staff have been squeezed and squeezed and we are now at a tipping point.

The new government now comes with yet another demand –the so-called 7-day NHS.

We already have a 7 day NHS for emergencies and, contrary to the Tory mantra, it is likely that patients admitted at weekends get more, not less, attention from the doctors on duty because they can focus on emergency admissions rather than ward rounds, outpatient clinics, teaching sessions, routine operating lists and all the other weekday activities.
Consultants are always available 24/7 for advice and to see very sick patients in person as required, it’s in their contract because they have legal responsibility for the patients.

We do not know why mortality seems to be higher in patients admitted at weekends but this pattern is seen in some other countries with advanced healthcare systems. Most countries do not know if this is a problem for them because they do not collect the data. If excess mortality exists, it may be due to specific patient characteristics or different healthcare-seeking behaviour of patients admitted at weekends. More research and analysis is needed.

Mortality may also be worse on Mondays and Fridays, and to a lesser extent on Tuesdays and Thursdays, so perhaps we should be campaigning for a one day NHS and only treat patients on Wednesdays, supposedly the ‘safest’ day to be in hospital – clearly ridiculous. The data are complex, they may even be wrong. The government could fund further research, which would be very useful, maybe compare the blood alcohol or blood sugar levels between patients admitted in the week and at weekends, obesity levels or smoking habits, even compare their incomes. We know poverty kills, there’s plenty of data to support that, even though it’s politically inconvenient, but no evidence that the presence or absence of doctors has any effect on patient outcomes – we are probably not that important.

For many of us what is going on now feels a lot like the 1980s when the Thatcher Tory government tried to crash the NHS by starving it of resources, and came within an ace of succeeding. We would not have an NHS today if Labour had not won the 1997 election and two years later (after sticking to Tory spending cuts for the first two years) started pouring money into a service which was on its knees. The recovery took a decade.

The last strike, in 1975 was in very different times, the NHS itself was not under direct threat, the juniors were not backed by the consultants who had a different agenda. This time we are one profession and stand together. It’s not just about the juniors’ contract, it’s about something much more fundamental, it’s about the existence and future of the NHS.

Practical advice to the person whose child has diabetes; I expect your child is seen regularly by both a GP and a paediatrician, both are trained and expert in treating diabetes. If you consider your child needs to be seen by another specialist you can simply request your GP to make a referral if there is a medical need. It will not cost you a penny – that’s the beauty of the NHS, access for all according to need. It’s definitely fit for purpose.

* Catherine Royce was previously PPC for Uxbridge (2001) and Romsey (2017) as well as being on the Liberal Democrat Women executive. She is currently a member of the Federal Policy Committee and the Liberal International British Group Executive.

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36 Comments

  • Eddie Sammon 14th Jan '16 - 2:02pm

    I disagree quite strongly. I want better conditions for NHS staff, but the strike takes this out on the patients. I think it is a disgrace that an emergency services strike is even on the table. I would understand if a massive cut in pay and conditions was threatened, but it doesn’t look like it is and negotiations haven’t even finished. We also have a big budget deficit.

    I don’t even understand the complaint that Jeremy Hunt is threatening to “impose” a contract – we can’t have all public sector workers writing their own contracts. Contracts are imposed in the private sector all the time.

    NHS workers and the public sector need to campaign for changes electorally and not start threatening people’s lives over a cut in conditions during a time of austerity.

  • Thank you for that, Catherine, and thank you for all you and your colleagues have done over the years. I completely agree with your diagnosis of the state of things. It ought to give pause for thought to all those who think market economics is all that life is about.

    As the recipient of a transplant I know I owe my life to the skill and expertise of your colleagues – thankfully in Edinburgh and well out of reach of Mr Jeremy Hunt.

  • As a patient I fully support the action that the Junior doctors are taking, I remember the deaths that used to feature in the news before the working time directive that were caused by tired and overworked doctors and I do not wish to see us going back to a similar structure.

    Patients are not cars to be tinkered with and thrown out at the other end instead they are people and as such deserve to be treated and cared for by doctors and nurses who are not on the verge of sufferring the effects of sleep deprivation or so rushed that they are trying to treat many patients at the same time.

  • A consultant of my acquaintance says it’s about pay.

  • Eddie Sammon 14th Jan '16 - 2:23pm

    I see the emergency services strike is only for junior doctors, but still, junior doctors can be quite senior.

    All liberals need to be weary of giving junior doctors unwavering support. We are talking about people’s lives and well-being here.

  • I agree with Eddie on the actual strike , not the imposition of the contract . The strike is wrong for the reasons Eddie states , and another , the doctors have not marched and leafleted or explained in their own time , enough to justify it , they are a powerful and popular group , they owe us better for the esteem they are held in ! Movements need to put themselves in the public eye with more than headlines , as other threads on here have said , and I on them , the case is not even well explained . Of course the government have been found to be making a mess of this , I think they have approached this , as with the previous reforms , in a bull dozer way inappropriate , but as to Catherine s view that this is about the survival of the NHS , that is very emotive about something that is not about cuts to the service but is by design , if not , in effect , is meant to be for the benefit of patients having a wider service ! Sorry Catherine , seeing the NHS from a patient perspective with a partner who has needed t ,over many years , and often not been given the help she has needed ,your above comments are a little complacent .Yes, fit for purpose , yet in no way good enough .

  • ………………they owe us better for the esteem they are held in…….

    Worthy of “Conservative Home” or “Daily Mail”….Such remarks and attitudes seem to apply equally to Nurses and Teachers…’Esteem’, in the eyes of this government seems to equate to , “The more you give, the less you will receive”…

  • The new contract is cost neutral,so the 11% pay rise will actually be a large pay cut for the specialities who work the longest hours.if there is no more money how can you increase services with no more doctors…they will have to work even more hours.Jeremy Hunt wants to privatise..that’s the reason behind this..it makes no sense

  • Just a few brief points:

    The whole argument about 7 day services is a smokescreen from the DoH, as is the argument this is about saving the NHS from the BMA.

    This article by the govts new chief negotiator may help you all understand junior doctors can and do already work a lot of weekends.

    http://www.independent.co.uk/life-style/health-and-families/health-news/jeremy-hunt-criticised-over-junior-doctor-fiasco-by-his-own-chief-negotiator-a6812521.html

    The contract detail is complex and trying to apply to all specialties from a+e to pathology. The basic pay is artificially low in the current contract as OOH payments were used to force trusts to reduce contracted hours (as too expensive). So the move to higher basic which results in less pay variation over rotations is a good idea BUT that means the Drs doing the most OOH lose out as currently they’re paid a lot more than those that don’t.

    Secondly the complete lack of trust between employer and employee means that the ‘safeguards’ in the current contract ensure that if Drs are working over their contracted hours (usually due to understaffing) they are compensated for this. That’s lost in the new contract. Just to be absolutely clear doctors have no say in their rotas and cannot choose to do overtime so the incentive argument is daft.

    Finally regarding the strike Doctors already tried marching and leafleting in every city before calling a strike, clearly some of you missed it.

    I agree the whole thing has been a farce from start to finish with fault on both sides but let’s be clear this isn’t about weekend working and the proposed contract as significant flaws (mainly around rest requirements) which could be fixed with a bit of movement from the DoH but for whatever reason they won’t move on this(so far).

  • The BMA have done very , very well in recent years. It could be argued that industrial relations have become a bit unbalanced as a result. I have to say the governments proposals do not appear to be that unreasonable. Why not test them on a 6 month trial , subject to a totally independent review.
    I sometimes wonder if Health service staff tend to live in a world where they actually think they are hard done by, bit like a goldfish bowl sydrome, whereas in fact the opposite is probably the case.

  • paul barker 14th Jan '16 - 7:45pm

    This sounds to me like the sort of Left paranoia that we see on Labour sites. If we beleived The Left then the NHS has already been privatised at least half a dozen times. This is a classic dispute about staff opposing change or holding out for a better price for their compliance. Political Parties should be neutral about such contests.

  • Paul barker 14th Jan ’16 – 7:45pm…………This sounds to me like the sort of Left paranoia that we see on Labour sites…………… Political Parties should be neutral about such contests………

    From that ‘Leftie Rag’ the ‘Daily Mail….”‘A government spinner tried to stop TV questions about where Jeremy Hunt was ahead of the first junior doctor strike in 40 years”..
    It appears that your comment about ‘neutrality’ only applies to ‘lefties’…

  • Expats you are keen to label my views with crass newspaper influenced references unjustified in the case of my comments . So what if I , to you , resemble Conservative Home , I do not call other more left wing views worthy of the Morning Star ! I particularly laugh at calling my heartfelt words above ,akin to the Daily Mail , a paper I dislike , and a silly description , lazy and irrelevent to the thrust of what those of us on here who do not agree with the strike , are trying to convey !Doctors do owe us more in the view of many of us , they owe us the respect they get in abundace , not strike action!

  • Lorenzo 14th Jan ’16 – 9:28pm………..Doctors do owe us more in the view of many of us , they owe us the respect they get in abundace , not strike action!….

    One strike in 40 years would seem ( if not to your ‘many’), at least to me, that WE owe THEM respect in abundance….

  • Dave Orbison 15th Jan '16 - 5:18am

    Catherine thanks for an open and full perspective on your views on the NHS and the strike. I fully support what you say. I’m only sorry that some on here simply cannot accept what you say. But at least Tim Farron offered support to his credit.

  • Dave Orbison 15th Jan '16 - 4:45pm

    Catherine and Simon – For the avoidance of any doubt, since Simon has questioned my sincerity, I can confirm that I genuinely meant every word of what I said in respect of thanking both Catherine and Tim Farron for their support and comments with respect to the junior doctors’ dispute.

  • Catherine Royce 16th Jan '16 - 12:07am

    OK Simon
    -the Tories have previous ‘form’ on this, Thatcher 1980s
    -Lansley ‘reforms’ clearly orchestrated in opposition but not stated in manifesto, then presented 3 months after the election in 2010
    -mandatory competitive tendering resulting in £12 billion of contracts to private sector by 2012, I predict this will be £30billion by 2020
    -Huntindon/Circle debacle (privatisation flagship) completely airbrushed out of existence, how many column inches have you read in the papers on that?
    – PFIs which are bankrupting Trusts/closing hospitals eg Lewisham, how many column inches?
    -almost weekly drip feeding of negative NHS stories to the press, to undermine public confidence
    -pick a fight with the doctors to undermine public trust in them too
    shall I go on?
    Note the NHS treats one million patients every 36hours, every week of the year.

  • Catherine Royce 16th Jan '16 - 12:20am

    Frankly we should be calling for Hunt’s resignation, for his incompetence in handling the negotiations, resulting in many thousands of outpatients appointments and elective operations being cancelled. His total lack of understanding of how the NHS works is truly stunning. Interesting that a new frontman has been announced to carry the negotiations forward, in my view an admission of Hunt’s inability.

  • Dave Orbison 16th Jan '16 - 6:17am

    Catherine Royce – thanks for responding to Simon’s demand for ‘evidence’. When Simon expresses his disappointment as to your alleged failure to explain your views to ‘the rest of us’, by ‘rest of us’ he means himself.

    Personally, I think you have made your points well and that you responded appropriately with further information when challenged by Simon. He is perfectly entitled to express his ‘disappointment’ for himself but he does not speak for anyone other than himself. The same of course applies to me.

  • @Simon Shaw
    “In what way is the NHS currently ‘under direct threat’?”

    Instead of hassling Catherine, whose article and answers seem very clear to me, perhaps you should try directing that question at your local Lib Dem colleague John Pugh MP, who certainly thinks the NHS is currently under threat judging by his sponsorship (alongside Jeremy Corbyn) of Carline Lucas’ NHS Reinstatement Bill :-

    http://www.nhsbill2015.org/john-pugh-mp-backs-the-nhs-reinstatement-bill/

    The Bill’s website has the opening line: “The NHS in England is being dismantled…”

  • Dave Orbison 16th Jan '16 - 3:20pm

    @Simon “@Dave Orbison I think I am correct in saying that you are not a Lib Dem supporter. Accordingly you perhaps wouldn’t understand this Lib Dem supporter’s disappointment that another Lib Dem with unusual exertise (sic) in an area has failed to explain why she has reached the conclusions she has.”

    You are right I do not understand your disappointment as a LibDem with Catherine’s views on the threats to the NHS. Although this is simply because I do not understand how you cannot accept that the NHS is under threat in the first place. That said I’m guessing that the views expressed by Catherine, are shared by many LibDems too, but I’m not sure if that makes you feel any better.
    As for not being able to understand your own disappoint as I am not a LibDem supporter where should I start? Prior to, and in the General Election of 2010, I was very much a LibDem supporter. This support ended with the decision to go into Coalition. My disappointment then as a LibDem supporter, a disappointment shared by many thousands of LibDem members let alone LibDem supporters, was simply dismissed by those who were gung-ho in favour of Coalition.

    So I’d say, contrary to your assumption, I know exactly what it’s like to have your disappointment as a LibDem supporter ignored.

  • -the Tories have previous ‘form’ on this, Thatcher 1980s Catherine Royce (16th Jan ’16 – 12:07am)

    As do the BMA, when have the BMA ever accepted a proposal from government that didn’t give it’s members a deal better than what they were already getting?

    Whilst the BMA can be said to be doing its job for it’s members, we should remember they are not an impartial player and source of information; they are in fact a player in this and have form for being a highly skilled negotiator. So on the twin issue of OOH and doctors having no say in their rostering for example, I find it telling that the BMA aren’t putting into the public domain any substantive proposals of their own, which suggests that they aren’t really interested in resolving this issue – because simply training and recruiting more doctors isn’t going to give doctors any more say in their rostering…

  • Richard Underhill 16th Jan '16 - 5:40pm

    Catherine Royce | Thu 14th January 2016 – 1:30 pm The Health Service is devolved, so there is no strike in Scotland, Wales or Northern Ireland, yet.
    We need a definition of ‘Junior Doctors’. How about ‘doctors who have not, yet, become consultants’. If this is broadly right promotion to consultant is likely to depend partly on the availability of vacancies at consultant level.
    Some of the things junior doctors say on TV sound extreme: for instance ‘I am an eye surgeon and have just finished a 100-hour shift. is that what you want?’ Well, no, doctors are human beings and get tired, but 100 hours is a very large number. Could it have included periods on call when the doctor was actually asleep?

  • Eddie Sammon 16th Jan '16 - 5:43pm

    In the last election the Conservatives and Lib Dems were both promising more money for the NHS than Labour, so let’s not get into conspiracy theories how the Conservatives want the destruction of the NHS.

    There seems to be what I consider healthy opposition to simply cheerleading NHS strikes on here, but the argument needs to be won in the wider world too. Most of the public seem to back the strikes, but I think the polls on it have been misleading. One poll had 44% support for emergency services strikes by junior doctors as long as “emergency care would be done by someone else”, but who are the thousands of senior doctors to undertake the workload of all the striking junior ones? The reality is an emergency services strike will negatively affect emergency care. The NHS arguably doesn’t have enough staff as it is even when there are none on strike.

    I thank Catherine Royce for some of the specialist information she has provided, but I don’t think the case has been made and ideological problems with an increase in private sector contracts in no way justifies removing emergency services or even non emergency services and I think more debate about the terms and conditions of the doctors contracts need to be made. At the moment we have respected people saying it isn’t about overwork and others saying it is about overwork and therefore safety, but it doesn’t seem to be entirely the case. It seems to me to be more about unsociable hours rather than more hours. But I’m open for pursuasion on that one.

  • Eddie Sammon 16th Jan ’16 – 5:43pm……………………………..In the last election the Conservatives and Lib Dems were both promising more money for the NHS than Labour, so let’s not get into conspiracy theories how the Conservatives want the destruction of the NHS……………….

    Well that’s all right then because we know that such ‘promises’ are always kept…..
    However, since 2015 manifesto promises on the social care cap, rail electrification, tax free childcare, etc. have all been broken; why should we believe NHS pledges should be treated with less suspicion?…

    BTW…. prior to 2010, the Tories promised “no top-down re-organisation of the NHS”…After 2010 It turned out that they had been working to that end for over 6 years…

  • @Simon Shaw
    “If you are saying Catherine’s article and answers are very clear to you, I presume you can answer my basic questions just as easily as Dave Orbison ought to be able to.”

    There’s no need because Catherine has already done so. I suggested that if you were unhappy with her answers, perhaps you’d be more satisfied with John Pugh’s explanations. I should think you’d be happier with his answers than mine! Have you asked him why he thinks the NHS is under threat?

  • Richard Underhill 19th Jan '16 - 2:48pm

    The good news is that the strikes have been called off. That means that the doctors and the government are talking to each other, instead of the previous dialogue of the deaf. If the talks fail the strikes might be on again, but it is a pity that this has happened. Frustration has been vented, but the losers include the doctors who have lost a day’s pay, the patients who have had their operations postponed and the Health Service trusts.
    The BBC tv programme Question Time balances its audience in many ways, but was nearly overwhelmed by doctors. They may well have included people who voted Conservative. Labour or Liberal Democrat in May 2015, but if they all came from the medical profession the programme would not have been balanced. As David Dimbleby said there were other questions to debate, so he did not want to spend the whole programme on one subject.
    The BBC radio programme Any Questions with Jonathon Dimbleby is not balanced in this way.
    As a patient I am not in a position to threaten anybody, even complaints about local car parking charges in England get ignored, but the BMA needs to accept that after a one day protest to attract attention they are at risk of endangering the public support on which they depend.
    The government’s manifesto covers a variety of subjects, so maybe a more precise democratic method would be a Swiss-style referendum, but please not at the moment, we have too many already.

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