Out yet again

United front needed

The junior doctors need a united front in their struggle, says Richard Galen

As the third strike by junior doctors takes place across England, with medics withdrawing all non-emergency cover for 48 hours, health secretary Jeremy Hunt is still pressing ahead with plans to unilaterally impose his controversial new contract, which he announced in the wake of the previous industrial action back in February.

He claimed that the decision was made on behalf of “Sir David Dalton … along with other senior NHS leaders” in an attempt to justify his actions, yet by the end of the day in which he made that claim, 14 out of the 20 senior leaders named on the letter sent to the government had denied they were in favour of his contract imposition, scheduled for August.

Amazingly, at the same time Hunt also announced a national review of junior doctor morale, apparently because the negotiation process had uncovered some “deep-seated issues” relating to doctors’ well-being and quality of life. Notably, the review explicitly excludes pay and working terms and conditions from the issues it considers worthy of discussion; instead shifting the focus - and therefore the responsibility - onto relationships between doctors, their hospitals and senior staff.

The announcement of the imposition has forced the doctors’ trade union, the British Medical Association, to consider other options alongside continued strike action. It has launched a judicial review of the new contract, based on the fact that there is no evidence that the government has carried out an ‘equality impact assessment’, as required under the Equality Act 2010. This process is designed to prevent a new policy or project from discriminating against disadvantaged or vulnerable members of society.

This seems an imprudent omission by the Department of Health, given the new contract’s potential impact on women, who take time out of their career in far greater numbers and make up a greater percentage of doctors in less-than-full-time training. Both of these factors would result in a loss of earnings under the new contract, as the old year-on-year pay progression is removed, and the premiums for working one in four weekends or more would very rarely apply.

However, the BMA’s lawyers have warned that despite the planned legal action having a “greater than 50%” chance of succeeding, it would most likely prove a “considerable drain” on the BMA’s resources, and advised that it should only be used as a stopgap measure to provide an opportunity to make further changes to the contract.

In order to defeat the imposition of contracts that not only adversely affect doctor’s working conditions, but also jeopardise the safety of their patients, two linked developments need to occur. First, we need coordinated action with our fellow NHS employees - soon to be also targeted by Hunt’s misguided crusade for a so-called “seven-day NHS”. It was recently announced that public sector workers will get a below-inflation 1% pay rise this year, following a five-year pay freeze, and this should certainly prove sufficient motivation for a united front amongst NHS staff. MPs are, of course, the exception to this, receiving a 1.3% rise just nine months after their previous 10% pay increase, even though they themselves voted for the 1% cap on public sector pay rises until 2019.

This will serve to further damage the NHS, as staff turn to agency working to boost their earnings, thus vastly increasing labour costs, or simply leaving their jobs altogether for better remunerated work elsewhere. Adding to this, the swingeing cuts to social care and mental health provision mean that more strain is placed on hospitals, which have to care for increasing numbers of ‘bed-blockers’ - patients who are medically fit to be discharged, but cannot go home due to a lack of support services in the community.

Other public-sector unions have yet to announce whether they will be balloting for strike action, but even if they do, coordinated action between healthcare workers may prove difficult. NHS workers are extremely reluctant to carry out any action that could have a detrimental impact on the patients who use the service - an effect that would be exacerbated if several groups of employees went on strike at the same time.

However, this kind of action would be about safeguarding the future of public healthcare, and the government’s response following the last set of strikes proves that doctors cannot do this on their own. This brings me to the second prerequisite for a successful campaign against the new contracts: we need solidarity from other workers, whether they work in the public sector or not, to force the department of health to drop its damaging campaign against the NHS.My advice to the BMA? Demand solidarity action from other unions, and call on the Trades Union Congress to initiate and coordinate such action. Such coordinated action would not only aid their fellow workers: it would represent a clear statement in opposition to the destruction of the health service upon which all workers depend. This needs to be linked to a political campaign for an end to austerity measures and for better funding for hospitals and all medical and social care.