07.04.2016
Harmful change is intolerable
Joint action is the way forward, says Richard Galen - and so is affiliation to the TUC
Last week the department of health finally released its ‘equality analysis’ of the proposed new junior doctors’ contract1 - and it contained plenty to fuel the outrage felt by striking medics on the picket lines this week during the fourth round of our industrial action.
The most inflammatory statement was this: “… any indirect adverse effect [of the contract] on women is a proportionate means of achieving a legitimate aim”. In other words, a blatant admission (even though it was followed by a swift denial) of discrimination in a contract that is supposed to “advance equality”. This was specifically noted by Jim Campbell, director of the World Health Organisation’s ‘Health Workforce’, who called the contract “regressive”, stating that it contradicts the stance of the UN commission on the status of women.
The UN body also notes the impact on single parents, who would have a higher burden of childcare costs as a result of the increased numbers of unsocial hours that the new contract would oblige them to work. But this is countered by the ‘equality analysis’ with the bizarre statement that working evenings and weekends can in one sense be considered a benefit - after all, informal and unpaid childcare may be easier to arrange outside normal hours. Another example of how out of touch with reality the authors are.
As expected, the true aim of the contract shines clear in its objectives section: “to enable employers to roster doctors … more affordably to support the delivery of a seven-day NHS” (my emphasis). It is important to note that the standards of the “seven-day NHS” - as set out in the findings of the Seven days a week forum2 - explicitly acknowledge the multifactorial nature of the so-called ‘weekend problem’. Lack of availability of social care, access to senior (ie, consultant) review, and inconsistent diagnostic and scientific services (such as labs and medical imaging) are just a few of those mentioned, yet none of these will be extended if the new contract is implemented. This is yet more evidence that improving patient care is not the motivation underlying the ‘action plan’ of health secretary Jeremy Hunt.
However, it has to be said that all of these points are mere confirmation of what was already suspected by junior doctors and their supporters. But the question still remains: what is the best way to combat the contract imposition and produce a better deal for both doctors and patients?
The judicial review launched by the doctors’ union, the British Medical Association, aims to challenge the legality of the new contract’s implementation, claiming that the government has failed to follow ‘due process’. This is currently underway and will possibly be bolstered by the findings of the equality analysis. A second legal challenge has also been launched by the NHS staff campaign group, #JustHealth,3 which has managed to raise over £120,000 through crowd-funding for its action. They aim to show that the government has no legal power to impose the new contract and that the necessary consultations with relevant parties have not taken place.
Ultimately, though, these challenges may only serve to delay rather than derail the department of health’s scheme, and, like the ongoing series of strikes, can hardly be relied on as the means of defeating the contract imposition. At best they should be viewed as part of a strategy based first and foremost on solidarity from other unions and other groups of workers. Such solidarity will surely be essential, as unfortunately the effect of our own action is felt mainly by those we are seeking to protect - our patients - not the government and NHS management. This will particularly be the case if the April 26 strike goes ahead, as planned, without emergency cover.
However, there are some small signs that such solidarity could yet be delivered. For example, at last month’s National Union of Teachers conference in Brighton, a vote was carried in favour of a strike ballot in the summer term, in protest at the department for education’s plans to force every school in England to become an academy. The motion also called for the NUT to join forces with the other teaching unions for collaborative action, including combined strikes.
This presents the BMA with both a model for progress as well as an opportunity. Following a letter of solidarity and support from the junior doctors committee of the BMA, the outgoing general secretary of the NUT, Christine Blower, has already stated that the union’s intention is to coordinate industrial action with junior doctors - the importance and benefits of such an opportunity cannot be overstated. Likewise, the BMA needs to open more lines of communication to other public-sector unions - especially those representing NHS staff, such as Unison and the Royal College of Nursing.
The BMA should also take the opportunity to strongly consider affiliating to the Trades Union Congress. This would not only provide more options for collaboration between NHS staff (the TUC affiliates include the unions for physiotherapists, radiographers, midwives and psychologists), but would also give a stronger public voice through association with non-medical workers as well. Displays of solidarity between workers both in and outside of the health service are what is truly needed to get the message across to the government: the imposition of misguided and harmful change will not be tolerated.
Notes
1. www.gov.uk/government/publications/junior-doctors-contract-equality-analysis-and-family-test.
2. www.england.nhs.uk/wp-content/uploads/2013/12/forum-summary-report.pdf.
3. https://twitter.com/justhealth2016.