In search of a viable strategy

Danger of disillusionment

Junior doctors have been left in the lurch, writes Richard Galen

Many junior doctors were left in shock on September 24 after their union, the British Medical Association, called off an impending series of five-day strikes, intended to be the next step in escalation against imposition of a new “unsafe and unfair” contract by health secretary Jeremy Hunt. Several immediately took to social media to vent their frustration, having heard the news indirectly rather than from their own union.

The decision came from an all-day meeting of the union’s junior doctors committee (JDC) - the first held by the newly elected leadership team, including its new chair, the “militant” (as termed by the red tops) Ellen McCourt. Until now she had been the interim leader following the resignation of Dr Johann Malawana in the wake of the rejection by BMA members of the amended contract negotiated by the leadership.

This all follows the recent cancellation of the first planned strike, originally meant to go ahead in the week beginning September 12. Ostensibly this was done due to patient safety concerns, with the union’s late decision only giving hospitals two weeks to prepare; and pressure from professional bodies, including the General Medical Council, the public body which controls the register of doctors, to postpone or cancel the industrial action due to the impact on patients.

Of course, while it is true that patients do indeed suffer inconvenience and delay when doctors go on strike, that impact was greatly exaggerated in one sense - available scientific research shows no discernible increase in death rates, especially as our action has never affected emergency cover. Concerns about public support also appear unfounded, as, although it had dropped since previous polls in the summer, a narrow majority remained in favour of industrial action, with only 48% voicing overt opposition to the planned strikes.

A much more pertinent reason may be the feedback received following the BMA-led referendum in July, aimed at gauging members’ opinions on further action in opposition to the new contract. Although what exactly was discussed in the JDC meeting has not been revealed by the union, following the decision, the South Thames regional JDC released the results of its own survey of members. This showed 53% stating that they would not be taking part in the next planned strike, with 28% of them citing feeling that this was too long a duration, and a further quarter of respondents voicing concerns about financial difficulties and meeting training requirements. There was a further suggestion in the report that this was among the highest levels of regional support for the planned action.

This is in stark contrast to the levels of support seen with the previous strikes and the 98% ballot in favour of industrial action last year. There are a number of important factors to note, however, including the fact that almost 70% of those same respondents were in favour of shorter-duration strikes.

The low response rate was also an issue, with only around 22% participating in the released survey. This is particularly pertinent, as some surveys were sent with an ironic indication that a lack of response would be taken as unwillingness to take part in further strikes. Finally, with the lack of details regarding the JDC discussions, it is impossible to say whether these trends were representative of the membership as a whole, especially since many members stated that they had not actually received their own survey to complete.

All of this raises significant questions about the course of action chosen by the BMA leadership, when there was a period of almost two months after the rejection of the negotiated contract by members in which no real announcements were made regarding future plans. With the abandonment of what many members regard as a hastily put together and poorly thought out programme of strike action, and the lack of information available about how and why the JDC made its decisions, backlash against the union has been evident across junior doctor forums - “spineless” and “omnishambles” being among the terms aimed at the union’s leaders.

The final straw for many was the announcement on September 27 that, following the abandonment of the strikes, the BMA would be inviting Hunt to an “open symposium” to discuss issues regarding the current standards of care in the NHS. This is a man who has repeatedly refused to openly discuss his “seven-day NHS” plans with junior doctors despite multiple invitations - the announcement was immediately ridiculed on social media, and swiftly followed by many members stating that they would be cancelling their subscription to the BMA - some even posting pictures of their direct debit cancellations.

Disillusioned by the JDC and their handling of the dispute, many medics have voiced opinions in favour of joining other public-sector unions to continue the fight, including the Medical Practitioners Union (part of Unite), which has stated its opposition to the strike cancellation, and had planned to provide £35-a-day strike pay for its members. The argument in favour of Unite is that it has greater expertise in protecting the general interests of public-sector workers, and would help to facilitate coordinated action with other healthworkers.

Other junior doctors had been pinning their remaining hopes on an ongoing legal challenge to the imposition of the contract by the group, Justice for Health, which is independent of the BMA, whose case was heard at the Royal Courts of Justice. However, on September 28 came the announcement that the court had rejected the move to have the new contract overturned. The judge was not persuaded that Hunt had acted outside his powers as secretary of state - although, interestingly, he ruled that Hunt had no right to impose it on local trusts.

So what happens next? In particular, where does all this leave trainees in obstetrics and gynaecology, for whom the new contract imposition is scheduled for October 5, the earliest of the planned implementation dates? They now seem to have very few avenues left to fight it. Some have proposed that we agree to ignore the new contract and continue working to the old rotas instead, but this would require an unlikely level of organisation and solidarity among juniors, given the uncertainty it would create in future salary levels and in meeting new training requirements.

It would also be severely hampered by the many existing ‘rota gaps’ - where there are simply not enough junior doctors employed to fully cover departments at the times required - a massive problem in itself that the new contract does nothing to attempt to remedy. The threat of mass resignation - a further suggested ‘strategy’ - would suffer similar problems, to say the least.

Ultimately, the decision to cancel the forthcoming strikes is a signal to the government that junior doctors can be cowed into submission if put under enough pressure. It also paves the way for further renegotiation of other healthworkers’ contracts, with the imposition of similarly unsatisfactory terms and conditions, including increased unsocial hours for poor remuneration. Consultant doctors are next in line, with nurses, radiologists, physiotherapists and others soon to follow, as laid out in the department of health’s ‘Agenda for Change’ plans.

A move towards solidarity with other public-sector workers is encouraging, but firm plans are needed to take the campaign forward. Unfortunately this is looking increasingly unlikely to come from the BMA. For the sake of all health sector employees, as well as for the future of the NHS, we cannot allow the fight to die with this decision.