Unlike previous occasions, this strike includes emergency services in hospitals across the UK. It is the BMA’s right to call this action, as a trade union representing those who work tirelessly to keep us healthy. The strike nevertheless rejects the fundamental principle that doctors are there to care for patients.
Negotiations between the Government and the BMA led to agreement over around 90 per cent of the contract, leaving only Saturday pay. Unfortunately, negotiations broke down in 2014 and the Government saw no alternative but to impose the new contract on junior doctors without agreement on that issue.
The Government’s position was laid out by the Secretary of State for Health:
While I understand that this process has generated considerable dismay amongst junior doctors, I believe that the new contract we are introducing, shaped by Sir David Dalton, and with over 90% of the measures agreed by the BMA through negotiation, is one that in time can command the confidence of both the workforce and their employers. I do believe, however, that the process of negotiation has uncovered some wider and more deep-seated issues relating to junior doctors’ morale, wellbeing and quality of life that need to be addressed. These issues include inflexibility around leave; lack of notice about placements that can be a long way from home; separation from spouses and families; and sometimes inadequate support from employers, professional bodies and senior clinicians. I have therefore asked Professor Dame Sue Bailey, president of the Academy of Medical Royal Colleges, alongside other senior clinicians, to lead a review into measures outside the contract that can be taken to improve the morale of the junior doctor workforce. Further details of this review will be set out soon. No Government or Health Secretary could responsibly ignore the evidence that hospital mortality rates are higher at the weekend or the overwhelming consensus that the standard of weekend services is too low, with insufficient senior clinical decision makers. The lessons of Mid Staffs, Morecambe Bay and Basildon in the last decade are that patients suffer when Governments drag their feet on high hospital mortality rates, and this Government are determined that our NHS should offer the safest, highest-quality care in the world.
The BMA responded:
At a time when the NHS is facing huge financial pressure, more attention needs to be paid to private sector provision of NHS services to assess whether it provides value for money, high-quality, safe care to patients, as well as the impact it has on other NHS services. The NHS exists to provide the highest quality care for its patients. Anyone who doesn’t accept that, or gets in the way of achieving it, should not be allowed near it. That’s true for anyone who works in the health service, and it’s also true for any individual or company providing services within it. Patient care simply cannot take second place to finances. In an era of declining funding, rising patient demand and staff shortages, we need a new way forward that addresses the challenges facing our NHS.
I have long found that the BMA is not universally admired by doctors, perhaps because of its long history of putting doctors’ interests ahead of patients’ interests. Will the Secretary of State ensure that he does not inadvertently drive doctors into the arms of the BMA, and will he look into adopting some of the old left ideas of mutuality, which would reconnect doctors to the interests of their patients?
The Secretary of state responded:
My hon. Friend and I have discussed that recently, and I do think that the mutual structure is something we should be open-minded about. When junior doctors go on to the new contracts, which will happen in stages starting this August, they will find that it is safer and better and that they have more predictable shift patterns. It will enable them to have a better quality of life. Then they will realise just how badly represented they have been by the BMA.
Clearly, there has been a breakdown in the relationship between the Government and the British Medical Association. As representatives of the people, MPs from all sides must ensure that the ties between patients and their doctors remain strong despite the politicking of interest groups. That’s why I care about mutuals: Green’s book lays bare the truth that for over a century, the BMA, on behalf of the medical establishment, has systematically captured the state to the benefit of its members.
The facts of the new contract for junior doctors are important. The BMA’s demand for 50 per cent extra pay on Saturdays is in stark contrast to police officers and fire fighters, who receive no weekend premiums. Medical graduates enjoy the highest pay of any degree and spend most of their working lives in the top 2 per cent of earners in society.
A solution to many of the problems within our NHS would be a system of mutualisation to reconnect clinicians much more directly to the taxpaying public who require their services.
Mutual healthcare is perhaps best represented today by the provider Benenden, of which I am a member: it is a ‘community of likeminded people coming together to share life’s big risks’. One effect of mutualisation would be the removal of power from interest groups campaigning nationally for the best possible deal for their members at the expense of the patients who are at the heart of healthcare.
Throughout history, co-operatives and other forms of mutual have proven that when communities unite to provide a key service, they can compete with the flawed business model of state domination. In British healthcare specifically, mutuals are a burgeoning success story. Mutual health pre-dates the NHS and was the inspiration behind recent reforms, including devolution to NHS Foundation Trusts by New Labour.
As was pointed out by Co-Operatives UK:
Genuine mutual and co-operatives with [a] combination of accountability to staff, patients and a public-service ethos are ideally placed to deliver the innovative productivity, patient-led approaches and financial responsibility which we need to secure our health system deep into the 21st century.
Mutual health care is run by and for the people involved, not for profit. Patient-led mutuals offer the promise of reconnecting patients, taxpayers and clinicians and dismantling some of the top-down, distant and inflexible organisational structures which are behind this deplorable strike.