Junior doctors strike: This is about more than pay. It’s about what the NHS is for

Jeremy Hunt’s imposition of a contract on the junior doctors is only the start of an assault on the health service

One day last week, I came out of a Tube station in central London to hear a cacophony of car horns. It was the sound of drivers tooting their support, as striking junior doctors marched across Westminster Bridge, hands linked. Most of us love the NHS, and the junior doctors, who are so passionate and articulate when they talk about their work, represent the best of it. 

The very next day the Health Secretary, Jeremy Hunt, told the House of Commons that he intends to unilaterally impose the contract at the heart of the bitter dispute. The doctors’ union, the British Medical Association, reacted angrily and so did opposition MPs. No wonder: it was a display of naked authority, signalling the imbalance of power between doctors and public opinion, on the one hand, and the Government, on the other. Within hours, Hunt’s claim to have the backing of “senior NHS leaders” began to look threadbare, as more than half of the supposed signatories to a letter of support distanced themselves from it.

Another politician, at another time, might have been embarrassed. But Hunt’s habitual expression of slight bafflement conceals a steely self-confidence that’s enabled him to emerge unscathed from what could have been career-breaking moments, including a difficult session (in his previous incarnation as culture secretary) before the Leveson inquiry in 2012. A message read out at the inquiry showed Hunt, who was about to become the minister responsible for overseeing a bid by Rupert Murdoch’s company to take control of the broadcaster BskyB, congratulating Murdoch’s son James as it cleared possible obstacles. Revelations about his chummy relationship with the Murdochs led to Hunt being described as “beleaguered”, an adjective used when journalists can’t quite believe that someone who is getting such terrible coverage is still in place. In the event, he was promoted to Health Secretary.

I’ve come to the conclusion, in other words, that Hunt is unembarrassable. For a government that’s impatient with the BMA and takes the view that doctors were treated much too generously by Labour health secretaries, that makes him the ideal candidate to take on a group of workers who have a special place in the public’s affections. I don’t think many people believe this is an argument about Saturday working, which is what Hunt says it comes down to, but I am also not sure that the BMA understands what formidable opponents it has taken on. It is hard to see what the doctors can do next, now that they have staged two one-day strikes to so little effect. 

Unlike strikes and picket lines, which encourage a communal spirit, Hunt has created a situation where individual doctors will have to decide whether to sign the new contract. They will have to take into account their own circumstances, including how to pay the rent or a mortgage, which is why it’s hard to see Hunt’s move as anything other than deliberately divisive. The dispute has been dragging on for a very long time and junior doctors are already demoralised, with good reason. The signs are that some are already exploring other options, producing anecdotal evidence about hospitals in Australia and New Zealand being staffed by an influx of British doctors.

This is very bad news for the NHS and all of us who use it as patients. While ministers try to present the dispute as turning on pay and conditions, it seems pretty clear that what is at stake is an idea about what the NHS is for and how it operates. 

At the beginning of their careers, doctors used to be attached to a consultant, accompanying him or her on ward rounds and seeing the same patients. There was continuity of care, support from other members of the team and a chance to see how patients progressed. Now junior doctors are basically shift workers, moved around to fill gaps on rotas, which isn’t good for them or their patients. It’s especially difficult for couples where both partners are doctors or have children who need childcare on weekends. The lack of continuity is frustrating for everyone, doctors and patients alike.  

The Government’s grasp of the public finances looks increasingly shaky, and I don’t doubt that ministers are terrified by the rising cost of healthcare. It doesn’t want to shoulder the blame as people’s experience of the NHS gets worse, as it inevitably will if it continues to try to provide a universal service without funding it properly. Hunt is still trying to divert our attention, quoting alarming statistics about elevated death rates in hospitals on weekends, even though the reason more patients die on Saturdays and Sundays is that they are sicker than those who are admitted on weekdays. Hospitals already provide a seven-day service, but extending clinics and routine appointments to weekends won’t just mean changes to how junior doctors work. It will require all kinds of support staff and diagnostic facilities, at a cost the Government hasn’t quantified.

Around the time of the last general election, I kept hearing people say they weren’t going to vote because it doesn’t make any difference. The result was not only a Conservative government, but the destruction of Labour and the Lib Dems as an effective opposition, allowing ministers with a modest majority to govern as though they have won by a landslide. This is only the beginning: once they’ve dealt with the junior doctors, consultants and nurses will be next in the firing line. 

Observing the warm public expressions of support for junior doctors up and down the country last week, I couldn’t help remembering the miners’ strike just over 30 years ago. Millions of people love the NHS, but when the stakes are so high, love may not be enough.

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