You may have watched an hour of half truths and lies slander from the Secretary of State for Health in Parliament on 18 April. Here are some answers to Hunt’s slander.
Junior doctors cannot close Accident and Emergency Departments, despite what the government will have you believe. During the all-out strike on 26-27 April the consultants and specialist doctors who would normally be providing non-urgent or elective services will cover our work. Emergency and Urgent Services will still be running and patients will be seen by the most senior doctors in the hospital. Who can close A&E’s?
1. Jeremy Hunt, Secretary of State for Health, since he gave himself the legal powers to do so after being stopped by a Judicial Review from closing Lewisham Hospital, called by the local campaign.
2. NHS Management. As part of cuts to services, or when they simply don’t have the staff. This is not just a pay dispute. It’s about safe rotas. Across the country hospitals are being asked to draw up rotas for the new contract. It’s an impossible task. They don’t yet know how many junior doctors they will have to fill these rotas. And they don’t know how to match these rotas to some of this government’s impossible promises on weekend working. (The government claim simultaneously that junior doctors will work both more and less weekends.) Hospitals also don’t know how to match our training requirements to the new rotas, to ensure that we continue to receive the high quality training we need for us to be high quality consultants in the future.
The government continues to claim that this contract is about reducing weekend mortality. This could not be further from the truth. Driving thousands of junior doctors out of the country and out of the medical profession will not improve weekend mortality. Junior Doctors already provide a 24/7 seven-day-a-week emergency and acute service. If the government really wanted to improve weekend admission mortality rates they would look at specific interventions, such as the ones made with stroke services or for patients with heart attacks. They could see how other services could be improved to match. Instead Hunt has created a new contract which rips up the safeguards which protect junior doctors from working unsafe hours. His claim to be on the side of patients is nothing short of a sham. seven day The government claims that by providing £10 billion extra funding they will be able to fund a “seven day service”.
Conservative estimates put the money required to fund our current NHS at its current level at £30 billion across the life of this parliament. Once again their figures just don’t add up. Jeremy Hunt likes to mention that Sir David Dalton recommend that no negotiated deal was possible. What he neglects to mention is that a large part of this recommendation is based on the stubbornness and irrationality of the Secretary of State for Health. The step up to an all-out strike from the previous strikes where emergency care was provided is a serious escalation for junior doctors, but it cannot be the end. It is likely that more strikes, and further escalation will be needed. But where can we go from an all out strike? One possibility is to escalate to include evening strikes, going from 8am-5pm to 8am-8pm.
Another is weekend strikes. These would mean less lost pay, as only 40% of the workforce are at work on weekends, but would cause a huge headache for hospital managements, who will need to get consultants into cover the work. Such escalations need to be part of a timetable of strikes which is publicised. For example three days strike, then strikes including evenings, then strikes on Saturdays, then strikes on a run of days to include Saturday. The junior doctors’ ballot also gave a mandate for industrial action short of strikes, and that mandate has not been used so far.
Such action is almost by definition more individualised than strikes, and should not replace them, but can complement them. “Soft” action short of strike could include the BMA asking every junior doctor to explain to each patient why they are taking industrial action. That could be followed up with a leaflet, or similar, encouraging patients to contact their MP, etc. “Harder” action short of strike could mean refusing to fill out the paperwork concerned with coding and payment-by-results methodology. That would have a large financial impact on trusts, and, if done properly, no impact on patient care. It would require careful planning. Another possibility is a BMA call for no doctors to take locum shifts. That would bring a significant financial hit for some doctors, and we would need to ensure that the hardship fund is in a robust state. In the program of strikes, and the action short of strikes, the public political campaign must not be neglected. The BMA must call a national demonstration, and soon. The whole labour movement should get behind such a demonstration.
The last major demonstration in support of junior doctors was on 6 February. That′s more than two months ago! Locally junior doctors have shown great creativity and energy in organising street stalls, protests and other actions, but this may fizzle out if not supported. The large demonstration to save the NHS in Leeds on Saturday 16 April shows that lively local demonstrations can be organised. As does the planned joint National Union of Teachers and BMA demonstration organised for 26 April in London.