Are the junior doctors’ strikes partly the result of intolerable workforce pressure?

Edmund Stubbs, 14 January 2016

Following the first of the planned British Medical Association led junior doctors’ strikes, and as talks are resumed with the conciliation service Acas, it seems that junior doctors can claim a victory of sorts.

Public opinion will be a key force in determining the government’s response to the strike, and at present, it seems to be supportive of the junior medics, despite the 3,300 cancelled non-emergency operations that the industrial action has caused and the ongoing disruption to schedules as a result. However, less support appears to exist for the next planned strike of 10th February when emergency care will no longer be provided.

According to a reliable poll (an IPSOS Mori poll for the Health Service Journal), the British public appears to believe that doctors should be permitted to leave their non-emergency duties, but that emergency care responsibilities cannot be so readily abandoned (66 per cent and 44 per cent in support respectively). Support for either scenario is also still higher than those that oppose all strike action (39 per cent).

This means that further strikes, if they are not averted, might produce two results as far as the public is concerned. On the one hand the public might believe that, after two previous strikes by medics producing no positive response from the government, medics would remain within their rights to abandon their emergency care posts. In this scenario, the public may feel the government has failed patients by letting relations with doctors get so bad. On the other hand, the strike planned for the 26th when emergency care will be abandoned over 48 hours, could well erode the public’s good will and reduce support for the most severe strike further.

In fact, public support for the junior doctors may have been bolstered by some of the methods the government has used to promote their side of the argument and by the actions of some of the doctors’ own employers. Sir Bruce Keogh in a letter of the 1st December 2015 addressed to the BMA, asked whether striking medics would provide cover if a terror attack occurred in the UK during the strike, a seeming politicisation of the recent Paris terror attacks, especially when it emerged that the letter was redrafted by the Secretary of State’s officials to make it as ‘hard edged as possible’. With Jeremy Hunt seemingly silent on the eve of the strike, appearing only on the day, possibly to enhance the impact of his interviews, the government risks being seen as too meticulous and cunning in their planning of press coverage and thus as being insincere.

An unusual incident also occurred at Sandwell hospital in West Bromwich, where the employing trust ordered junior medics to leave the picket lines and return to their posts because of extreme pressures on its services. Despite it being issued two hours into the strike, the letter outlining this move was dated the day before, January 11th. The striking medics claimed that the level of staffing was the same as would be provided on any bank holiday anyway, with extra consultants present and that the request to respond to ‘extreme pressure’ had not come through the agreed official channels. In the event, the Sandwell medics remained on the picket line.

A staggering 98% of junior doctors voted in favour of strike action, of course in part the result of clear and significant disagreements over contracts and especially over concern that the 11 per cent pay rise offered in compensation would not match lost income from overtime payments and that whatever the contractual arrangements, hospitals would still expect junior doctors to cover overrunning shifts. But there is also something else: NHS staff are not happy.

In his Wednesday blog, the BBC Health correspondent, Nick Triggle writes that the strikes could also be a response from a system that we are attempting to squeeze ever more from. He states that: ‘There are plenty of people – both in government and outside it – who think there is more the health service can give. And they may be right. But it is also quite obvious that the tide of goodwill is running low.’

I am also of the opinion that in addition to their valid concerns over the new contracts to be imposed on them, the strikes are also a display of straightforward displeasure. The NHS is a huge, often idiosyncratic organisation that is certainly, in many instances, inflexible and inefficient. Nevertheless, those staff, directly involved in patient care, are likely doing all they can to improve the service.
The government is not implementing these contractual reforms just to keep itself busy, it clearly wants to reduce unnecessary mortality and improve patient care, both admirable goals. Junior medics are also not striking just to spite the government; this seems a genuine last resort on their part when under intolerable pressure and faced with the uncertainties of the new contract. These strikes are the symptoms of an underfunded system being asked to do too much for a rapidly growing and increasingly unhealthy population.

Edmund Stubbs is Healthcare Researcher at Civitas @edmundstubbs1