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The post-strike dust settles in the dispute between the government and junior doctors

Edmund Stubbs, 28 April 2016

Two days of all-out strikes by junior doctors have come to an end, and not a lot seems to have been resolved. The full walk out seems to have restored the strike in terms of public attention to that following their first strike, whereas further partial strikes had gradually dwindled in impact.

The total walk-out generated a great deal of discussion leading up to, and during its two days. Both sides in the dispute made every effort possible to promote their positions. Social media added greatly to the discussion with many thousands thereby joining the debate. Piquant video clips were posted and amusingly (and sometimes angrily) captioned photos appeared in abundance.

The health secretary had a tough time of it, himself admitting that this ministry was likely to be his last big job in politics. One junior doctor stated a sizeable problem he now faces: that the health secretary will not be able to set foot in most hospitals without being heckled and pursued by a large proportion of its workforce, making it almost impossible for him to do so. Whether such hostility is deserved or not, this will certainly prove to be a permanent issue for him from now on, and could generate much negative publicity for him and for the government.

It is hard to predict what will happen next if the dispute continues. As BBC Health Correspondent Nick Triggle writes the junior doctors ‘don’t have a nuclear option’, concerning what to do next, which is something Triggle believes that the government knows. The disputed contract will therefore almost certainly be presented to the junior doctors in May.

Nevertheless, there do seem to be some options left to the junior doctors that do sound fairly atomic in scale. The most menacing and serious of these would be a campaign of mass resignation which the BMA has it seems, added to its list of active options. If instigated, this truly would represent a disaster for patients and possibly an end to the NHS as we know it.

Other possible options, such as refusal to do some types of administration could also cause major problems, although this is likely to be restricted to the type of paperwork which is not clinically essential, and could even, on a positive note, highlight areas where inefficient administrative procedures have hindered the effectiveness of and de-professionalised, competent, highly trained, doctors.

The Conservative government made a manifesto commitment to provide a ‘seven day NHS’. This manifesto was voted for by the British public, as Jeremy Hunt often likes to remind us. This is one reason why the government is unlikely to back down in the dispute. Hunt represents the junior doctors as having a vested interest in opposing the contract’s imposition and reminds us, in an uneasy parallel, of how unpopular Nye Bevan was amongst doctors when he strove to establish the NHS.

Both the government and junior doctors claim to have only the interest of patients at heart but, if the dispute continues, the NHS’s patients will suffer all the more as time goes on.

On a practical note, if the Health Secretary is truly serious about establishing a genuinely seven day NHS, he must now demonstrate how he will bring all the other needed staff groups (including lab technicians, administrative staff and operators of diagnostic equipment) into hospitals over the weekend, and the Treasury needs to support him by explaining how these enhanced weekend services will be funded.

Tensions between the two sides might be alleviated if the government could be clear as to why they wish to enhance weekend services, as opposed to  other areas of the NHS’s operation. Specifically, they need to justify the reasoning behind beginning their reforms with revising junior doctors’ contracts before improving the general weekend infrastructure in hospitals.

If the government can produce convincing reasons, then they might stand a good chance of winning over more of the British public to their cause and even some of the junior doctors. If they cannot do so they need to re-assess their current position before it is too late.

Edmund Stubbs is Healthcare Researcher at Civitas

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