It is difficult to know whether Secretary of State Hunt is deliberately promoting a fight, or has blundered into a conflict because he does not understand the undercurrents in the medical profession. He seems unprepared for a dispute. The economic modelling to show who would gain and who would lose from the new contract had not been completed, right up to the strike ballot.
A little history may help clarify this. In 2007 the Blair government tried to introduce an electronic system for matching junior doctor applicants to training programme posts, the Medical Training Application Service (MTAS). The electronic system fell over almost immediately, and caused so much distress to junior doctors that they organised street demos and issued threats of emigration. The government retreated to fix the failed system, but the debacle revealed that 28,000 trainees had applied for 22,000 jobs. The prospect of substantial medical unemployment appeared for the first time in the NHS.
Then in 2012 the Coalition introduced a reform of NHS pensions, ending the final salary pensions that previously made NHS employment such an attraction for doctors. The BMA led a campaign of protests that rapidly petered out, leaving it looking both ineffective and overly privileged. One BMA Council member, Dr Kailash Chand, described the protest as the “wrong fight at the wrong time with the wrong tactics”. In the same year the Coalition introduced the controversial and much challenged Health and Social Care Act that extended market mechanisms into the NHS, in order to reduce system stability and promote competition between NHS and private providers. We can add to this list of conflicts the government’s pressure to implement “7 day working”, and the stresses and strains produced by the short-fall in the health service budget.
Within a few years both Labour and Conservative governments have demonstrated to new entrants to medicine that they face possible unemployment, but if successful will work hard in increasingly competitive and potentially unstable environments. At the end of their career they will receive a smaller (although still substantial) pension than their predecessors. The security and stability that the NHS used to offer to its medical staff, even when it was exploiting them, is being eroded. Can we be surprised at the rage of the junior doctors and their apparent determination to strike? Whether they are right about the new contract being a danger to their salaries is almost beside the point.
Steve Iliffe took part in the 1975 junior doctors’ industrial action in 1975 as a House Officer at Leicester Royal Infirmary, and was co-author of the history of the dispute, “Pickets in White”, published by the Medical Practitioners Union in 1977.
Read more about the junior doctors’ dispute at www.healthmatters.org.uk