Should doctors strike?

There is to be a further strike by junior doctors in England next week. They will not work between 8 am and 5 pm on 26 and 27 April. In previous strikes, cover for emergencies was maintained; this time it is ‘all out’. (The strikes, and the challenges of the new contract, don’t apply in Wales, Scotland or N Ireland.)

The strikes come as negotiations between junior doctors and the Department of Health have broken down. The negotiations were about a new contract, which both sides agreed was necessary. The sticking point for the doctors was the reclassification of hours of duty; where previously certain times were classified as ‘out of hours’ and attracted extra ‘overtime’ payments, these hours have been reduced. There is to be a 13% increase in basic pay, but overall most doctors won’t earn more. The new contract is said to be ‘cost neutral’.

In addition, what seems to have been a late development is the need, according to Mr Jeremy Hunt, the Health Secretary, to concentrate on weekend provision, to give the English NHS seven-day working. Of course, emergencies have always been covered for seven days. Mr Hunt bases his view on the reported ‘weekend effect’, where patients admitted at weekends have a greater chance of dying than those admitted during the week. This claim has been vigorously challenged, not least by the authors of the original academic paper.

It does seem that the Department’s aim is for there to be a greater number of junior doctors working at weekends. There won’t be an increase in junior doctor numbers, so presumably there will be fewer of them available during the week, as doctors’ hours overall are to be reduced. Quite how this will improve medical care throughout the seven days isn’t at all clear to me.

Mr Hunt has also said he will ‘impose’ the new contract, though in recent days this seems to have changed to ‘introduce’. Meanwhile, there is a legal case before the Courts seeking clarification of whether Mr Hunt has the power and authority to do this.

Once junior doctors contracts have been ‘introduced’ or whatever, it is the intention of the Health Department to renegotiate senior doctors’ contracts. Junior doctors will one day be senior doctors.

Meanwhile, although it was the British Medical Association who were always associated with ‘shroud waving’ – if we don’t get what we want, patients will suffer – this politicking has been taken up by the Department, saying in effect, if doctors don’t do as they are told, patients will suffer.

Add to this evidence that the working conditions of junior (and senior) doctors are such that many have mental health and addiction problems and marital difficulties, and there is the making of a very toxic atmosphere in what has become a game of ‘chicken’.

Doctors traditionally don’t strike, they are there to help and to heal, to be present and to be ’available, affable and able’. Yet, when they feel that new working conditions will seriously compromise patient care, what alternative do they have when government will not listen?

At present, the general public is behind the doctors and their strike action. How much longer will this continue?

And, as Mr Hunt has previously written about the desirability of privatising the NHS, is this all evidence of further dismantling and ‘death by a thousand cuts’?