Cameron declares the Trident review redundant

The PM's decision to reject calls for a "viable cheaper option" represents an opportunity for Labour to woo the Lib Dems.

The coalition is supposedly conducting a review into whether a £20bn like-for-like replacement for Trident is required but you wouldn't know it reading David Cameron in today's Telegraph. Following North Korea's sabre rattling, the PM denounces those who suggest that we "need to find a viable cheaper option", observing that our current nuclear weapons capability costs "less than 1.5 per cent of our annual benefits bill." 

There is a token reference to the review, currently being led by Danny Alexander ("all governments should, of course, carefully examine all options"), but Cameron immediately adds that he has seen "no evidence that there are cheaper ways of providing a credible alternative to our plans for a successor". All of which suggests that the official study into alternatives to Trident is little more than a Lib Dem face saving exercise. 

But Cameron's obstinacy should come as little surprise. It was only a few months ago that Philip Hammond announced £350m of further funding for a new generation of nuclear-armed submarines, appearing to rule out any option but the full renewal of a sea-based system. Back then, Clegg accused the Defence Secetary of "jumping the gun", noting that "The coalition agreement is crystal clear: it stands, it will not be changed, it will not be undermined, it will not be contradicted. The decision on the Trident replacement will not be taken until 2016, however much other people may not like it that way." Now Cameron has similarly pre-empted the conclusion of the review, how will his deputy respond? 

For Labour, the Tories' absolutism represents a political opportunity. By signalling that it is genuinely willing to consider cheaper alternatives to Trident, the party can lay down an important  bargaining chip for any coalition negotiations in 2015. So it is notable that while Labour has responded by declaring that it is "absolutely right and necessary that the UK retains an independent nuclear deterrent" (Ed Miliband has no desire to allow himself to be painted as a soft-minded unilateralist) it has also insisted that "the precise nature of the deterrent must be judged on meeting military capability requirements and cost". That proviso leaves Labour with significant room for maneouvre, a fact that won't have escaped the Lib Dems' attention this morning. 

HMS Vanguard sits in dock at Faslane Submarine base on the river Clyde in Helensburgh, Scotland. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

Joe Raedle/Getty
Show Hide image

The proposed cuts to junior doctors’ pay will make medicine a profession for the privileged

Jeremy Hunt is an intelligent man with a first-class education. This makes his ill-fated proposed contract appear even more callous rather than ill-judged.

The emblem of the British Medical Association (BMA), the trade union for doctors in the UK, symbolises Asclepius, who was believed to be the founder of western medicine. Asclepius was killed by Zeus with a thunderbolt for resurrecting the dead. In the same way, the proposed government-led contracts to be imposed on doctors from August 2016 may well be the thunderbolt that kills British medical recruitment for a generation and that kills any chance of resurrecting an over-burdened National Health Service.

The BMA voted to ballot their junior doctor members for industrial action for the first time in 40 years against these contracts. What this government has achieved is no small feat. They have managed, in the last few weeks, to instil within a normally passive profession a kindled spirit of self-awareness and political mobilisation.

Jeremy Hunt is an intelligent man with a first-class education. This makes his ill-fated proposed contract appear even more callous rather than ill-judged. Attacking the medical profession has come to define his tenure as health secretary, including the misinformed reprisals on hospital consultants which were met not only with ridicule but initiated a breakdown in respect between government and the medical profession that may take years to reconcile. The government did not learn from this mistake and resighted their guns on the medical profession’s junior members.

“Junior doctor” can be a misleading term, as we are a spectrum of qualified doctors training to become hospital consultants or General Practioners. To become a consultant cardiac surgeon or consultant gastroenterologist does not happen overnight after graduating from medical school: such postgraduate training can take anywhere between 10 to 15 years. This spectrum of highly skilled professionals, therefore, forms the backbone of the medical service within the hospital and is at the forefront of delivering patient care from admission to discharge.

Central to the opposition to the current proposed contract outlined in the Review Body on Doctors' and Dentists' Remuneration is the removal of safeguards to prevent trusts physically overworking and financially exploiting these junior doctors. We believe that this is detrimental not only to our human rights in a civilised society but also detrimental to the care we provide to our patients in the short term and long-term.

David Cameron recently stated that “I think the right thing to do is to be paid the rate for the job”. This is an astute observation. While contract proponents are adamant that the new contract is “pay neutral”, it is anything but as they have tactfully redefined “sociable hours” as between 7am and 10pm Mondays to Saturdays resulting in hardest working speciality doctors seeing their already falling inflation-adjusted pay slashed by up to further 30 per cent while facing potentially unprotected longer working hours.

We acknowledge that we did not enter medicine for the pay perks. If we wanted to do that, we would have become bankers or MPs. Medicine is a vocation and we are prepared to sacrifice many aspects of our lives to provide the duty of care to our patients that they deserve. The joy we experience from saving a person’s life or improving the quality of their life and the sadness, frustration, and anger we feel when a patient dies is what drives us on, more than any pay cheque could.

However, overworked and unprotected doctors are, in the short-term, unsafe to patients. This is why the presidents of eleven of the Royal Colleges responsible for medical training and safeguarding standards of practice in patient care have publically stated their opposition to the contracts. It is, therefore, a mystery as to who exactly from the senior medical profession was directly involved the formation of the current proposals, raising serious questions with regard to its legitimacy. More damaging for the government’s defence are the latest revelations by a former Tory minister and doctor involved in the first negotiations between the BMA and government, Dan Poulter, implying that the original proposals with regard to safeguarding against unsafe hours were rejected by Mr Hunt.  

The long-term effects of the contract are equally disheartening. Already, hundreds of doctors have applied to the General Medical Council to work abroad where the market price for a highly trained medical profession is still dictated by reason. With medical school debts as great as £70,000, this new contract makes it difficult for intelligent youngsters from low-income backgrounds to pay back such debts on the modest starting salary (£11-12 per hour) and proposed cuts. Is medicine therefore reserved only for students from privileged backgrounds rather than the brightest? Furthermore, the contracts discourage women from taking time out to start a family. Female doctors form the majority of undergraduate medical students – we should be encouraging talented women to achieve their full potential to improve healthcare, not making them choose unfairly between work and family at such an early and critical stage of their career.

Postgraduate recruitment will therefore become an embarrassing problem, with many trusts already spending millions on hiring locum doctors. Most hospitals are not ready for Hunt’s radical reforms as the infrastructure to supply seven-day working weeks is simply not available. With a long-term recruitment problem, this would also be a toxic asset for potential private investors, should the health secretary venture down that path.

Jeremy Hunt has an opportunity to re-enter negotiations with the BMA to achieve a common goal of improving the efficiency and recruitment to the health service while protecting patient care. Although the decision for industrial action should never be taken lightly, as future leaders of clinical care in the UK, we will do everything in our power to defend against such thunderbolt attacks, by men playing god, the integrity and dignity of our profession and on the quality of care it delivers to our patients.