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Why the junior doctors’ strike matters to everyone

Overworked and tired doctors make mistakes, so getting these arrangements wrong is tantamount to gambling with patients’ lives.

Doctors are striking for the first time in over 40 years. We do so with a heavy heart, as it goes against the very ethos of our vocation. Yet the fact that more than 98 per cent of us voted to do so speaks volumes about the current impasse.

In 2012 – long before any talk of a seven-day NHS – our union, the BMA, began negotiating in good faith on a new contract. Two years later they walked away because the government were refusing to listen to their concerns, threatening to impose unsafe changes on doctors regardless.

Tens of thousands of us took to the streets, to social media, wrote letters to the press, met our MPs and talked to the public – we even recorded a hit single. Still the government would not listen. 

Finally, with the threat of strikes looming, and at the eleventh hour when it was too late to reinstate cancelled procedures, the government agreed to the very reasonable BMA request of talks mediated by Acas. Now these have failed because of government intransigence and, having exhausted all other options, we feel we have no choice but to strike before it is too late and this contract is a reality.

The latest offer is much improved. But important differences remain. The existing, effective system for monitoring our hours is to be abolished. The proposed replacement is inadequate, leaving doctors vulnerable to being pressurised into working long beyond their rostered hours, something that can ultimately jeopardise patient safety. It’s like asking people to drive within the speed limit – while simultaneously removing speed cameras and fines.

There’s more. Under the new proposals, doctors working an 11 hour shift will get just one 30 minute break. Worse, there are no requirements for rest periods for those who provide an on call service overnight, when they could be called in frequently. These doctors could be asked to work both the day before and the day after one of these “non resident” night shifts. Effectively we could be working 72 hours continuously. As this arrangement costs less and requires fewer rest provisions (less time away from work) than having resident staff, hospitals will have a powerful incentive to make such 72 hour shifts commonplace. Overworked and tired doctors make mistakes, so getting these arrangements wrong is tantamount to gambling with patients’ lives.

The government argues that these changes are needed to provide a seven-day service. Extra money is promised for the NHS, but our wage bill is set to stay constant (and for the record, we are not asking for a pay rise). The only way the sums add up are if existing staff are stretched more thinly. 

11 years ago I quit my job as a management consultant to retrain as a doctor. I’ve lost count of the number of doctors who have asked me for advice about going in the other direction in the last six months. Morale is at a record low. Only 52 per cent of doctors finishing their second year of work after graduating chose to stay in the NHS last year, down from 71 per cent as recently as 2011. The consequence has been vacancies in every specialty, with as many as half the posts in A&E unfilled. The shortfall? It’s covered in part by the rapidly eroding goodwill of those doctors who stay, but increasingly by costly locum staff at the taxpayers’ expense. A new contract that encourages doctors to stay is urgently needed.

And this is the crux of it. There is a real danger that many doctors will leave rather than work under conditions they feel are unsafe and unfair. The government has refused to listen, risking patient safety in pursuit of a rash and ill-conceived manifesto commitment to an as-yet undefined seven-day service. 

As a taxpayer and a patient, I’m not worried about a strike – our consultants will ensure emergencies are covered and patients are safe – but about a contract that prompts a mass exodus of doctors. That’s why when junior doctors say they are striking to save the NHS, it’s not just rhetoric. If you care for the NHS, please support us.

Dr Hugo Farne is a junior doctor and a specialist registrar and clinical research fellow in respiratory medicine 

A pro-union march in 2014. Photo: Getty
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The legacy of sectarianism is still poisoning the air of Scotland

Ruth Davidson has reinstated two Stirling councillors who posted anti-Catholic and racist messages on social media. That this kind of cretinous guff still goes on in my hometown in 2017 raises my hackles.

Kenny Dalglish was a bluenose: as a boy in the mid-60s, he and his father would make the short journey to Ibrox to cheer on Rangers, then Scotland’s most successful team. With the football allegiance came a cultural one, too. Or, probably, the other way round.

Wee Kenny could play a bit, obviously, and dreamed that his beloved Gers would sign him up. But, as Richard T Kelly writes in Keegan and Dalglish, his enjoyable new double biography of the two footballing greats, "Rangers had a certain preference for big lads, or else lads with an obvious turn of pace; and Dalglish, despite his promise, had neither of those easy attributes."

Rangers’ loss was Celtic’s gain, but it took some effort. The former, writes Kelly, "was the club of the Queen, the Union, Scotland’s Protestant majority… founded by Freemasons and members of the Orange Order, strongly tied to the shipyards of Govan. Glasgow Celtic was the team of Irish Catholic patriots, revolutionary Fenians and Home Rulers, begun as a charitable organisation… a means to bolster the faith and keep the flock out of the clutches of Protestant soup kitchens. It was going to be a serious step across a threshold for Dalglish to accept the overtures of Celtic."

In the end, Jock Stein dispatched his number two, the unhelpfully named Sean Fallon, to meet the young starlet’s family. "Fallon entered a domestic environment he felt to be 'a bit tense' -  a Rangers house, a lion’s den, if you will. Fallon even picked up the sense that Bill [Dalglish’s father] might rather his son pursue [an] apprenticeship in joinery."

The deal was done ("My dream was to become a professional footballer – the location was just a detail," Dalglish would later say) and the most gifted player Scotland has ever produced went on to make his reputation kitted out in green and white stripes rather than royal blue -  a quirk of those difficult times for which those of us classed as Fenian bastards rather than Orange bastards will be forever grateful.

Growing up in west and central Scotland, it was hard to avoid being designated as one type of bastard or the other, even if you supported a team outwith the Old Firm or had no interest in football at all. Thanks to 19th century immigration, the terrible religio-political divide of Ulster was the dominant cultural force even in Stirling, the town around 25 miles from Glasgow where I grew up and where I now live again. If you went to the Catholic school, as I did, you were a Fenian; if you went to the Proddy (officially, non-demominational) school, you were a Hun. You mostly hung around with your own, and youthful animosity and occasional violence was largely directed across the religious barricades. We knew the IRA slogans and the words to the Irish rebel songs; they had the UVF and the Red Hand of Ulster. We went to the Cubs, they went to the Boys’ Brigade. We got used to the Orange Walks delivering an extra-loud thump on the drums as they passed the chapel inside which we were performing our obligatory Sunday observance.

At the time – around the early and mid 80s – such pursuit of identity might not have been much more than a juvenile game, but it was part of something more serious. It was still the case that Catholics were unemployable in significant Scottish industries – "which school did you got to, son?" was the killer interview question if your answer began with "Saint". This included the media: in the late 90s, when I joined the Daily Record – the "Daily Ranger" to Celtic fans (its Sunday sister, the Sunday Mail, was known to Rangers fans as the "Sunday Liam") – vestiges of this prejudice, and the anecdotes that proved it, were still in the air.

The climate is undoubtedly better now. Secularisation has played its part - my own daughters attend non-denominational schools – even if, as the sportswriter Simon Kuper has observed, many are "not about to give up their ancient traditions just because they no longer believe in God". The peace process in Northern Ireland and important gestures such as the late public friendship between Ian Paisley Sr and Martin McGuinness have made a difference. And I suppose the collapse of Rangers as a footballing force, amid financial corruption that saw them dumped into the bottom tier of Scottish football, helped.

But the sensitivity remains. The 2014 Scottish independence referendum broke down in part across tribal lines, with many Celtic supporters, once Labour, now SNP, loudly backing a Yes vote, while Rangers fans were on the No side. The prospect of Brexit creating a significant border between the north and south of Ireland, which could inflame recently and shallowly buried tensions, makes one shudder. And even locally, the old enmities continue to raise their grubby heads. Ruth Davidson, leader of the Scottish Tories, is currently taking flak for allowing the reinstatement of two Stirling councillors who had posted anti-Catholic and racist messages on social media prior to their election. The pair have apologised and agreed to take part in diversity training, but I confess that this kind of cretinous guff still goes on in my hometown in 2017 raises my hackles. The rawness remains.

That this is so was brought to me a few years ago when I filed a column containing the word ‘sectarianism’ to a Scottish newspaper. Though the context had nothing to do with Catholic/Protestant or Celtic/Rangers, the editor asked me to remove it. "It’ll be deliberately misunderstood by one side or the other, and probably both," he said. "It’s not worth the hassle. In Scotland I’m afraid it never is."

Chris Deerin is the New Statesman's contributing editor (Scotland).