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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 

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"We repealed, then forgot": the long shadow of Section 28 homophobia

Why are deeply conservative views about the "promotion" of homosexuality still being reiterated to Scottish school pupils? 

Grim stories of LGBTI children being bullied in school are all too common. But one which emerged over the weekend garnered particular attention - because of the echoes of the infamous Section 28, nearly two decades after it was scrapped.

A 16-year-old pupil of a West Lothian school, who does not wish to be named, told Pink News that staff asked him to remove his small rainbow pride badge because, though they had "no problem" with his sexuality, it was not appropriate to "promote it" in school. It's a blast from the past - the rules against "promoting" homosexuality were repealed in 2000 in Scotland, but the long legacy of Section 28 seems hard to shake off. 

The local authority responsible said in a statement that non-school related badges are not permitted on uniforms, and says it is "committed to equal rights for LGBT people". 

The small badge depicted a rainbow-striped heart, which the pupil said he had brought back from the Edinburgh Pride march the previous weekend. He reportedly "no longer feels comfortable going to school", and said homophobia from staff members felt "much more scar[y] than when I encountered the same from other pupils". 

At a time when four Scottish party leaders are gay, and the new Westminster parliament included a record number of LGBTQ MPs, the political world is making progress in promoting equality. But education, it seems, has not kept up. According to research from LGBT rights campaigners Stonewall, 40 per cent of LGBT pupils across the UK reported being taught nothing about LGBT issues at school. Among trans students, 44 per cent said school staff didn’t know what "trans" even means.

The need for teacher training and curriculum reform is at the top of campaigners' agendas. "We're disappointed but not surprised by this example," says Jordan Daly, the co-founder of Time for Inclusive Education [TIE]. His grassroots campaign focuses on making politicians and wider society aware of the reality LGBTI school students in Scotland face. "We're in schools on a monthly basis, so we know this is by no means an isolated incident." 

Studies have repeatedly shown a startling level of self-harm and mental illness reported by LGBTI school students. Trans students are particularly at risk. In 2015, Daly and colleagues began a tour of schools. Shocking stories included one in which a teacher singled out a trans pupils for ridicule in front of the class. More commonly, though, staff told them the same story: we just don't know what we're allowed to say about gay relationships. 

This is the point, according to Daly - retraining, or rather the lack of it. For some of those teachers trained during the 1980s and 1990s, when Section 28 prevented local authorities from "promoting homosexuality", confusion still reigns about what they can and cannot teach - or even mention in front of their pupils. 

The infamous clause was specific in its homophobia: the "acceptability of homosexuality as a pretended family relationship" could not be mentioned in schools. But it's been 17 years since the clause was repealed in Scotland - indeed, it was one of the very first acts of the new Scottish Parliament (the rest of the UK followed suit three years later). Why are we still hearing this archaic language? 

"We repealed, we clapped and cheered, and then we just forgot," Daly says. After the bitter campaign in Scotland, in which an alliance of churches led by millionaire businessman Brian Souter poured money into "Keeping the Clause", the government was pleased with its victory, which seemed to establish Holyrood as a progressive political space early on in the life of the parliament. But without updating the curriculum or retraining teaching staff, Daly argues, it left a "massive vacuum" of uncertainty. 

The Stonewall research suggests a similar confusion is likely across the UK. Daly doesn't believe the situation in Scotland is notably worse than in England, and disputes the oft-cited allegation that the issue is somehow worse in Scotland's denominational schools. Homophobia may be "wrapped up in the language of religious belief" in certain schools, he says, but it's "just as much of a problem elsewhere. The TIE campaign doesn't have different strategies for different schools." 

After initial disappointments - their thousands-strong petition to change the curriculum was thrown out by parliament in 2016 - the campaign has won the support of leaders such as Nicola Sturgeon and Kezia Dugdale, and recently, the backing of a majority of MSPs. The Scottish government has set up a working group, and promised a national strategy. 

But for Daly, who himself struggled at a young age with his sexuality and society's failure to accept it, the matter remains an urgent one.  At just 21, he can reel off countless painful stories of young LGBTI students - some of which end in tragedy. One of the saddest elements of the story from St Kentigern's is that the pupil claimed his school was the safest place he had to express his identity, because he was not out at home. Perhaps for a gay pupil in ten years time, that will be a guarantee. 

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