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After suspended strikes and media backlash, what next for the junior doctors?

A junior doctor looks ahead at what will happen in the struggle for fairer contracts, and says the fight is far from over.

We are now approaching the one-year anniversary of the junior doctor movement and, far from running out of steam, it is escalating. At the end of June, nearly 60 per cent of junior doctors voted against a suboptimal amended contract.

Jeremy Hunt has announced that he will enforce the contract. The BMA has responded with a programme of industrial action with rolling strikes. Neither side has blinked.

The backlash has already started. The Daily Mail and The Times are framing BMA leaders as “radical” and “militant”. The same reports describe how junior doctor leaders are co-ordinating a winter of discontent with rail workers, firefighters and teachers in efforts to topple the government. Even if that were true, it would hardly be surprising. Various public sector workforces are pursuing industrial action in the face of austerity and privatisation policies.

However, the smears of radical militancy are absurd. The BMA represents traditionalist, middle-class professionals. Many of the junior doctors are Conservative voters. It is telling that the government has managed to alienate this constituency.

Last week, reports also described how the public is turning against doctors and how senior doctors have come out against industrial action. This is surprising as both groups had previously showed strong support. Nevertheless, the BMA has sensibly responded by cancelling the September strikes in order that there is sufficient preparation for the strikes in October and beyond.

The international evidence is that strikes do not generally harm patients provided that they are organised with sufficient back-up. Nevertheless, this will be used to attack doctors. The astonishing hypocrisy of this claim cannot be over-emphasised. It is the government’s policies that represent the real danger to patients.

The government is accelerating the privatisation programme. We have seen £15bn in cuts in the last parliament with a further £22bn to come in this one. Over 650 GP surgeries have been closed, merged or taken over since 2010. A quarter of walk-in centres have also closed in this time frame. The manufactured crisis means that thousands of procedures and operations are cancelled every week regardless.

However, this does highlight a key problem for the cause. Public support may not be indefinite. The smear campaign against junior doctors is likely to be ramped up. The government will exploit any situation in order to turn the public against doctors.

The government has U-turned on other controversial policy areas, even if it ends up introducing measures through the backdoor. However, it has shown no signs of relenting here. In fact, Theresa May underlined continuity of policy by keeping Hunt in place.

This suggests that opening up the NHS oyster of over £100bn to global capital is a massive project. The health trades press tends to be more frank in discussing such matters. The US market is saturated, hence why American private healthcare and insurance corporations are opening up global markets.

The junior doctor contract is a cost-saving exercise to stretch a five-day NHS over seven days. Even the government’s own risk register states that this cannot be achieved with current funding, resources and staff. The redesigning of the workforce is an attack on pay and conditions to bring down the wage bill – paving the way for privatisation.

It is also part of the deprofessionalisation and deskilling of NHS staff. It fits in with the removal of the student nursing bursary and the use of physician associates. If the junior doctor contract is imposed, then similar contracts will follow for all other NHS staff. NHS England is promoting health apps, Skype consultations, pharmacies and self-care as substitutes for high-quality medical and nursing care.

The junior doctor movement is paramount because it may be the last line of defence stopping the juggernaut of privatisation. The messaging has to move beyond the focus on pay, conditions and the small print of a contract dispute.

The BMA and junior doctors must make it clear that this about the healthcare of an entire nation as the NHS is privatised and a private insurance system is brought in. If the public becomes aware that this is really about them and the future of their healthcare then we may be able to restore the NHS as publicly provided, owned and accountable.

Dr Youssef El-Gingihy is a doctor and the author of How to Dismantle the NHS in 10 Easy Steps, published by Zero books. He tweets @ElGingihy.

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The rise of the green mayor – Sadiq Khan and the politics of clean energy

At an event at Tate Modern, Sadiq Khan pledged to clean up London's act.

On Thursday night, deep in the bowls of Tate Modern’s turbine hall, London Mayor Sadiq Khan renewed his promise to make the capital a world leader in clean energy and air. Yet his focus was as much on people as power plants – in particular, the need for local authorities to lead where central governments will not.

Khan was there to introduce the screening of a new documentary, From the Ashes, about the demise of the American coal industry. As he noted, Britain continues to battle against the legacy of fossil fuels: “In London today we burn very little coal but we are facing new air pollution challenges brought about for different reasons." 

At a time when the world's leaders are struggling to keep international agreements on climate change afloat, what can mayors do? Khan has pledged to buy only hybrid and zero-emissions buses from next year, and is working towards London becoming a zero carbon city.

Khan has, of course, also gained heroic status for being a bête noire of climate-change-denier-in-chief Donald Trump. On the US president's withdrawal from the Paris Agreement, Khan quipped: “If only he had withdrawn from Twitter.” He had more favourable things to say about the former mayor of New York and climate change activist Michael Bloomberg, who Khan said hailed from “the second greatest city in the world.”

Yet behind his humour was a serious point. Local authorities are having to pick up where both countries' central governments are leaving a void – in improving our air and supporting renewable technology and jobs. Most concerning of all, perhaps, is the way that interest groups representing business are slashing away at the regulations which protect public health, and claiming it as a virtue.

In the UK, documents leaked to Greenpeace’s energy desk show that a government-backed initiative considered proposals for reducing EU rules on fire-safety on the very day of the Grenfell Tower fire. The director of this Red Tape Initiative, Nick Tyrone, told the Guardian that these proposals were rejected. Yet government attempts to water down other EU regulations, such as the energy efficiency directive, still stand.

In America, this blame-game is even more highly charged. Republicans have sworn to replace what they describe as Obama’s “war on coal” with a war on regulation. “I am taking historic steps to lift the restrictions on American energy, to reverse government intrusion, and to cancel job-killing regulations,” Trump announced in March. While he has vowed “to promote clean air and clear water,” he has almost simultaneously signed an order to unravel the Clean Water Rule.

This rhetoric is hurting the very people it claims to protect: miners. From the Ashes shows the many ways that the industry harms wider public health, from water contamination, to air pollution. It also makes a strong case that the American coal industry is in terminal decline, regardless of possibile interventions from government or carbon capture.

Charities like Bloomberg can only do so much to pick up the pieces. The foundation, which helped fund the film, now not only helps support job training programs in coal communities after the Trump administration pulled their funding, but in recent weeks it also promised $15m to UN efforts to tackle climate change – again to help cover Trump's withdrawal from Paris Agreement. “I'm a bit worried about how many cards we're going to have to keep adding to the end of the film”, joked Antha Williams, a Bloomberg representative at the screening, with gallows humour.

Hope also lies with local governments and mayors. The publication of the mayor’s own environment strategy is coming “soon”. Speaking in panel discussion after the film, his deputy mayor for environment and energy, Shirley Rodrigues, described the move to a cleaner future as "an inevitable transition".

Confronting the troubled legacies of our fossil fuel past will not be easy. "We have our own experiences here of our coal mining communities being devastated by the closure of their mines," said Khan. But clean air begins with clean politics; maintaining old ways at the price of health is not one any government must pay. 

'From The Ashes' will premiere on National Geograhpic in the United Kingdom at 9pm on Tuesday, June 27th.

India Bourke is an environment writer and editorial assistant at the New Statesman.

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