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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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Scotland's vast deficit remains an obstacle to independence

Though the country's financial position has improved, independence would still risk severe austerity. 

For the SNP, the annual Scottish public spending figures bring good and bad news. The good news, such as it is, is that Scotland's deficit fell by £1.3bn in 2016/17. The bad news is that it remains £13.3bn or 8.3 per cent of GDP – three times the UK figure of 2.4 per cent (£46.2bn) and vastly higher than the white paper's worst case scenario of £5.5bn. 

These figures, it's important to note, include Scotland's geographic share of North Sea oil and gas revenue. The "oil bonus" that the SNP once boasted of has withered since the collapse in commodity prices. Though revenue rose from £56m the previous year to £208m, this remains a fraction of the £8bn recorded in 2011/12. Total public sector revenue was £312 per person below the UK average, while expenditure was £1,437 higher. Though the SNP is playing down the figures as "a snapshot", the white paper unambiguously stated: "GERS [Government Expenditure and Revenue Scotland] is the authoritative publication on Scotland’s public finances". 

As before, Nicola Sturgeon has warned of the threat posed by Brexit to the Scottish economy. But the country's black hole means the risks of independence remain immense. As a new state, Scotland would be forced to pay a premium on its debt, resulting in an even greater fiscal gap. Were it to use the pound without permission, with no independent central bank and no lender of last resort, borrowing costs would rise still further. To offset a Greek-style crisis, Scotland would be forced to impose dramatic austerity. 

Sturgeon is undoubtedly right to warn of the risks of Brexit (particularly of the "hard" variety). But for a large number of Scots, this is merely cause to avoid the added turmoil of independence. Though eventual EU membership would benefit Scotland, its UK trade is worth four times as much as that with Europe. 

Of course, for a true nationalist, economics is irrelevant. Independence is a good in itself and sovereignty always trumps prosperity (a point on which Scottish nationalists align with English Brexiteers). But if Scotland is to ever depart the UK, the SNP will need to win over pragmatists, too. In that quest, Scotland's deficit remains a vast obstacle. 

George Eaton is political editor of the New Statesman.