So, after months of high drama – involving brinkmanship over Acas, two strikes, and two others called off following last-minute concessions – Act I has finally drawn to a close. The Secretary of State for Health, Jeremy Hunt, has decreed that talks with the medical profession have failed irretrievably, and he will now impose his deeply unpopular contract on junior doctors.
Condemnation has come from the medical royal colleges, the political opposition, and from the pointed failure by 144 of the 154 NHS trust chief executives in England publicly to support the move. At the time of writing, the British Medical Association is contemplating its response.
While everyone dashes out for preordered drinks from the bar, or simply to go to the loo, it’s time to consider what play we’re actually watching. Hunt has been trying to sell a tragedy titled The Weekend Effect. The script goes like this: patients are dying unnecessarily because of inadequate levels of medical staffing at weekends, and the new junior doctor contract is a vital part of the solution. Hunt has kept parroting these same lines even though every piece of evidence he has cited has been dismantled and been shown – unarguably – to undermine, not support, his assertions.
Hunt’s dogged adherence to his thoroughly discredited script has infuriated the medical profession and the wider NHS. Collectively, we feel slandered and unvalued. There is also deep suspicion and fear. We know what he is saying is untrue, and offers a smokescreen for him to do something that, were he open and honest about his intentions, he would not be able to force through.
If there were any doubt, the BMA scotched it at the end of December, when it proposed a fully worked-up, cost-neutral alternative contract that differed from the government’s position in one crucial respect: by offering to accept a much-reduced enhancement to basic pay, junior doctors would continue to receive a higher rate for hours worked during antisocial periods. It has been widely reported that NHS Employers wanted to accept this, but Hunt personally vetoed the deal. He has failed to deny these reports despite being pressed on several occasions by Heidi Alexander, the shadow health secretary.
What Hunt is trying to achieve is a health service that does routine work across at least six, if not seven, days of the week, rather than the current five. This would certainly please bodies such as the Confederation of British Industry; employers could require employees to attend medical appointments on days off rather than in work time.
Of itself, it is something the medical profession would help deliver. But the core issue is that the government does not want to pay for it. Hunt wants a six- or seven-day routine NHS for the same price as a five-day service. To achieve this, antisocial hours have to be redefined as ordinary working time. Anyone with basic maths can see that the costs then fall elsewhere: in diminished weekday services, in blighted quality of life for front-line workers, and reduced incomes for those in areas such as A&E who work the longest antisocial hours – the very specialties in the grip of a grave recruitment crisis.
We are already seeing the consequences. Increasing numbers of doctors are leaving the profession; many others are emigrating in search of better conditions. Hunt scents victory either way. If the exodus is limited, he’s got a “buy five, get two free” special, though the remaining staff will be even more stressed, stretched and demoralised. If ultimately the NHS collapses, something will have to replace it, and he has friends in the private sector only too happy to help.
It is often said that no party would be elected on a manifesto of dismantling the NHS, and the Tories understand that very well. They think they might have found another way.
The curtain will rise again; it may already be Act II as you read. Lend your support to the doctors on stage, and – please – consider joining them.
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This article appears in the 17 Feb 2016 issue of the New Statesman, A storm is coming