I’m writing at the start of the first full walkout by junior doctors in the 68-year history of the NHS. By the time you read this, the post-mortem will be well under way. There will doubtless be noise and confusion, but there are only two statistics to watch out for – figures that will shape the NHS and its future in England.
The first is turnout. In the past few weeks, the government has thrown everything it can at juniors’ ranks – from ethical rebukes by the head of NHS England and the Chief Medical Officer to ominous “advice” by the General Medical Council – in an attempt to make the more faint-hearted pull back from fully withdrawing their labour. If substantial numbers of juniors prove to have been swayed, the battle over contracts will be all but over.
If, however, the strike is well supported, then Jeremy Hunt and David Cameron will be facing a nightmare. Throughout this dispute, the Tories have sought to portray the British Medical Association as a militant union, misleading its membership in pursuit of a political agenda. In part, that is mere playground name-calling, but it also indicates an analysis of industrial relations that belongs to the past.
Far from leading the charge, the BMA has been propelled by a groundswell of opinion. The momentum has come from thousands upon thousands of grass-roots juniors, sick to death and scared rigid by working in a terminally stretched and underfunded English NHS. They are genuinely incensed – as are innumerable colleagues throughout the service – by the imposition of a contract that will further jeopardise patient safety, discriminate against female and single-parent doctors, compromise training, and eat away at what is an already too-precarious work-life balance, to the detriment of recruitment and retention.
Social media has been very important in the dispute, enabling rank-and-file doctors to form networks, identify natural leaders, and create and spread innovative campaigning. There has been lots of it, which has kept the issue, and the government’s unreasonableness and intransigence, in the public eye. The BMA has its statutory role in balloting for and organising industrial action, but in campaign terms the union has been dwarfed by the rank and file. A well-supported strike would signal loud and clear that the passion driving this movement is still burning fiercely.
The other vital statistic will be English death rates. If there proves to have been excess mortality over the strike days, it will devastate the medical profession. Doctors who supported the walkout firmly believed that patient safety would not be compromised. Throughout the country, thousands of consultants and staff-grade specialists publicly declared their support for their junior colleagues and vowed to provide exemplary urgent care during the strike. Disruption, not danger, was the aim.
New Zealand – which has gone through three waves of junior doctors’ strikes in the past 20 years – found that mortality rates fell during industrial action, because the most experienced doctors were diverted to emergency care. If this is what the English figures show, the government will be privately dismayed. A vital element of its strategy approaching the full walkout has been to weaken doctors’ resolve by rattling consciences. If mortality data confirms that the strike has been neutral in this regard – or even positive – junior doctors will be emboldened when contemplating further action.
I once wondered whether this generation, born and raised in an environment of neoliberal marketisation, would feel the passion for public-service health care that brought me into the NHS. Events of the past six months have shown that they do. For the sake of all who are treated by the NHS, and all who work for it, I sincerely hope that the strike will succeed in terms of both turnout and patient safety. That will put the ball firmly in the government’s court. Then, finally, it may be time for Jeremy and David to talk to doctors again
This article appears in the 27 Apr 2016 issue of the New Statesman, The new fascism