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31 August 2016

The junior doctors’ dispute hasn’t gone away – Theresa May is in for a headache

Theresa May has shown an instinct for dialogue. It's time she used them to ensure patients' safety.

By Phil Whitaker

With the summer dominated by the EU referendum fallout, you could be forgiven for thinking that the junior doctors’ contract dispute had gone away. However, all the signs point to it becoming a big domestic headache for Theresa May in the coming months.

A brief summary: last winter’s long battle between the government and the British Medical Association culminated in April in the first ever full walkout by junior doctors in the history of the NHS. The shock of this seemed to lead to a collective pulling back from the brink, both at the Department of Health and in the offices of the BMA. After a diplomatic “pause” in contract imposition in May, a compromise of sorts was hammered out.

The BMA then went on an information offensive, conducting roadshows around the country to explain the revised terms to the association’s membership. Johann Malawana, the then chair of the BMA’s Junior Doctors Committee (JDC), recommended it – reluctantly – as the best deal achievable in the circumstances. His measured yet steadfast conduct throughout the toxic dispute had earned him huge respect among his peers, but even that didn’t give his endorsement sufficient weight. In early July, rank-and-file junior doctors rejected the amended contract by 58 per cent to 42 per cent on a 68 per cent turnout.

Malawana resigned at once, making way for Ellen McCourt, a trainee registrar in emergency medicine, to be elected JDC chair. Simultaneously, Jeremy Hunt, the Health Secretary, announced that, come what may, the latest version of the contract would be introduced from October. McCourt was faced with taking on the government again with still strong (but unarguably reduced) grass-roots support – and at a time when some senior BMA figures are rumoured to have lost the appetite for the fight. Hope surged briefly when it was reported that Hunt had been moved in the post-Brexit reshuffle, but the dream of a more conciliatory secretary of state was soon snuffed out; Hunt was staying put.

Since her election, McCourt has made repeated attempts to engage Hunt in renewed dialogue, all of which have been rebuffed. On 11 August the JDC met and, like the members, it voted to reject the contract negotiated on Malawana’s watch, calling instead for fresh talks. It is backing this demand with a plan for escalating industrial action, to commence in September. The profession will have its hitherto united front tested.

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Focusing all doctors’ minds is the effect the government’s war of attrition has been having on medical morale. Applications to study medicine have fallen by 13.5 per cent over the past two years and, for the first time ever, unfilled places on medical degrees are being advertised on the Ucas clearing system.

Many qualified doctors are leaving the profession or emigrating. The Royal College of Paediatrics and Child Health has just published its latest workforce survey; one in every five middle-grade junior posts is now vacant. Two A&E departments have announced closures because they are unable to recruit doctors.

The malaise is wider than the hated juniors’ contract. The NHS is being starved of funds, posting a record deficit of £2.5bn in England last financial year. Performance is declining, with breaches in A&E waiting times doubling since 2013/14. The Patients Association reports that numbers waiting longer than 18 weeks for elective surgery have increased by 80 per cent over the past year.

Theresa May has shown an instinct for dialogue following the Brexit vote, setting off post-haste to build relationships with top European leaders and the heads of government of the home nations. One can only hope she will require similar of her Health Secretary. Hunt’s approach to date has alienated the entire NHS at a time of unprecedented challenge. The government must urgently turn conflict into collaboration if it is to avoid a new season of bitter discontent this coming autumn and winter. Patients deserve nothing less. 

This article appears in the 24 Aug 2016 issue of the New Statesman, Cameron: the legacy of a loser