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13 March 2024

The deep roots of doctors’ dissent

Disputes between the UK government and its lowest-paid physicians go back decades. They began in 1964, with the creation of the Junior Hospital Doctors Action Committee.

By Hugh Purcell

Sixty years ago Michael Hession was a senior houseman at St Bartholomew’s Hospital in London (Barts), Britain’s premier teaching hospital. He was 24, fully qualified after six years studying medicine at Cambridge University and Barts, and his starting salary was just £28 per month. In fact, it was £531 annually, but from that there was a compulsory deduction of £195 for board and lodging. His contract required him to be on call round the clock, and for six months he could not leave the hospital. Frequently he worked 120 hours a week or more. He calculated that for a job working to save lives he was paid 11 pennies (4.5p today) per hour.

One weekend Hession donned his theatre gown at 8am on a Friday and took it off at 4.30pm the following Monday. He then slept for 27 hours. Much as he loved his work – indeed, he saw it as a privilege – Hession found this unbearable: he was exploited and was risking health, including his own. His anger must have been shared by many of the 20,000 junior hospital doctors, some in their late thirties, who worked in the NHS. He and a few others formed the Junior Hospital Doctors Action Committee. Their campaign of 1964 became the first major protest by junior doctors since the foundation of the NHS in 1948.

The consultants were unsympathetic. They had suffered, so why shouldn’t their successors? Many had trained before the NHS was founded, so they had not been paid in the London teaching hospitals. But after the ten years or so of “apprenticeship”, as they called it, they earned good money as consultants. Starting salaries were roughly three times higher than Hession’s senior houseman grade, and in addition most consultants had their own private practices. They were all-powerful. They represented all hospital doctors on the British Medical Association (BMA)’s Central Committee for Hospital Medical Services, confining the juniors to an impotent subcommittee. Their patronage was huge, for they ran the “firms” (teams) on the wards and picked which juniors to work with. Protest could harm preferment. Hession was dubbed “the red rebel from Barts” and found he was unable to hire premises for meetings.

Consultants and juniors together wore the “old school tie”; they were Britain’s social elite, despite starting salaries being way below those of other professions. The intake of junior doctors in Hession’s year at Barts numbered about 60, of whom only five were female and none was from an ethnic minority. They came from public schools because a private income was necessary to get by. Hession and his wife found a flat costing £1.50 a week and ate out when necessary for a few shillings.

Hession and his team stirred up the dormant discontent. Their campaign could be called industrial action, but they did not contemplate a strike. No one wanted patients to suffer and Hession considers today’s hospital strikes by junior doctors “heartbreaking”. Their weapons were lobbying and enlisting public support. They had no national organisation to work with and no social media, of course, so they communicated most effectively by planting information in the national press – in particular the Daily Telegraph and Daily Express. Hession lobbied the papers’ medical correspondents, and used radio and TV appearances. He found an open door. Journalists were shocked to be told what working conditions were like in NHS hospitals and seized on a good story.

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The action committee operated a countrywide telephone campaign to nearly all UK hospitals. It organised a London conference attended by about 400 junior doctors on a Sunday afternoon, with many others on duty or on call supporting them. Hession presented a survey of their terms and conditions within NHS hospitals since 1948 and put forward a proposal. It amounted to an increase in pay to £700 a year with no deduction for board and lodging. The meeting unanimously approved the proposal, donations were collected and key contacts in provincial hospitals set up.

This demand was much more than the feeble and unrepresentative BMA had on the table. Initially the BMA was hostile, but when it saw the growing public support for the junior doctors it called for a meeting with the action committee. Its offer was incorporation into the BMA structure: the price was a non-disclosure agreement with the press. Hession’s team refused and left. Comparisons with Mr Bates vs The Post Office come to mind.

Michael Hession and another doctor, Maurice Rosen, their bulging briefcases full of documents, were invited to put the action committee’s case to the Cabinet Office. They were interviewed by Robert Armstrong, later head of the civil service. The result was a much improved offer for junior hospital doctors. Not all the demands were met immediately, but in a series of steps over the following years. The action committee became the Junior Hospital Doctors Association, a formalised body which later merged with the BMA’s Junior Doctors Committee.

One improvement was to pay hospital doctors overtime, but only when they worked more than 80 hours a week. This may have been acceptable in the 1960s but it was not in the 1970s: in 1975 it led to the first junior hospital doctors’ strike. Meanwhile, thousands of British-trained doctors had left the service – more than 8,000 to Canada alone in the 1960s. But the Junior Hospital Doctors Action Committee of 1964 had made a start.

[See also: Bust Britain]

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This article appears in the 13 Mar 2024 issue of the New Statesman, The battle for Keir Starmer’s soul

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