It's the first full walkout in the history of the NHS. On 26th and 27th April, up to 45,000 junior doctors will stage a “full withdrawal of labour." This all-out strike goes a step further than the two held earlier this year, as junior medics will not provide emergency cover: they will not staff A&E units, intensive care units or emergency operations.
The doctors have reached an impasse in their dispute with Health Secretary Jeremy Hunt, who is planning to impose a new contract on them to create a "seven day NHS." The new contract reclassifies standard working hours—known as "plain time"—to be from 7am until 10pm, including Saturdays. This means that junior doctors working during evenings and on Saturdays will no longer be paid extra for doing so. Moreover, they will be expected to work weekends more frequently. It will also replace automatic pay rises with a basic salary increase of 13.5 per cent. The British Medical Association says it has “no choice” but to intensify its strike action, and has also launched a judicial review regarding the contract’s legality.
Some public service workers, including police and prison officers, are banned from striking (though the latter group broke the law to walk out in 2012). Given the potential risk that all-out doctor strikes pose to patients, should such action also be banned? Or are the strikes in patients' long-term interests? Our panellists offer their views.
Breaking point
Rachel Clarke, NHS Junior DoctorThe government has spun very hard to frame junior doctors as striking over Saturday pay. If we were, for me, an-all out strike would be impossible to square with my duties to my patients.
But we’re not. This strike centres on the government’s dishonesty in pledging a "seven-day NHS" in soundbite form only—with no actual funds and no actual staff to deliver on that promise. There are no new doctors for these new weekend services. Yet on the NHS frontline right now, we’re already close to breaking point. Stretching us more thinly over seven days can only endanger our patients.
That’s the crux of why even all-out action can be justifiable: when it is a last-ditch, desperate attempt to protect our patients in the long-term from a contract that will make our hospitals more dangerous places for them. In the short-term, on strike days, our consultant colleagues are firmly committed to covering our roles, protecting our patients from harm.
An opportunity for revival
Peter Kellner, journalist and former President of YouGovDoctors should not strike. But nor should governments simply have the power to enforce contract changes willy nilly. Here is a perfect opportunity to revive an idea first proposed some decades ago by the great economist James Meade: pendulum arbitration.
The British Medical Association and the government would put their final proposal to an independent body (eg the Advisory, Conciliation and Arbitration Service), which would then have to choose one proposal or the other. It could NOT split the difference or propose a compromise. Its decision would be binding on both sides. Its brief would be to choose which of the two proposals would be most conducive to affordable, high-quality, 24/7 health care in NHS hospitals, taking account of the need to recruit and retain good doctors.
If the doctors and health secretary knew that these were the rules, they would have a big incentive to negotiate a compromise, for intransigence would be punished by the arbitrator. If negotiations still breakdown, pendulum arbitration would reward the side that puts forward the more reasonable case.
If such a system were put in place it would then, and only then, make sense to outlaw strikes by NHS doctors.
The NHS doesn't exist to serve its staff
Sam Bowman, Executive Director of the Adam Smith InstituteIt is difficult to sympathise with junior doctors who complain about pay—and, whatever they say about safety, ultimately this is all about pay for working unsociable hours. But most junior doctors will go on to earn vast salaries later on in their careers—the median GP earns just under £100,000 per year. Many NHS doctors earn even more by moonlighting in the private sector.
Doctors’ pay is so high because the supply of doctors is kept artificially low. In 2014, there were 125 applications for every 10 pre-clinical Medicine university places. We should try to lower doctors’ wages by training more of them and fast-tracking the visa applications of any foreign doctor who would like to come and work in the UK. The NHS exists, or should exist, to serve patients, not its staff. Doctors who endanger patients by staging walkouts of emergency services will probably find public opinion turning against them. Good.
Patients as ammunition
Nick Summerton, NHS General Practitioner, Public Health Consultant & Medical Director, Bluecrest HealthConcern for the safety of the general public is a good argument to make in defence of a strike. Train drivers have used it, so have air traffic controllers. Now it is the turn of junior doctors.
But there is a difference between doctors striking and these other workers striking. Doctors call themselves professionals and this obliges us to follow a code of ethics. I have consistently argued that striking is something doctors should not do—and the proposed all-out strike at the end of April, when emergency cover will be withdrawn, is particularly worrying. Using patients as ammunition in an argument with any employer is wrong. Patient safety cannot be considered at risk simply because doctors may have to work slightly longer hours or treat Saturday as a normal working day.
I accept that if junior doctors had genuine concerns about the wellbeing of their patients then, perhaps, they should strike (while still covering emergencies). But if their real gripe is with their terms and conditions of employment, they need to consider their broader professional responsibilities. Refusing to cover A&E departments and intensive care as part of an all-out strike is indefensible under any circumstances.
If the British Medical Association does eventually win its dispute with the Department of Health I worry that it will be just a Pyrrhic victory. The toll on the reputation on all of us in the medical profession will make it tantamount to a defeat.
A pretty good deal
Andrea Jenkyns, Conservative MP for Morley and Outwood and a member of the Health CommitteeThis strike is totally unprecedented. No group of doctors before have been willing to put patient safety at risk over a dispute about pay, unsociable hours at weekends, and working the sort of hours that many across the public and private sectors work every week.
Like all of us, doctors want to make enough to support their families and get a fair reward for the work they do. Historically, they have had a pretty good deal, and like any other body of workers they have the right, through their union, to seek better pay and conditions. But seeking that requires a meaningful negotiation between both sides in the debate.
My argument is that it is the British Medical Association that has failed in its duty to hold a proper, meaningful negotiation. The BMA repeatedly had the chance to negotiate with the government and reach an agreement acceptable to all sides and, most importantly, safe for patients. Time and again the BMA has walked away from the negotiating table and balloted for industrial action, while the Department of Health negotiators have offered it the chance to come back to talks. And the reason is that the BMA is driven by a desire, according to one of the doctors involved, to “be the first crack in the edifice of austerity.”
Justified in the long-term
Clive Peedell, Leader of the National Health Action PartyI don't believe taking strike action is ever an easy decision for anyone, and for doctors it is doubly difficult. But the government's imposition of the junior contract is totally unacceptable and has completely undermined trust between those in the medical profession and Department of Health. It is highly likely that the imposed contract will lead to an exodus of junior doctors from the NHS. This will have disastrous consequences for patient care because there are already shortages of junior doctors and major rota gaps in hospitals all over the country.
It is totally unacceptable to ask NHS staff to deliver a seven day non-emergency NHS, when delivering seven day emergency care is already under stress. It is vital for the public to understand that the decision for junior doctors to withdraw emergency care from eight am until five pm over two days will not put patient safety at risk. This is because, while junior doctors won't be providing emergency cover on April 7th and 8th, consultants will cancel clinics and routine operations to deliver the service. So, for the longer term safety of NHS provision, the doctors are justified in their action.
I'm moving—and I might not come back
Alasdair Joyce, a junior doctor who recently left his job at Derriford Hospital, Devon, to move to New Zealand
Is it right to strike? Well, is it right for a government to enforce an unsafe contract saying that seven-day elective care is something everyone wants or needs? That it is something that can be achieved while the NHS faces a funding gap? Is it right for MPs to have been awarded successive pay rises, while at the same time junior doctors have had their pay frozen (which amounts to a real terms pay cut)? Patient mortality actually decreases with doctor strikes, likely because the care suddenly becomes completely consultant-led, and elective operations (which carry a degree of risk) get axed. I'm moving to New Zealand because I want to travel, and now is the only decent time to do that in a doctor's career. However, I'm glad I’m going, and the contract may result in me staying abroad to complete training out there.This week's Big Question was put together by Alex Dean and Thomas Seal
Now read: Big question: Is the London housing crisis Boris Johnson’s fault?
