Junior doctors voted by a staggering 98 percent to strike over working hours. Doctor Ron Singer explains the long term issues and BMA activist Yannis Gourtsoyannis talks about the campaign.
The proposed strike by junior doctors is only the second in NHS history. The first was in 1975 over hours of work — then a usual 120 hours a week. The government does not think that the NHS works 24/7. The call for a “full” seven days a week service needed a way round the current junior doctor contract.
Negotiations with the British Medical Association (BMA) failed because NHS employers would not discuss any of the implications of a changed contract. The BMA walked away and called a ballot for industrial action. The government states it will impose a new contract that NHS employers will write.
There are over 39,000 junior doctors in the NHS; many are not “junior” at all but in their 30s or 40s and fully trained specialists waiting to become consultants.
The NHS hospitals (and many community based services) rely on this group of workers for minute to minute care of patients. Most of these doctors work well beyond their contracted time, as do many other NHS workers.
There has been a huge, positive reaction to this government’s bullying: among junior doctors themselves, their consultants, GPs and medical students — the juniors of tomorrow. Demonstrations in many cities have seen thousands of doctors marching, with support from other staff and the public.
Few would have predicted that it would be a usually accepting and relatively privileged workforce that would come to represent what has been done to all NHS workers in the last seven years. The further surprise is the passion with which the doctors have chanted support for the principles of the NHS — principles that have suffered gross undermining for 15 years.
The government too thought the junior doctors would not resist. Jeremy Hunt had to go against the hated Health and Social Care Act’s attempt to distance government from taking responsibility for the NHS (clause one of the act) and call in the juniors’ leaders for crisis talks.
The government thought that by redefining unsocial hours for doctors — normal hours were to be widened to 10pm every night, including Saturday — they could use this precedent to reduce other NHS staff’s unsocial hours payments too, lowering the overall wages bill.
Hunt’s intervention angered the doctors when he claimed he would increase their basic salary by 11 percent. He failed to mention that the unsocial hours rate would fall dramatically and wipe out the 11 percent increase in basic pay.
If the doctors are beaten in their attempt to have a contract that is safe for patients and fair to them, if unsocial hours are redefined, not only are staff costs reduced, but the NHS becomes a “better” proposition for private companies to take over more NHS services.
The Unite union has one of the largest numbers of staff in membership on Agenda for Change bandings. It has recognised that if the doctors lose, so do thousands of other staff. Its health committee — representing 100,000 — has called on the NEC to support the doctors.
Doctors in Unite, besides supporting the junior doctors, are involving other NHS staff in a way the BMA simply cannot. Unite reps with their experience are being asked to support BMA reps in solidarity. As always it will be up to activists among the doctors (and their supporters) to make a success of any action.
Strikes are never easy to organise and sustain, of course, doubly so when direct care of patients is involved. Therefore any lead given by health staff should be supported widely by those outside the NHS. Hospitals are relied upon by local communities; now is the time for communities to show their support for staff.
Hospitals should be swamped by solidarity demonstrations. Boosting the confidence of staff who — having never taken action and no doubt attacked in the media — need that visible support.
SUPPORT STRIKE TO SAVE NHS
Interview with Yannis Gourtsoyannis
What has the reaction to the vote been like?
Well, the vote is 99.4 percent for industrial action and 98 percent for striking. This represents a very wide mandate that the leadership has listened to. It means we must mount a real challenge to the government and not stop until we see a real reversal in their position.
Straight after the vote there was an offer to go to ACAS for arbitration. To us, patient safety is paramount and if the government made serious commitments then we would withdraw the threat of strike action. Within minutes they rejected it. Since then, though, there have been signs that they might accept it.
The public is on our side. I can tell partly from having spoken at hospital and local Labour Party meetings. We have received messages of support from general secretaries of the RMT, BFAWU, UCU, NAPO, and the letter from the FBU, which has electrified (and educated) junior doctors. On our own social media the result announcement has received 4,000 likes in the last 48 hours.
We are well aware in the BMA, and so is the government, that we, potentially, will light the fuse which will ignite the wider health worker movement in a common defence of the NHS.
The proposed contract is unsafe for patients, detrimental to doctor’s well-being, it widens pay inequality within the profession, and it’s ultimately the latest attempt to erode the NHS as a sustainable public institution.
Since the introduction of the Health and Social Care Act, the majority of trusts are now in deficit. A normal day on a hospital ward often resembles a crisis. There is a critical shortage of beds. We are seeing more and more delays in ambulance response times, and safe staffing levels on the wards have been hit.
If NHS trusts are to remain financially viable within the constraints of austerity, the government has to come after the pay and conditions of doctors and nurses. Individual doctors, as well as medical students, had a great deal of illusions. These are fast falling away.
We have always seen ourselves as professionals. But what many of us have failed to see is that over the last few decades especially, we are in the process of being proletarianised.
So we are coming to the realisation that the only possibility of there being a continuing NHS over the next few decades, and of realising a fair contract for both doctors and other healthcare workers, is if all the health unions work together in a committed and comprehensive way over the next few weeks, months and years.
This contract dispute did not appear out of the blue. It has been wilfully invited by a government beholden to the failed economic theory of austerity. In choosing to cut public spending Cameron must attack the NHS. In doing so he must attack the terms, conditions, and pay of staff. Our working life, and our patients’ well-being is of no concern to this government.
What is the organisation like on the ground?
The BMA has a council, branches and regional committees. The junior doctors’ committee is leading with the strike. We need to organise pickets but also forms of mass action. We want to do stalls in busy areas, with petitions, and explain to the public what is going on. There are also organisations like Keep Our NHS Public which are playing an important role.
What can we do?
The government wants to destroy the very existence of a safe, effective, publicly funded NHS. It wants the NHS to fail and it wants it to be seen to fail.
The very future of the NHS will depend on the actions of every single member of my union, of every health worker, and every trade union over the next few months and years.
So get your local and national union branches to issue short messages of support. Be prepared to defend us against the vociferous smears and obfuscation which will saturate the media shortly.
The most important thing is to organise visits to the picket lines. There will be one at every hospital of a decent size between 8am and midday.