The junior doctors were on strike yesterday – April 6th 2016 – and again today. I’ve just come back from the picket line.
(‘Junior’ doctors in the UK are qualified and not necessarily young. They may have been working in the NHS for 15 years and heading up teams, but they are not yet consultants, and are continuing to train, as they work, in specialisms or towards being general practitioners.)
It’s great to see a group of professionals so clear about what they are taking on. Middle-class people often don’t realise that they are workers, don’t usually organise collectively against their mistreatment as workers, and rarely put their complaints in a wider social context. The junior doctors (and the teachers, in solidarity) are doing all this, and I’m right behind them. As they say: ‘It’s everyone’s fight’.
The government is trying to force a contract on them which makes long days and weekends normal working hours, at basic pay (the same thing is happening to many people in working-class jobs). But pay is not the main issue. They will not be in control of their rotas. The same pool of doctors, already too small and getting smaller as many leave for corporate medicine or for other countries, will have to provide a full weekend service. Nothing wrong with the aim of a full seven day a week NHS. But without extra investment? Impossible. Junior doctors already work weekends (not every weekend, but many) and long hours – they will have to work more weekends and longer hours. Simple arithmetic shows this – the same number of people will be spread thinner.
Exhausted doctors make mistakes
At a Green Party meeting last night, a junior doctor explained that the EU Working Time Directive currently means they may not work for more than an average of 48 hours per week over 6 months. In any one week they can work up to 91 hours, which she had recently done. By the end of that week, she didn’t feel confident that her decisions about patient care were always safe. Although the new limit for one week will be 72 hours, under the new contract doctors will on average work longer and more unsocial hours than now.
On the picket line this morning I met a doctor who had very recently worked for 36 hours without sleep. “But that’s not allowed,” I said “under the current contract or the new one, surely?” She and her colleague explained that there are ways round it. “Theoretically I was on call at home for the middle of that period. But I live so far from the hospital, so there was nowhere to go. And there are always patients who need you, so in practice I couldn’t leave.” She was terrified of making life-threatening mistakes. “That would be with you for ever.” The hospital has to fill in monitoring forms to show they are not overworking junior doctors. They were. The response was “Let’s try again next week. Maybe that will come out better.” No wonder doctors are worried about the regime getting even worse!
The new contract will mean that night shifts need not be consecutive. If doctors work just one night or two nights, they are not eligible for the 48 hour rest period the EU regulations stipulate after four nights on the trot. That will give hospitals an incentive to separate night shifts in the rota. But occasional night shifts are very difficult in terms of sleep cycles – and therefore aren’t safe for patients. There will be even less continuity of patient care, even less regard for doctor as a breathing, feeling human being whose mind and skills depend on the health of her or his body.
The government has now admitted the new contract will disadvantage women (who are 60% of junior doctors), which in theory makes it illegal, but the government says this can be ‘comfortably justified’.
“Any indirect adverse effect on women is a proportionate means of achieving a legitimate aim,” said the Department of Health in March 2016.
Statistics show – or do they? that more patients die who are admitted to hospital at weekends. This uncertain and complex claim is used to blame the doctors. But the government’s motivation is actually deregulation – so-called ‘flexibility’. At the moment the proposed new contract will run in tandem with the EU Working Time Directive, but hospitals will no longer be fined if they overwork doctors. Already junior doctors can sign to opt out of this regulation on an individual basis, and some are being pressured to do this.
The secret-ish privatisation of the UK’s National Health Service
The privatisation of the NHS is being done piecemeal, like a jigsaw assembled behind the scenes. With the help of McKinsey, the famously loyal, secretive and disliked management consultancy company, The Health and Social Care Act 2012 filled in the sky and that tall building on the right. The junior doctors’ new contract is an important piece, part of that tricky bit in the middle where all those people are waving. One day soon the last pieces will the in and – Hey Presto! NHS England will unveil itself as a poor copy of the failed US health system. Everything that can be done for profit will be hived off to private companies, and the state sector will train everyone and do the complicated likely-to-fail sort of medicine. Private providers already have car parks, cafes, TV, telephones, cleaning, catering and ‘Independent Sector Treatment Centres’ providing relatively straightforward clinical services, such as hip replacements and cataract operations. There are many more cherries to be picked, and Simon Stevens, the man in charge of NHS England, makes no secret of his commitment to private providers like Virgin and United Health, and using international treaties like TTIP and CETA to get rid of obstacles to that process
It’s not over yet
Unless talks begin again, the junior doctors are planning a 48 hr strike, and for the first time they won’t provide emergency cover. This will mean cancelling many non-urgent operations, and consultants will have to do the emergency work. It won’t be like the British General Strike of 1926 in which the managers (and university students!) broke the strike by driving buses and trains and so on. Those strike-breakers were emphatically against the strikers. On the 26th and 27th April it will not be the NHS managers – a massively expanded group – who step in, but more senior doctors, most of whom are in sympathy with the junior doctors’ protest. They may have come late to this position, they are not natural activists, they may make plenty of money in private practice, but they work in the NHS as well and most of them now realise that the creeping privatisation – marketisation – of the NHS has been disastrous.
“An empowered, rested, happy and appropriately remunerated workforce across all cadres of medical, nursing and allied health professional staff is essential to sustain high clinical standards in the face of increasingly complex healthcare delivery challenges,”wrote 505 consultants from the Royal Free London NHS Foundation Trust in a letter to The Guardian, on 13th November 2015.
“We regret, yet clearly understand, that public protest and possible industrial action by doctors has become necessary to safeguard these basic requirements.”
Consultants are unhappy. When my husband had a day-case operation recently on a Saturday, the surgeon said to him beforehand ‘I hate doing this. If anything goes wrong, I have no bed to put you in.’ Not what you want to hear before the knife bites. It did go wrong. Before seven in the morning we were in Accident and Emergency.
The Daily Mail puts great stress on cancelled operations due to the strike. But when they count how many there have been, they don’t subtract the average number cancelled every day because of staff shortages. Look at NHS England’s own figures:
“During the quarter ending 30th September 2015, 16,397 operations were cancelled at the last minute for non-clinical reasons by NHS providers. In the same period in 2014/15, there were 15,898 cancelled operations.”
Alright, enough ranting. What about climate change?
Haven’t you got it? The ideology that is destroying the NHS and treating junior doctors like robots is the ideology that is ruling the world, destroying species, ruining farms, burning forests and poisoning the seas – as side effects of the rush for profit. The market is neither human nor personal. It is served by the greedy, but they can’t control it. We are going to have to think of some better way of organising how to produce the things we need and how to share them out between all those who need them.