Wednesday, 17 February 2016

What's Really going On with the Junior Doctors - Guest post by That's Rich

I read this post because I had so many questions about doctors striking - especially about the one last sticking point which nobody seemed to have made clear. 
I love doctors - surgeons are at the very top of my 'hero' list but in direct proportional measure I loathe union masters.
Having read this it confirmed what i had already believed - that the unions are playing politics and are using the doctors as their little chess pieces - except they're not playing anymore and instead of 'check' the government has now called 'checkmate' and I am 100% behind that move.
And of course, the doctors are not the pawns in all this - WE are - the patient.
This is a long read but it's worth it and there are several useful links. it's rare for me to read a long blog post all the way through but I did on this occasion and with the kind permission of the writer @RichH1337 (twitter account) - I hereby give you the best balanced summary I have seen so far:

Junior doctors and #SaveOurNHS activists – eat a snickers.
I was best man for a junior doctor not long ago – I want what’s best for them as much as anyone else does, but the mind-blowing hyperbole and hypocrisy surrounding this issue helps nobody.
I’m going to put a few things down here which should help bring some order to the chaos.
First things first though, let’s get this out of the way:
No, the Tories don’t hate junior doctors, and no, it’s not an evil conspiracy to privatise the NHS. This is the standard codswallop spouted by the kind of people whose default position is to oppose anything and everything the Tories do. If you find yourself being talked at by someone like this, it’s best to politely make your excuses and go back to the bar. You will gain nothing from the exchange other than globs of spittle in your drink.
Junior doctors have been in the wars plenty of times in recent years – and not just under the Tories. Let’s not forget these headlines from 2008:
So with this in mind, let’s start looking at what’s really going on.
The first thing to note is that there is a broad consensus – including within the BMA – that the current junior doctor contract is unsustainable and needs to be reformed. Have a look at the executive summary of this scoping report by NHS Employers in 2011. Reading that document (read points 1.6 and 1.9 of the executive summary if you’re time-strapped!), it is clear that this isn’t a vanity-project or war on the NHS by the Tories as some people are claiming.
The next thing to remember is that, despite the placards and general hatred thrown his way, Jeremy Hunt is not handling the negotiations. Being someone who knows nothing about medicine, he has quite rightly left it in the hands of NHS Employers with the caveat in place that overall spending is not allowed to increase. NHS Employers describe themselves thus:
“The Department of Health sets the broad framework within which we operate, but it is employers themselves who drive our agenda.
NHS Employers is a not for profit organisation which is part of the NHS Confederation. The NHS Confederation is a charitable company whose charitable aims are ‘the relief of sickness and the preservation and protection of public health’. The charity is governed by a board of trustees who oversee the strategic direction and governance of the organisation.
The NHS Employers’ policy board guides the focus and priorities of our policy work.”
As we’re all aware, talks have broken down a few times, with the BMA balloting for strike action including two days of full walk-outs (removal of all care, including emergency), citing concerns over patient safety, doctor training and pay among other things.
After the first strike, the BMA and NHS Employers started negotiating again, this time including the Advisory, Conciliation and Arbitration Service (ACAS) in the discussions. In their own words, they:
“…provide free and impartial information and advice to employers and employees on all aspects of workplace relations and employment law. We support good relationships between employers and employees which underpin business success. But when things go wrong we help by providing conciliation to resolve workplace problems.”
According to this letter from NHS Employers’ Chief Exec Daniel Mortimer dated the 4th Jan 2016, significant progress was made before the BMA withdrew from negotiations again:
“In summary, very good progress has been made to reach agreement or make a substantive offer on 15 of the 16 issues raised in the ACAS process or subsequently by the BMA in the areas of safety and education… One issue does remain outstanding regarding the length of paid rest breaks, but the most material outstanding issue is on pay, which centres on the definition of unsocial hours. In light of that it is extremely surprising that the BMA refused to discuss our latest proposal – including the application of financial penalties – at all during the day today and have now indicated that they will move to strike action. I am disappointed and frustrated that this has been the outcome.”
After this happened, Jeremy Hunt appointed Sir David Dalton, the Chief Executive of Salford Royal NHS Foundation Trust, to oversee the negotiations.
EDIT: He also sent a letter to the BMA Council Chair Mark Porter, that I have just come across. It essentially just conveys his disappointment at the information he received from Daniel Mortimer that day.
Negotiation continued, under the supervision of ACAS, until 29th January. On the 9th Feb, Sir David made a final offer to the BMA, as outlined in this letter to Jeremy Hunt. Here is an extract from his letter – I have highlighted some particularly interesting passages:
“There has been substantial progress since the end of last year and all significant issues associated with safety and training had largely been addressed before Christmas. Despite the most recent progress and substantial agreement on many elements of the contract, the BMA has refused to compromise on its insistence that the whole of Saturday must be paid at a premium rate. In contrast Employers’ position has moved several times, on each occasion offering more hours attracting premium pay. Regardless of these changes no agreement has been possible. It became clear that the only way to move forward was to make a ‘best and final’ proposal in the hope that this would lead to settlement. Yesterday I asked the BMA to respond to my letter by 3pm today confirming that they would unequivocally recommend this offer to the JDC meeting on 20th February or I would otherwise have no alternative but to conclude that there was no realistic prospect of a negotiated outcome. Regretfully no such assurances have been received. “
The letter also included a list of 20 NHS Trust Chief Executives who agreed that the final offer was:
“…considered ‘fair and reasonable’. They also confirm that the NHS needs certainty on the Junior Doctors’ contract and that a continuation of the dispute, with a stalemate and without clear ending, would be harmful to service continuity, with adverse consequences to patients.”
There has been reporting that this text above was changed after the Chief Executives signed it, but that’s not true, as we can see in this tweet by Andrew Fisher, Chief Executive of Wrightington, Wigan & Leigh NHS. The ‘change of the text’ story is regarding imposition of the contract, not the contract itself.
This is the NHS Employers summary of the new contract, and is essential reading for people who want to talk about this with any kind of knowledge. In addition to showing what the new contract is about, it shows how it has changed since November 2015.
EDIT: NHS Employers have a Q&A section on their website about the new contract. You can find it here.
After receiving that letter from Sir David, Jeremy Hunt decided that the only course of action was to impose the new contract offer on junior doctors without the consent of the BMA, andannounced this in the House of Commons.
The result was a huge backlash against the Health Secretary. Cries rang out declaring that there was an all-out war on the NHS from the Tories, and junior doctors were going to start leaving the country in their thousands as a consequence of the ‘unsafe and unfair’ new contract. At the time of writing, a petition calling for a vote of no confidence in Jeremy Hunt is approaching 300,000 signatures.
I’m not going to lie, this really wound me up. I’ve been following the dispute very closely for a very long time, not least because it directly impacted several good friends of mine, but faced with the intransigence of the BMA, I would have made the exact same decision that Jeremy Hunt has.
It is clear that the original concerns raised by the BMA were valid – which is great, that’s exactly what the BMA are there for. What’s less clear, when you only see what is reported in the media, is that NHS Employers appear to have addressed all of these concerns with the exception of Saturday pay – and on that issue, they moved significantly towards the BMA’s position from their starting position. I see absolutely no reason to assume that NHS Employers and the heads of NHS trusts are lying – they have nothing to gain from it whatsoever.
Media outlets and indignant social-media based self-proclaimed protectors of the NHS are still yelling that patient safety is the sticking point, but this clearly isn’t true, unless paying doctors more for a few hours on a Saturday somehow makes them safer.
The sticking point is that the BMA have not shifted at all on the amount of time that is paid at premium rate on a Saturday.
The BBC reported a graphic that showed the offer from NHS Employers (remember the contract being imposed has an increase of 13.5% on the base rate, not 11%) vs what the BMA demanded:
As you can see, the offers really aren’t that far apart.
So let’s look at this logically, people. Are conditions for junior doctors now so awful that they should leave the country?
Put simply – no. No they’re not. Not least because:
  • They’re well paid – their new starting wage is £27,000 (for perspective, the average UK wage is about £26,500), plus at least 33% extra for anti-social hours worked.
  • Their pension scheme is amazing – people working in the private sector can only dream of a scheme like that, and the 13.5% increase in base rate contributes further to this.
  • They have a high level of job security – they don’t have to worry about redundancy like other workers do.
  • They have guaranteed career progression – they don’t have to worry about being stuck in a dead-end for the rest of their working lives.
  • They have guaranteed pay rises as their responsibilities increase.
  • They are not contractually obliged to remain in the NHS, despite the taxpayer having paid in excess of £250,000 to train them (unlike, for example, Army officers – who definitely don’t get overtime for working on Saturdays!).
  • They can reach eye-wateringly high wages after qualifying as consultants.
So, why are the BMA behaving like this? My theory (which, of course, I can’t prove) is that the BMA is full of hard-Left activists who support Jeremy Corbyn and, seeing him floundering in the polls, are trying to damage the government on his behalf. A base level of research shows that this really isn’t that far-fetched.
theBMA theBMA2
Don’t get me wrong, I think that mistrusting government is healthy. In my mind, government is generally bad at everything it tries to do, so skepticism is a healthy default position. But for me, the same applies to trade unions, particularly considering how politicised they are.
(image borrowed from The Mirror)
How is it possible to be so skeptical of government, yet trust the BMA explicitly? I struggle to trust a union that threatened to withdraw emergency care from patients. What they’re saying is, “do what we say, or people will probably die”. That threat sickens me.
In reality, it seems to me that the BMA have ran out of arguments. I now expect the dispute to become even more emotion-based than it is already. They will try to justify their stance by telling us how great junior doctors are and how much we need them.
It’s beginning already – people on Twitter are talking about being alive because a junior doctor saved them. Well, that’s great, but adds nothing to the discussion whatsoever. Nobody is saying that junior doctors aren’t great or aren’t important, so who are you trying to convince?
I’ll leave you with a few links to, who have been great through all of this.

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