Last Friday evening Leeds North West Labour Party voted unanimously to support the Junior Doctors in the current dispute.
A packed meeting at the Otley Labour Rooms heard a passionate, controlled but devastating presentation of the facts of the situation from Dr Chloe Fairbairns – herself a junior doctor in Leeds.
This is NOT a dispute by ‘greedy’ junior doctors.
This is action taken by committed people who have been driven to the limit – action which few of them would ever once have envisaged taking.
It’s symptomatic of the low levels of morale in the NHS.
It’s a wake-up call to all of us about what’s happening in the NHS and the threat the present government poses to it.
Today the Junior Doctors, tomorrow the nurses, then the porters – then us, OUR NHS.
We need to understand what’s happening – and why it’s happening.

Here are the main points of Dr Fairbairns presentation.
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Who are the Junior Doctors?
54,000 of them, spread across the entire NHS. They range from the newly qualified – perhaps in their early twenties – to people with 15 years or more of working experience.
They are doctors who are training to become the consultants and GPs of the future – and they fear that their training may be harmed by the proposed contract.
They are the doctors any one of us would see if we came into contact with the NHS – responsible for day-to-day patient care, on the wards, in operating theatres, in clinics and GP practices, in accident and emergency – as well as working in medical research, teaching students, and taking on management roles.
They are the doctors who are responsible for much of the day-to-day running of the NHS, especially emergency care – and as a result they are the canary in the coalmine of the NHS.

What’s the dispute about?
Under the current contract junior doctors are paid a base salary – plus banding payments to reflect aspects of their work, especially unsociable hours. Those remunerated unsociable hours rarely reflect the hours junior doctors actually do. As Dr Fairbairns stressed over and over again – the NHS works on goodwill from all staff.
The current contract also protects time for on-the-job training.

3 years ago the NHS employers approached the BMA about renegotiation of the contract – doctors did NOT initiate this, this does not begin with ‘greedy doctors’ asking for more money.

What are the Junior Doctors being asked to accept?
The new offer is of an increase in basic pay – but the removal of banding payments. Above a 40 hour week junior doctors will be paid at an hourly rate. But unsociable hours will be redefined – so that unsociable hourly payments will not kick in until later.
In effect the contract will represent a pay cut for most junior doctors.

But the new contract is far more complicated than that.
– There will, for example, be differential weekend pay rates for part-time doctors. This disproportionately affects women doctors.
– An increase in unsocial hours will make it harder to manage childcare and may make it impossible for some doctors to carry on working.
– There will be no monitoring of hours, and no penalties for employers who contravene – and this in the context of a government seeking an ‘out’ from the EU working time directive
– There will be less time for training, less continuity of care.
– The arrangements for pay protection for the next 3 years are complex, poorly designed and won’t stop pay cuts for lots of doctors. More chillingly, they mean that the doctors qualifying now will earn considerably less than current doctors over the course of their careers.

The junior doctors are angry – and these changes explain why.
But the negotiations have taken place in a context of intransigence from the side of employers and government which have added to that anger.
And – for her audience perhaps most chilling of all – in the context of a crisis in morale which is unprecedented in the NHS.

Why is morale so low?
– the levels of debt faced by new doctors at the end of university are now huge – £60,000 is not uncommon – against real-terms pay cuts over the past 15 years
– micro-management, rising costs of necessary additional training, overwhelming paperwork
– the risk of prosecution if mistakes are made as a result of overwork
– the staffing shortages at ALL levels in the NHS – which makes everyone busier, less safe – and inefficient.

And all this in the context of the constant drip drip of negative stories – from government and media – including misusing statistics and research produced by doctors themselves to make ordinary people afraid of the NHS.

Hunt’s response to this anger has been to impose the contract, despite the fact that details have not been finalised.

Discussion in the meeting.

Dr Fairbairns painted a terrifying picture – of a Health service stretched to breaking point. Of an NHS which has long run on the goodwill, motivation and high levels of training and expertise of its staff – all threatened as demoralised staff are pushed to the point of quitting.
It was a picture underlined by other health service workers in the audience.
So too was a picture of a Health service undermined by constant privatisations – as yet not usually of the ‘sexy’ areas – but where, already, expertise is being lost, expertise which will never be recovered.

The immediate aim of all this is cost cutting – short term, inefficient – penny-wise now, but pound-foolish in the longer term.
But behind it lies the drip drip of privatisation – a privatisation which will not work, at least not to provide the sort of NHS provision for all which the great post-war settlement offered, and which the British people have – rightly – come to expect.
The NHS of the future will provide only the most basic needs, keeping body and soul together. Everything else will be paid for.

A Call for action

This is not the NHS as we know it. It is not the NHS the great bulk of British people want. But it is the NHS we will get unless we wake up to what is happening.
It’s our job to get out there and tell the story the mass media are – deliberately? – obscuring.
The meeting voted to do just that – starting with support for the Junior Doctors case, including mobilizing members for the NHS march and rally in Leeds on 16 April, and publicizing the threats the NHS faces.
This blogpost is a first step.
But we can all do our bit there – day-by-day – challenging the ill-informed comments we hear around us; defending the Junior Doctors – and the NHS.

Dr Fairbairns began by calling the Junior Doctors the canary in the mine of the NHS.
They’re the canary because they are everywhere in the NHS – their anger and disillusion is a warning of the anger and disillusion building throughout this greatest of British institutions.
They are the canary, too, because they’re at the very front – the first line of attack.
They’ve been taken on first because they were seen as an easy target. How wrong that was – 98% of them have voted for action, many joining up to the BMA just to register that vote. People whose first and last priority is the safety of their patients have been driven to this.
After them will come the nurses, consultants, porters, cleaners, scientists, technicians, secretaries, clerks – the NHS employs millions of people, and staff are both the greatest expense and the greatest asset.
In the end their fight is the fight for the NHS – OUR NHS.

We take the NHS for granted – we notice it when we need it. But like the goodwill of its staff on which it is built, it’s easy to lose, and will be very hard to recover when it’s gone. It won’t be there when we need it, and it will be too late.
The Junior Doctors need our support. And they should get it.

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