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No doctor chooses to strike without good reason – it goes firmly against the grain and our sense of professional duty – so why are the junior doctors in England going on strike but not those in Wales? It’s the same contract and the same pay so why the difference? Here’s my take on it as Chair of BMA Welsh Council.
Health is devolved and the four UK Governments have taken different approaches towards their respective health services and the manner in which they engage with doctors.
In England, there has been a fundamental breakdown in trust with junior doctors, for which the UK government is directly responsible. The BMA has attempted for two years to reach a resolution to this contract dispute, including proposing the involvement of the arbitration service ACAS, which the UK government initially rejected.
Despite this, the UK government has repeatedly threatened to impose an unsafe and unfair contract in England, while Welsh Government has rejected imposition in favour of a more mature collaborative approach.
The biggest threat to patient care is the UK government’s insistence on removing safeguards which prevent junior doctors from being forced to work dangerously long hours without proper rest breaks, with patients facing the prospect of being treated by exhausted doctors. This is something from the past we fought successfully to change for the better. The BMA wants a contract that is safe for patients, fair for juniors and good for the NHS. This is well supported: the BMA’s ballot of its members received a near unanimous vote for industrial action in England.
So why is Wales different?
There is a commitment in the NHS in Wales, that whatever the solution, it will come from collaboration not confrontation. In the longer term, we believe the Health Minister, Mark Drakeford’s ‘Prudent Healthcare Agenda’ may translate into better health and a sustainable NHS. Just as we welcome the fact that Wales dares to tread a different policy path aimed at preserving Bevan’s principles, we are encouraged by Welsh Government’s recognition that doctors have a key role in delivering this vision. Doctors are, therefore, respected partners.
Rather than insisting on undeliverable routine services seven days a week, Wales is working to ensure safe services 24/7 first. The latter is still highly challenging, but it engages the profession specifically because it recognises patient needs and priorities.
Welsh Government’s statement that it does not intend to impose contract changes is recognition that we are all in this together for better or worse; that we must jointly persevere in striving for better, and not shy away from tackling deficiencies and differences. Our challenge, in 2016, is to work together to deliver an NHS and healthcare education system in Wales that materially and manifestly makes Wales a highly desirable place to live, work and train in.
Doctors come from varied cultures and backgrounds – in amongst the 53,000 juniors, many of whom will be on strike today, there are bound to be some richer, some poorer, with a variety of political views and leanings. Yet, they are united because they care enough about the NHS in England to take the action they feel they have been backed into by an increasingly belligerent Health Secretary. And we stand as one profession with them.
Thankfully, because of the Welsh Government’s willingness to negotiate rather than impose contract changes, the doctors in Wales are not in dispute with their employers – and long may that remain the case.