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(or....The Road So Far and The Road Ahead)
On Saturday the BMA Junior Doctors Committee voted to ballot for Industrial Action. It is the single most important decision that it has made in decades. It was a decision arrived at after much careful thought. It was unanimous. And it was the right decision.
On occasion the BMA can seem a distant, even remote organisation. And it can also be frustratingly slow to act, and too trusting of the Government of the day’s good intentions. It is also too often guilty of attempting to operate in splendid isolation from other Trade Unions.
The reason I joined however, and why I could not help but get more involved is simple. Despite its flaws the BMA is the ONLY organisation which represents all UK doctors. It is the ONLY organisations which is mandated to negotiate on behalf of ALL doctors and it is an organisation which, over the years, has consistently fought to protect patient welfare.
As a relatively new member on the BMA’s Junior Doctor’s committee I feel it necessary to provide for all who are interested a potted history of how we got here. I have been asked this question by my medical colleagues on many occasions. Here is my attempt to answer that question.
In 2012 the Coalition Government successfully pushed its pernicious and far-reaching “Health and Social Care Act” through Parliament. In doing this, the Government clearly signalled its intention to transform the NHS into an ostensibly “competitive” health service. Fresh from that victory the then Coalition government initiated a process to reform both doctor’s contracts and the contracts of our health worker colleagues. Why this push for reform? The recently published DDRB report leaves us in no doubt as to the Governments true purpose. That purpose is best summarised in two words; cost containment. If a government chooses to cut public spending, it has to cut the NHS. If it has to cut the NHS it has to cut its workers pay. Our working conditions and even more importantly our patients’ safety, were to be sacrificed at the altar of Austerity. Let us pause and consider an objective fact: Her Majesty’s present Government has no concern for the wellbeing of either patients or NHS staff.
In October 2013, with integrity and good faith our negotiating team embarked on talks with the Government over our future contract. The BMA sought to put training, patient safety, a decent work-life balance and fair remuneration at the heart of any new contract. With systematic bad faith the Government chose to render any fair negotiated contract impossible. It reneged on each of the key promises it had made to the BMA at the start of the negotiating process.
In October 2014 the BMA withdrew from a process which had become a negotiation only in name. It had transformed into an attempt by government to gain our complicity in accepting an unjust contract. The government had dropped its mask. Its contempt for both patient safety and for the challenges which we face as working doctors was clear.
Many Unions, including the BMA, come in for a lot of criticism. They can be criticised for being too “militant” and they can be criticised for being to “soft”. The BMA has received its fair share of both of these charges. However, to all critics, from whichever direction, I would say this: if the BMA did not exist the present contract reforms would have been imposed with ease 2 years ago. The BMA is the last line of defence for tens of thousands of junior doctors and the millions of patients which rely on them.
When talks collapsed in October 2014 the Government chose to refer the whole situation to the DDRB (the “Doctors and Dentists Review Body”). The DDRB is a pay recommendation body ostensibly independent from Government. It was tasked with coming up with recommendations on what our future contract should look like. At the time, the odd nature of the Government’s decision to refer the process to the DDRB did not escape our attention; only a few months previously the Government had actually chosen to ignore the DDRB’s recommendation of a 1% pay-rise for doctors. A possible explanation for the referral is that the government was buying time; it wanted to avoid a direct confrontation with doctors in the run-up to the May 2015 General Election.
After the general election, over the summer of 2015, the new Conservative government, unshackled, moved swiftly. One of its first acts was to initiate the passage of the Trade Union Bill through Parliament. This seeks to provide the legal basis for unprecedented curtailments on Union activity in the UK. It is objectively the most restrictive piece of anti-Union legislation in Western Europe. The government is well aware that its policies in both health service reform and in other spheres of the economy will inevitably lead to a period of significant unrest in industrial relations.
In July, on the same week as the Trade Union Bill’s introduction to Parliament, the DDRB report was published. On all substantive points the DDRB report endorsed the Government view on the doctors’ contracts whilst disregarding the concerns of the BMA. The details of the report are well known and can be found on the BMA website or downloaded in full 1,2. However, it may be useful for the purposes of this text to distil the essence of the report into one phrase: In the name of cost-containment the DDRB proposals hand our Employers all power over our working conditions whilst providing no contractual protection for us as a workforce and squeezing as much labour from us as possible, for as little remuneration as possible.
It is no surprise therefore that the independence of the DDRB process has been called into question.
In the wake of the DDRB report the Secretary of State then asked us if we would like to re-enter negotiations. On 13th August, at our JDC meeting, we voted overwhelmingly in favour of NOT re-entering negotiations. The reason was straightforward. Jeremy Hunt clearly indicated to us that a precondition for re-entering negotiations was our acceptance of the DDRB recommendations in full. If this sounds like a paradox it’s because it is. This was a sham offer of negotiation. It was an Ultimatum. An attempted Imposition was its logical consequence. Cameron, Hunt et al are not stupid. After all they have a clear aim: to achieve a less well-paid, “flexible”, thinly stretched, fragmented workforce with no safeguards against Employers whims.
When we said NO on the 13th August we knew that we had crossed the Rubicon. Some form of bold, co-ordinated action was inevitable. And over the past few weeks we have been heartened to see a growing and unstoppable tidal wave of support for this position on social media.
So, given the decision taken on Saturday to ballot for Industrial Action, I wish to make a plea… in six parts.
Finally, and most importantly, whilst debates on social media are hugely valuable, NOW is the time to channel that anger into real politics. Join the BMA. Your power as an individual has the potential to be multiplied a thousand-fold. Get down to your local meeting. Hit the streets. Pick up your ballot paper and vote for Action. Let’s get moving.
by Dr Yannis Gourtsoyannis, BMA UK Junior Doctors Committee Member. Infectious Diseases SpR.
In reply to Anonymous:
This is a really interesting discussion - thanks, Yannis, for kicking it off!
As an outsider, it's interesting to hear how JDC have reached the current position. I think the commenters make really really good points too. This is going to be a difficult fight, but I personally think we need to have evidence and professionalism on our side. Those are some of our best qualities as doctors. That's not to say we shouldn't make political points or point out hypocrisy forcefully. But we need to make sure that the membership remains (as far as possible) united in the fight. Crossing the line the line into insults and aggression would probably leave us split, as the comments here demonstrate. I don't know where the line between forceful point-scoring and insults lies, so it's probably a good job that it's not my call!
The other good thing about sticking to clearly cited evidence and direct quotes is that it might help avoid the debate getting sucked off topic (into whether the Conservatives really care or who said what in which manifesto!)
I think JDC can demonstrably say they've judged well and done a good job on uniting the profession so far. After all, didn't they cause the new member signup site to crash over the weekend?!