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YOUR UNION CALLS!

(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.

Beginnings

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.

Breakdown

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.

Acceleration

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.

The Fightback

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.

  • Do not under-estimate what is at stake. This is the final, definitive battle over whether a workable NHS even continues to exist. Do not emigrate for balmier climes. Do not flee to the comfort cushion of Private Practice. Stay and fight. We have often as Doctors emphasised our leadership role within the NHS. We have often decried the Governments ignorance of our professional responsibilities. Now therefore is the time to step up to those responsibilities, to reach out to and collaborate with our fellow health workers, to change the tone of public discourse. History will judge us harshly if we fail to do so, and rightly so.
  • As junior doctors we are proud to be true professionals, in that we live by a code of rigorous, disciplined training welded to a public good. As professionals we have more in common with nurses, teachers, scientists, police officers and other public servants, rather than the shiny misnamed “professionals” in management, marketing and the financial services. Our interests lie with the health worker colleagues with which we interact on a daily basis. They face their own struggles too, against a common enemy. Let’s pick up the conversation again. Let’s start helping each other out. Let’s speak up for each other.
  • For the time being the Media is relatively favourable towards us. This may rapidly change, soon. If, or most likely when, the media headlines turn against us we should bear in mind that media opinion is not the same as public opinion. The British public possesses an intelligence which is too often underestimated. Have faith in public opinion. It will be on our side
  • Industrial Action, agitation and mass mobilisation are not alternatives to negotiation, or even reflective of a failure in communication with Government. If we are to stand any chance of changing the Governments position various forms of Action are in fact necessary tools to be deployed before, during and after negotiation.
  • We are entering a period which will entail many challenges both foreseen and unforeseen. The process going forward will be long and arduous. The legal barriers we have to overcome in the coming weeks and months will mean that at times it can be tempting to feel frustrated. Nurture your patience. Rest assured that the BMA will stand with you.

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.

 

  1. http://bma.org.uk/working-for-change/in-depth-junior-and-consultant-contract/ddrb-recommendations-analysis-for-juniors

  2. https://www.gov.uk/government/publications/contract-reform-for-consultants-and-doctors-and-dentists-in-training-supporting-healthcare-services-seven-days-a-week

 

14 replies

  • Anonymous
    Anonymous
    Statements like "Her Majesty’s present Government has no concern for the wellbeing of either patients or NHS staff" make me lose faith in the BMA. This is not "objective fact". The Government is made of people, people who have all been and will all be patients at some point in their lives. Some, like the Home Secretary, have spoken publicly about their own longterm conditions and reliance on NHS services. These people also have relatives, young and old, some of whom rely on NHS services.

    Even if they were solely self-interested - and they are not, they have chosen to dedicate their lives to public service - your statement would be patently untrue (not to mention offensive).

    I strongly disagree with the Government's plans for the NHS. I will protest them. But there is simply no need for these sorts of personal jibes and insults. They are not worthy of the BMA's name, and exmplify an aggressive approach which the BMA is increasingly associate with. The Tories, whatever we a medical profession think of them, were elected with a huge popular majority in England. And even if you don't think that means they deserve basic courtesy, at least show enough respect for your membership body to not associate them with this sort of gutter political punching.
  • Anonymous
    Anonymous

    In reply to Anonymous:

    In reply to the above A) I disagree with you profoundly. We actually can indeed come to the conclusion that the Government has no concern for the well being of patients/NHS staff because there is overwhelming and accumulating evidence that points to this. From the passage of the Health and Social Care Act, to its public health decisions, to the manner in which Government has negotiated, to the specific proposals in the new contract. B) I at no point claim that Government MP's are solely self-interested as individuals. On the contrary, to be clear, they collectively represent the interests of one small, and very rich, section of society whilst enacting policies detrimental to most of the rest of the population. I do not call this 'public service'. C) I would remind you that courtesy is a two way process and urge you to examine the governments comments r.e the medical profession over the last few months.
  • Anonymous
    Anonymous

    In reply to Anonymous:

    Fantastic article placing the whole subject into a wider context - really interesting read, thanks!
  • Anonymous
    Anonymous

    In reply to Anonymous:

    Good response. Actions are what count and the approach to this contract speaks volumes as to where the priorities of this government lie.

    And let's remember another member of the government shamelessly using his son's disability and reliance on the NHS to buy credibility whilst he systematically lied about his intentions, for 'no top down reorganisation' in the run up to 2010 whilst holding behind his back the white paper for the largest top down reorganisation in its history.

    This government cannot be trusted. That is objective fact.

    I would add that ultimately public opinion is of limited importance in this battle. The tube unions rarely have the balance of public opinion on their side. What is important is that we are right and united we are powerful.
  • Anonymous
    Anonymous

    In reply to Anonymous:

    From my day-to-day ward experience, I would argue that courtesy is very often not a two-way process; but it is a cornerstone of professionalism. Just because someone is unpleasant about me doesn't mean I have to be the same way to them. The BMA could (and, in my opinion, should) rise above it with calmness, professionalism, and the strength of having rational, evidence-based arguments on their side; rather than slinging more mud.

    If the Government has no concern for the wellbeing of patients, why bring in plain packaging against the wishes of tobacco company lobbyists? Why ban smoking in cars? Why ring fence public health spending in local authorities? Why guarantee a real-terms increase in NHS funding? Why pay for a MenACWY vaccination programme? Why put so much international diplomatic work into antimicrobial resistance? In fact, why bother going to work every day? I think we would agree that the Government's health record is - to be diplomatic - poor. But to suggest they have no concern whatsoever is simply nonsense.

    This accusation and the tone it represents is insulting, unhelpful, and detracts from important rational messages about the reasons for balloting for industrial action. This should not be "The BMA against the nasty Tories"; it should the the BMA standing up for doctors and patients.
  • Anonymous
    Anonymous

    In reply to Anonymous:

    Would you like to point out where in the Conservative Party 2010 manifesto the 'no top down reorganisation' line appears? Or point out any point in the election campaign where a Conservative Party representative said this?

    Does the line appear before or after the section on page 45 which talks about the independent sector being allowed to provide NHS services? Before or after the section on page 46 which talks about GPs being put in charge of commissioning? These two are things for which it is repeatedly claimed that the Government had no mandate, despite being there in black and white - and both being pretty big hints of what the white paper contained.
  • Anonymous
    Anonymous

    In reply to Anonymous:

    I feel sorry for you. Your posts come across as hopelessly naive. The time for calm, professional stoicism is over. The Government is CHOOSING to force us into this position. They are dishonest and cannot be trusted and it is time to take action. They, with their dishonesty have chosen the game and it's not marquis of queensbury rules - it's a streetfight. Please step aside whilst everyone else looks after your interests.
  • Anonymous
    Anonymous

    In reply to Anonymous:

    It's hard to wade into a debate with so many "anonymous" people, but I think this is exactly the sort of interpersonal argument the original commenter wants the BMA to avoid. You might disagree with the poster's views, but they are no less valid than yours, and the BMA's job is to represent all doctors, not just those who shout loudest and hurl the most insults. No members should be called "hopelessly naive" or asked to "step aside" - unless, you want members who don't support your position to "step aside" out of the BMA and weaken everyone's position.
  • Anonymous
    Anonymous

    In reply to Anonymous:

    Yes, let's unite not be divided
  • Anonymous
    Anonymous

    In reply to Anonymous:

    Cameron said it to Andrew Marr one week before the election, on nationally broadcast radio. Yes, that's not in the manifesto, but it was a pretty clear statement. Salt and pepper with your words, or perhaps you prefer a plain meal.
  • Anonymous
    Anonymous

    In reply to Anonymous:

    Perhaps most infamously, the Conservatives repeatedly promised before the general election that there would be no more "top-down reorganisations" of the NHS (Andrew Lansley, Conservative Party press release, 11 July 2007). In a speech at the Royal College of Pathologists on 2 November 2009, Cameron said: "With the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS."

    In his 2006 Conservative conference speech, he said: "So I make this commitment to the NHS and all who work in it. No more pointless reorganisations."

    The coalition went on to launch the biggest top-down reorganisation of the service in its history
  • Anonymous
    Anonymous

    In reply to Anonymous:

    http://youtu.be/nH2EmVGowCk And then came 281 CCG's...
  • Anonymous
    Anonymous

    In reply to Anonymous:

    Well said. This fight is not going to be for the faint hearted!
  • 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?!