As they had threatened to do for months, British junior doctors went on strike on Tuesday, January 12, to protest against the government’s reform of their status, with the full support of the British Medical Association, but also a vast majority of public opinion. (See opinion polls below) On Tuesday, junior doctors organized so as to still provide emergency care, and they will do so too during another, 48-hour strike scheduled for January 26. But a full ‘walkout’ is planned for February 10, which will lead consultants and nurses to take care of Britain’s A&E departments (i.e., Accident and Emergency departments) alone.
For more information about the conflict, please read the articles below:
– a presentation of the current situation published in The Economist this week.
– an analysis by The New York Times, with interesting comparisons with the situation in the US.
– a populist take on the strike published in the left-wing tabloid The Daily Mirror.
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Strike one
The Economist, January 16, 2016
Junior doctors walk out over a change in their contracts
CARS honk cheerily as they pass a line of shivering junior medics, protesting outside the Royal London Hospital in east London during Britain’s first doctors’ strike in 40 years. Inside, most patients support the strike: doctors work hard, they say, and deserve a better deal than the one being offered to them by the health secretary, Jeremy Hunt. Further north, outside University College Hospital, an elderly passer-by goes further. “When the revolution comes,” she tells protesters, “you will have Hunt’s body for your dissection classes.”
The medics (some of whom, despite the term “junior”, are actually quite senior) are angry at Mr Hunt’s proposal for a new contract, intended to improve out-of-hours care, which he has threatened to impose on them if no agreement is reached. In the strike on January 12th they provided only emergency care, and will do so again in another picket on January 26th. In February a total walkout is planned, which would leave consultants, nurses and temporary staff alone to treat emergencies.
Round one has gone to the doctors: an Ipsos Mori poll this week found that 66% of the public backed the strike, which led to 3,300 operations being cancelled. But the same poll found that just 44% would support a strike that affected emergency care, as February’s would.
The details of the dispute are fiddly, concerning working hours, top-up rates of pay and working-time rules. But there are two, quite straightforward, main disagreements. The first is about how much the National Health Service (NHS) should police doctors’ working time. The British Medical Association (BMA), which represents doctors, and the Department of Health have provisionally agreed on rules governing the length of shifts, and on the creation of an independent “guardian” responsible for enforcing them. But the BMA wants stricter limits (for example, for consecutive long shifts to be capped at three rather than the offered five) and argues that enforcement will be weaker than before.
The second beef is about whether evening and weekend work should command higher pay than that between 7am and 7pm during the week. Assuming it should not, it is hard to disagree with Mr Hunt when he claims his reforms will leave 99% of junior doctors no worse off than before. Assuming it should, more doctors will lose out: although their basic pay will rise, top-ups for antisocial hours will be curbed (moreover, as this will make it cheaper for hospitals to roster doctors during these hours, more will be roped into evening and weekend shifts). The upshot, says the BMA, is that fewer doctors will take jobs in all-hours fields like acute medicine.
Mr Hunt’s goal of a seven-day NHS is laudable, but he has carelessly wound up medics by implying they do not work hard enough and by over-simplifying research documenting higher death rates at weekends. On the day of the strike he attempted to portray those staffing emergency departments as having “crossed the picket line”. Junior doctors (many already contemplating better paid, more leisurely careers in America or Australia) quickly turned against him.
The seeds of their resentment have been nurtured perhaps too enthusiastically by the leadership of the BMA, whose rallies resonate to juvenile abuse of a health secretary who, the doctors neglect to acknowledge, has a manifesto commitment to fulfil. That the rhetoric surrounding the strike suggests that the very existence of the NHS is at stake, and not just the pay and protections of a portion of its staff, perhaps concedes that the details of the matter do not match the scale of the action.
As the dispute goes on, at the Royal London Hospital the accident and emergency (A&E) waiting room is stuffed with runny noses and other non-urgent cases. “People used to go to their local priest for pastoral care; they now come to A&E,” says Chris Uff, a consultant neurosurgeon who recalls a well oiled reveller chasing down an ambulance on New Year’s Eve to ask whether he had money on his bus pass.
Such gentle grumbling about patients is common, but there is a more serious way in which the public is to blame for the sickness of the health service. The electorate that notionally adores “our NHS” and propels a saccharine song by health workers to the top of the Christmas charts shows remarkably little willingness to pay more in tax towards what remains a relatively cheap system. Without extra money and facing ever wider and wrinklier patients, the NHS must tighten its belt by £30 billion ($43 billion), or about one-fifth, by 2020. It is in this context that Mr Hunt is trying to expand services to evenings and weekends. Pity the well meaning health secretary, pity the hardworking doctors—and blame the sentimental but hypocritical British public.
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Junior Doctors’ Strike in England Disrupts Care for Thousands
By Stephen Castle, The New York Times, January 12, 2016
Operations were postponed and appointments canceled in a bitter dispute over pay and working hours between employers and junior doctors, a term that covers medical professionals with as much as a decade of experience.
With the junior doctors offering only emergency care, about 3,500 operations had been affected by Tuesday afternoon, including routine procedures for knee and hip replacements — prompting a warning from Prime Minister David Cameron that the labor action would create “real difficulties for patients, and potentially worse.”
Yet the dispute over the health system carries risks for the government. The National Health Service, which is funded by taxes and payroll deductions but has faced years of financial strain, delivers most treatment without charge. Despite regular funding crises, there has been no similar strike since 1975.
Mr. Cameron’s Conservative Party has always found it hard to make changes to the health service, which was created by the Labour Party in the 1940s and is now creaking under the strain of an aging population and tightened budgets.
In his memoirs, Nigel Lawson, a chancellor of the Exchequer under Prime Minister Margaret Thatcher, wrote that health practitioners regarded themselves as “a priesthood,” making the sector “extraordinarily difficult to reform.”
The National Health Service, he wrote, “is the closest thing the English have to a religion.”
It is also a significant presence in national life, employing 1.6 million people which, it says, puts it in the top five of the world’s largest work forces, alongside the United States Defense Department, McDonald’s, Walmart and the Chinese People’s Liberation Army.
Weekend shifts are at the heart of the current dispute. A proposed new contract would increase basic pay but would reduce the number of hours for which junior doctors receive added compensation for work, particularly on Saturdays.
The government argues that this would improve treatment by creating a genuine seven-day service, and the health secretary, Jeremy Hunt, on Tuesday highlighted the elevated mortality rates recorded for some medical conditions on weekends, when hospitals have fewer staff.
Speaking to the BBC, Mr. Hunt compared the situation of a hospital doctor to that of an airline pilot’s being told, “‘I’m sorry, but as it’s Sunday you don’t have a co-pilot, but off you go to New York.’”
The doctors counter that their stand against excessive working, and the strain it puts on them, makes them the guardians of safety in hospitals.
Officially, junior doctors are required to work a 48-hour week, but that is calculated over a 26-week period, and they can end up working long stretches, particularly over weekends.
The government insists that doctors would not be worse off under the new contract, but that is disputed by the British Medical Association, which represents more than 37,000 of the country’s 55,000 junior doctors and which describes the proposed conditions as “unsafe and unfair.”
The dispute has crystallized a broader set of worries and frustrations felt by many doctors working in a system in which demand for health care sometimes seems infinite, but for which resources are definitely not. When junior doctors were asked to authorize a strike last year, 98 percent voted in favor.
Some opinion surveys have suggested that public support lies with the medical professionals, at least in the initial phase of the walkout. The doctors are planning two more protests in the coming weeks: a 48-hour strike that would also affect nonurgent care, and another day’s walkout in which they would withdraw all treatment.
Several opposition politicians sided with the strikers on Tuesday. Justin Madders, who speaks for the Labour Party on health issues, said that junior doctors had been left with “no choice but to take this action,” while the shadow chancellor, John McDonnell, visited a London hospital picket line.
The dispute highlights a crucial distinction between the government-administered British health care system and the market-driven American approach to health care.
The National Health Service has been praised for providing universal access while being cost-effective, while the American system, despite the introduction of the Affordable Care Act in 2010, is still so expensive that many people cannot afford treatment.
Although British doctors can operate private practices, most participate in the National Health Service, making them subject to the government workplace rules that the junior doctors are now protesting.
In the United States, doctors are more likely to work in for-profit practices, with health insurers’ payment menus setting the rules.
Whatever the comparison, the British system is well regarded internationally by some measures, despite its stretched resources. A 2013 survey of 11 industrialized nations by the Commonwealth Fund, a nonpartisan health policy research group in the United States, ranked Britain No. 1 over all and at the top in categories including quality of care, patient access and efficiency.
The United States was ranked at the bottom over all, despite having the costliest care per capita ($8,508), compared with Britain’s lowest cost by this measure ($3,405).
The National Health Service fared less well compared with other European countries, however. A 2014 survey by the Health Consumer Powerhouse, which is based in Sweden, ranked England’s health service 14th out of 36.
Like other aspects of the dispute, the scale of the strike in England was contested on Tuesday. The British Medical Association said that “tens of thousands of junior doctors” were striking, but N.H.S. England, which leads the health service, said that 39 percent of junior doctors, out of a possible 26,000, had reported for duty on the day shift. The current action is scheduled to end Wednesday morning.
Johann Malawana, who leads the medical association’s junior doctors’ committee, said that his members felt that they had no alternative but to strike, and appealed to ministers to address “concerns around safe working patterns and ensure the contract recognizes the long, intense and unsocial hours which junior doctors do.”
Anne Rainsberry, the national incident director for N.H.S. England, apologized to all patients affected. “It’s a tough day,” she said, “but the N.H.S. is pulling out all the stops, with senior doctors and nurses often stepping in to provide cover.”
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No doctor anywhere should be allowed to abandon their patients like striking junior doctors did
Op-Ed by Carole Malone, The Daily Mirror, 16 January 2016
The strike was chosen over new contract terms, they say – but what of the people suffering and in pain who have no choice at all
Someone needs to explain to me how any doctor who has taken a sacred vow to save lives and whose career is dedicated to healing the sick can then abandon desperately ill patients because they don’t like the terms of their new contract.
No doctor anywhere should want or be allowed to do that. Not for any reason. And those striking junior docs can say as often as they like they had no choice but to strike – but they absolutely did.
The people who had no choice were the cancer patients whose operations were put on hold. The blind people whose cataract ops were cancelled. The people who still can’t walk because their hip ops were scrapped. And the thousands more who are still in agony because the medics in charge of their care walked out on them.
These striking doctors cannot keep saying that no patient’s life will be in danger during these walkouts. Because if they’re so overworked, so strapped for staff, so short of resources how can the absence of 40,000 of them NOT be dangerous?
Most of us have good reason to be grateful to doctors. We also know from personal experience many of them work like dogs and do stuff that is above and beyond the call of duty.
And that’s what makes these strikes so impossible to understand – that people who have dedicated their lives to healing the sick can desert their patients for one hour, let alone 24.
I don’t get the mindset of a doctor who can do that knowing their patients could come to harm, even if they try to justify it by saying it’s only for a short time.
And how in God’s name can a doctor abandoning his patients ever improve patient safety, which is what they claim the strikes are all about?
Whether any of the parties involved choose to admit it or not, these strikes have become political. Why else would a BMA boss say they would “signal the first real crack in the entire edifice of austerity in the UK”? THAT’S political.
But health care has to transcend politics. Because it’s not the Tory party or ministers who are suffering here (most of them probably have private health care). It’s ordinary people, sick people, powerless people.
So the question is – is it wrong for any government to want an NHS which offers the same level of service every day of the week, not just Monday to Friday? Is it wrong to want to reduce a doctor’s 91-hour week to a 72-hour week?
These doctors need to forget politics and remember why they came into the job.
They also need to stop their union walking away from the negotiating table and they need to forget their old contracts and remember that Jeremy Hunt (or any health secretary) has the power to impose new contracts with or without their consent. They also need to stop sounding like they’re the only people who work unsocial hours and at weekends.
Millions do but they don’t get anywhere near as well rewarded for it as doctors.
Nor are they respected and idolised the way doctors are.
Currently, they have the public’s support – but only because we don’t know if anyone died.
And I’ll bet many of the people supporting the strikes haven’t been personally affected or had someone they love left in agony by them.
But it’s funny how people see disputes. In this one I don’t actually give a toss about the doctors or Jeremy Hunt.
All I can think about are the thousands of frightened, vulnerable people who last week thought the pain that had defined their lives for months, maybe years, was about to end – only to discover it didn’t because a bunch of pig-headed politicians and medics were arguing the toss over a clause in a contract.
The CONDORCET 