Whatever the rights and wrongs of the stand-off between the government and junior doctors, failure to reach agreement on a new contract is bad for patients and for staff. The all-out strike planned for the end of the month will cause disruption and delay for patients, and add to the pressures on staff who cover for absent colleagues. It will also create dilemmas for junior doctors torn between loyalty to their peers and their primary – and strongly felt – duty to patients.
The dispute may also affect recruitment into medicine and the willingness of newly qualified doctors to practise in England. It will have an impact too on the discretionary effort of junior doctors who form the backbone of patient care throughout the NHS. We know that patient experience is closely correlated with staff experience, and when a key group of staff is feeling undervalued patients will notice the difference.
The King’s Fund has intentionally not taken sides in a dispute in which total lack of trust between the two sides has been overlaid on outstanding differences on the contract itself. We are speaking out now to suggest a way of circumventing the impasse that has been reached, in the hope that a resolution may be found. Our suggestion is that the presidents of the royal medical colleges should reach out to the Prime Minister to offer their services in finding a way forward.
It might be objected that the royal medical colleges have no locus in negotiations about doctors’ contracts, which is firmly the responsibility of the BMA. This is of course correct but they do exercise leadership on standards of medical care and the training of doctors. There have also been occasions in the past when college presidents have seen fit to go beyond their formal responsibilities to make known their concerns.
This happened in 1987 when a crisis in NHS funding led three of the most senior college presidents to call on the government of the day to take action in protecting patient care. The dispute over the junior doctors’ contract is different, but it is beginning to affect patient care and if it continues the consequences could become much more serious. Already there are shortages of doctors in some specialties and a prolonged dispute risks accentuating these shortages.
When two sides disagree so fundamentally, intervention by a respected third party is necessary. In this case the college presidents are well placed to take on this role if they can find the will to take the initiative. Statesmanship among medical leaders is needed now more than ever. Patients deserve nothing less.
The idea of a neutral third party was explored through ACAS. It appeared that progress was being made. Unfortunately the process was not completed in time for agreed implementation by the arbitrary deadline of August 2016. Given the success of the ACAS process, introducing a fourth party seems unnecessary.
Ironically, both sides may perceive the Royal Colleges to be close to the other for true independence. Doctors wear many hats. This is another reason for adjudication from outside the profession. The government erred when they first undermined the independent authority of the DDRB and now there are questions over attempts to manipulate that board.
The real problem is that currently it is not in the interests of any single actor to back down unilaterally. Even officials at DH and NHSE stand to lose face, and employment, if they admit that the SoS was badly briefed in the first place.
The only way to de-escalate is through a bilateral process. Everyone will need to take a chance. The Colleges might offer the safe space to broker how this could happen. It seems that we may need to start with 'talks about talks'.
Personally I am always happy to listen to those in a leadership position and see whether there can be a solution, however I simply don't understand a government that's opening gambit was imposition and then simply stopped talking.
I agree though that nothing can be achieved without talking, but the problem I see is despite every effort to try and talk to the government, everyone that talks to the government seems to get the same answer, without junior doctors giving up everything the government won't talk to us.
Even when third parties talk to the government the answer is the same, the juniors must give up everything government wants, put it in writing so we can show that you have given it up, and then we can talk about implementation.
I fear that with that attitude we are heading for a very worrying place. Even as someone massively committed to the NHS and this country, I am simply not seeing what kind of employment that is a positive thing we as doctors can see in the future.
I look at my GP colleagues, many giving up due to stress and ill health, I look at consultants that are so demoralised by a system that treats them as spoilt children that need to be put in their place. Is this what years of not being trained in the NHS as a junior doctor has waiting for us? Is this what being abused on the frontline of the NHS will eventually lead to? You can see why junior doctors take a look at the governments attitude and think actually what other choice do we have. Apart from a slow inevitable decline in the NHS.
The fact that the JDC agreed to a cost neutral envelope originally says everything about how this was not about money. Juniors just didn't want to be abused anymore. However instead of dealing with those issues the government used the very mechanism we entered into in good faith to abuse us even more, and lock that abuse in so we have very poor mechanisms to actually even complain anymore.
Sorry Chris. I am very much like the 54000 doctors I represent. I am demoralised after 11 years in a system that simply treats everyone around me as the problem. When actually the problem is at the very top of the NHS and government that does not understand that without the frontline, any organisation is doomed.
Thanks for the comments. My point is that the presidents should act collectively and publicly. The time for informal approaches and discussions behind the scenes has passed. it would be difficult for the PM to reject a united approach - if that can be achieved.
A number of College presidents have already been very forthright in expressing their concerns about this entire omnishambles and, thus far, they appear to have been roundly ignored.
Mr Hunt seems to want to do nothing so much as the political equivalent of sitting in his office at the DoH in Whitehall with his fingers in his ears shouting "La-la-la-la, I can't hear you..."
He began this debacle standing up at the King's Fund and insulting our professionalism by telling us that what ALL doctors *needed* was a new contract (of all things) to renew our sense of vocation... (!).
Everything that has followed has been little more than political willy-waving by the Secretary of State.
He has refused to listen so far, even when publicly chastised from many directions for misleading the public through his blatant misrepresentation of data — why would this be any different...?
If Sue Bailey (AoMRC chair!) isn't already in discussion with Bruce Keogh, I'd be deeply disappointed.
However, if they are, they need to produce *outcomes* - suggesting solutions like shelving Sat working changes from the new contract for the time being, seeing how things pan out (presumably under a new SoS), and revisit the detail of Sat arrangements (& maybe hours monitoring & control) then.
Our staffing is in crisis - most of us are on our knees - and both DH & HEE seem in complete denial (or ignorance) about the extent of this, judging by the performance at the Public Accounts Select Committee on 23 Feb.
As was mentioned in Parliament today, a cohort of doctors is being at best disaffected, and at worst put off pursuing their career - just when we really need them. If SB & BK aren't speaking daily this week, & frantically networking behind the scenes indirectly with BMA contacts & Confederation bosses among others, then NHS 'leadership' - never mind statesmanship - is dead, in my view.
It's a good idea, Chris. But how on earth did this get so personalised? Would the PM really want to sideline his SoS by getting involved? And there is real fragmentation at the top of medicine. One wonders how many different answers there are to the question of who leads the medical profession? I have never thought it was the CMO. Bruce Keogh is often called Britain's Top Doctor (which might cause amusement in the devolved nations). Yes, maybe the the Medical Royal Colleges - but they conglomerate into the Academy (AoMRC) and can anyone name its Chair?
Surely the Government's own Chief Medical Officer should be playing a leadership role? This is, after all, the most important crisis affecting the medical profession for decades.
Comments
The idea of a neutral third party was explored through ACAS. It appeared that progress was being made. Unfortunately the process was not completed in time for agreed implementation by the arbitrary deadline of August 2016. Given the success of the ACAS process, introducing a fourth party seems unnecessary.
Ironically, both sides may perceive the Royal Colleges to be close to the other for true independence. Doctors wear many hats. This is another reason for adjudication from outside the profession. The government erred when they first undermined the independent authority of the DDRB and now there are questions over attempts to manipulate that board.
The real problem is that currently it is not in the interests of any single actor to back down unilaterally. Even officials at DH and NHSE stand to lose face, and employment, if they admit that the SoS was badly briefed in the first place.
The only way to de-escalate is through a bilateral process. Everyone will need to take a chance. The Colleges might offer the safe space to broker how this could happen. It seems that we may need to start with 'talks about talks'.
Personally I am always happy to listen to those in a leadership position and see whether there can be a solution, however I simply don't understand a government that's opening gambit was imposition and then simply stopped talking.
I agree though that nothing can be achieved without talking, but the problem I see is despite every effort to try and talk to the government, everyone that talks to the government seems to get the same answer, without junior doctors giving up everything the government won't talk to us.
Even when third parties talk to the government the answer is the same, the juniors must give up everything government wants, put it in writing so we can show that you have given it up, and then we can talk about implementation.
I fear that with that attitude we are heading for a very worrying place. Even as someone massively committed to the NHS and this country, I am simply not seeing what kind of employment that is a positive thing we as doctors can see in the future.
I look at my GP colleagues, many giving up due to stress and ill health, I look at consultants that are so demoralised by a system that treats them as spoilt children that need to be put in their place. Is this what years of not being trained in the NHS as a junior doctor has waiting for us? Is this what being abused on the frontline of the NHS will eventually lead to? You can see why junior doctors take a look at the governments attitude and think actually what other choice do we have. Apart from a slow inevitable decline in the NHS.
The fact that the JDC agreed to a cost neutral envelope originally says everything about how this was not about money. Juniors just didn't want to be abused anymore. However instead of dealing with those issues the government used the very mechanism we entered into in good faith to abuse us even more, and lock that abuse in so we have very poor mechanisms to actually even complain anymore.
Sorry Chris. I am very much like the 54000 doctors I represent. I am demoralised after 11 years in a system that simply treats everyone around me as the problem. When actually the problem is at the very top of the NHS and government that does not understand that without the frontline, any organisation is doomed.
Best wishes
Johann
Mr Hunt seems to want to do nothing so much as the political equivalent of sitting in his office at the DoH in Whitehall with his fingers in his ears shouting "La-la-la-la, I can't hear you..."
He began this debacle standing up at the King's Fund and insulting our professionalism by telling us that what ALL doctors *needed* was a new contract (of all things) to renew our sense of vocation... (!).
Everything that has followed has been little more than political willy-waving by the Secretary of State.
He has refused to listen so far, even when publicly chastised from many directions for misleading the public through his blatant misrepresentation of data — why would this be any different...?
However, if they are, they need to produce *outcomes* - suggesting solutions like shelving Sat working changes from the new contract for the time being, seeing how things pan out (presumably under a new SoS), and revisit the detail of Sat arrangements (& maybe hours monitoring & control) then.
Our staffing is in crisis - most of us are on our knees - and both DH & HEE seem in complete denial (or ignorance) about the extent of this, judging by the performance at the Public Accounts Select Committee on 23 Feb.
As was mentioned in Parliament today, a cohort of doctors is being at best disaffected, and at worst put off pursuing their career - just when we really need them. If SB & BK aren't speaking daily this week, & frantically networking behind the scenes indirectly with BMA contacts & Confederation bosses among others, then NHS 'leadership' - never mind statesmanship - is dead, in my view.
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