The row over the imposition of the Junior Doctor contract has been ratchetted up yet another notch as England now faces its first ever full Junior Doctor strike, including the withdrawal of emergency care. Neither side has given any indication that they are going to concede defeat. The BMA has ordered 4 non-emergency strikes to date and is pursuing legal action against the Department of Health. In return, the government has repeatedly accused the BMA of misleading Junior Doctors, endangering patient care, and most recently, "trying to trying to topple the government".
In ordering this all-out strike, has the BMA gone a step too far? Or is the government responsible for forcing the Junior Doctors into striking?
Whose Fight is it Anyway?
Ever since Jeremy Hunt's statistics about weekend death rates were shown to be phoney, according to both the authors of the main studies and the government's own Health Select Committee spokeswoman, Hunt and Cameron have effectively stuck to the tried and tested Tory line of defence- blame the trade union. Hunt has repeatedly accused the BMA of a wide range of allegations, from lying about working hours to "trying to topple the government", as the BBC reported yesterday.
However, a cursory look at the evidence shows that the strategy of simply blaming the BMA is deeply flawed. If we go back to the start of the dispute about strike action, we find that the call for strike action did not come from the BMA leadership rallying the medical workforce for an ideological political cause. Rather, this debate about strike action started because an online petition was launched that received 94,330 signatures imploring the BMA to ballot Junior Doctors for strike action. Of course, the BMA could have ignored this petition and carried on their daily business. But I doubt any member of any trade union would deem this an appropriate response, given the sheer size of the petition.
Thus, these strikes are not happening because the BMA ordered the Junior Doctors to leave their posts. Rather, it is because the Junior Doctors ordered the BMA to ballot them on strike action, and the BMA acted in accordance with the unambiguous wishes of the overwhelming majority of their large membership. And it is worth remembering that the strike ballot saw 98% of Junior Doctors vote in favour of full strike action.
The Health Secretary obviously wants to paint this conflict as between the government and the mighty and corrupt BMA. However, this is simply not the case. This conflict is between the government and the vast majority of the Junior Doctor workforce in England.
Is An All-Out Strike Too Far?
However, Junior Doctors and their representatives in the BMA must accept a significant degree of responsibility for the consequences of the all-out strike. Many people fear that the strike will endanger patient safety and potentially even increase mortality. Could this all-out strike really jeopardise the well-being of patients?
This question is very difficult for anyone to answer. We know that there will be a large withdrawal of Junior Doctor Cover in A&E departments across England. However, we also know that these Junior Doctors will be replaced by increased Consultant Cover, as well as increased cover from allied health professionals such as nurses and midwives. Therefore, the overall workforce covering A&E departments will change in make-up, but not necessarily in overall sized.
Nonetheless, it is impossible to objectively predict exactly what impact this shift in A&E workforce will have on patient safety. The NHS has never seen a full withdrawal of one type of healthcare professional, and A&Es deal with such diversity and fluidity of patient presentations that predicting overall morbidity and mortality on a particular day is virtually impossible anyway.
So how can we possibly tell if an all-out strike is defensible? For me, there is only group of people who can justifiably make that call; that is the people who know the thorough ins and outs of A&E workload, patient problems, staffing protocols and how all of these would respond and interact in the new situation of a strike. I think the Junior Doctors themselves are in the best possible position to judge whether this strike will endanger patient safety or not. Therefore, it is my belief that the Junior Doctors who withdrawal their emergency cover (which may not be all A&E Junior Doctors in England) will do it in the best possible knowledge that patient safety will not be endangered.
Junior Doctors are trusted all over the country, every hour of every week, to look after the health of their patients. My plea would be that none would be swayed by the spun conspiracy theories from the government that the BMA to trying to destroy Westminster. Rather, I would appeal for trust that this country's doctors will continue to do what they are the best in the world at doing- looking after their patients.