The NHS is currently in the midst of a winter crisis. Many NHS Trusts are on black alert, which means the hospital is at full capacity: admissions are temporarily closed, escalation beds are in use, patients are waiting in A&E for beds, and routine surgery is being cancelled. Meanwhile, problems are so bad in General practice that the BMA's General Practitioners Committee (GPC) has called an unprecedented crisis summit later this month to discuss the ongoing problems. So on the face of it, there couldn't be a worse time for junior doctors to take industrial action over their proposed new contract. But as I will argue, Jeremy Hunt's deal is so unfair and unsafe, that it will lead to an exodus of junior doctors from an already highly pressured and understaffed NHS. This will undoubtedly have a long term detrimental effect on patient care and will put lives at risk. It is therefore essential for junior doctors to take action to protect themselves and to help prevent a worsening health service crisis with serious implications for public health.
Make no mistake - this is an incredibly difficult situation and although the published evidence shows that mortality rates may actually decrease during strike action, the risk of patient harm is not insignificant. Having an operation cancelled or delayed is an extremely distressing experience for patients and their relatives. They may well be left in pain or disabled by their current condition so treatment delays may be detrimental psychologically, physically and economically. There is also a risk that patients who have elective treatment delayed may present with an emergency admission at a later date. A good example would be a patient made to wait longer for a hernia operation who then presents as emergency admission with strangulation of the hernia. These events will be rare, but when thousands of patients with a whole range of medical and surgical conditions have treatments delayed, significant harm is possible by the simple laws of probability, even in low risk conditions.
So if patients are potentially going to be harmed, how as a doctor can I possibly support strike action? The answer is simple: If this contract is forced upon junior doctors, the longer term risks posed to the NHS and patient care far outweigh the risks posed by temporary strike action. The proposals are so unfair, that the NHS is likely to see an exodus of highly trained junior doctors. This country is already short of doctors and a number of specialties have a recruitment and retention crisis. Accident and Emergency and General Practice are good examples where training places have been left unfilled and there are high drop out rates. A recent survey has shown up to seven out of 10 junior doctors will leave the NHS if this contract is pushed through. Although this survey is likely to be subject to bias due to the current dispute, even if only one in 10 doctors left the NHS, it would have very serious implications for patient care, because junior doctors are one of the bedrocks of the health service.
The real risk to patients is not the industrial action of junior doctors, but government policy on the NHS, including chronic underfunding. We've already had a £20 billion efficiency savings program between 2011-2015 (Nicholson challenge), and a disastrous £4bn top-down reorganisation of the NHS, which have led to staff shortages, ballooning agency staff costs, and the current NHS crisis. Yet the government has chosen to inflict another £22billion of efficiency savings by 2020, whilst simultaneously trying to force through their undeliverable pie-in-the-sky manifesto pledge of a "seven-day NHS", where they expect more elective care to be done at weekends. This is precisely why they are forcing new contracts on all doctors and other NHS staff. The government wants an already over-burdened NHS workforce to shoulder the burden of their £22billion "efficiencies", by doing more unsociable hours, for the same or less pay. The abolition of nursing bursaries is another example of these "more for less" policies.
Thus, the crux of the current dispute between junior doctors and the government boils down to the very simple fact that the Government wants to make them work more unsocial hours (ie nights and weekends) to deliver their seven-day manifesto pledge, for no extra cost to the Treasury (a cost neutral contract). The simple maths means that however you jiggle the contract, it is inherently unfair, because doctors who work the most weekends and nights will be the most disadvantaged. These doctors just happen to work in the most hard pressed emergency specialties, where there are already serious recruitment and retention problems. If this contract is enforced, many will vote with their feet and leave the NHS with very serious consequences for the service and patient care. Therefore, we simply cannot allow this contract to proceed. NHS staff and the public should stand with junior doctors and force Jeremy Hunt and the Government to see sense and back down. It won't be easy, because the Government is ideologically committed to reducing public spending and continuing with its NHS "efficiency savings". Since staff salaries account for 2/3 of the NHS budget, contract changes to terms and conditions are crucial to the Government's approach, and if they can crack the junior doctors, the rest will follow. We will therefore need to be ready for a long and bitter battle with the Government and a sustained attack from the right wing media, which is already beginning. With such an unjust contract, which puts the entire future of our NHS and our public health system at risk, as a consultant, I owe it to the public to back the junior doctors' strike and help to keep patient care as high quality and safe as possible.