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Imposing Figures, Imposing Contracts: How 2016 Compares With 1975 For Junior Doctors

08/04/2016 11:02 | Updated 08 April 2016

After another 48 hour strike by junior doctors, the clock is still ticking for Jeremy Hunt to come off his bike and move back into the negotiating room.

With a National Health Service that is running on empty amidst swingeing economic austerity, it has been more than a major inconvenience to junior doctors that the government has decided to expand routine clinical care across the whole week. A 'cost neutral pay envelope', lack of workforce expansion and serious questions asked about both the logistics of balancing training with service delivery and work-life balance have caused emotions to boil over. Raised eyebrows have been followed swiftly by raised placards, as was the case in 1975. The big difference is that the mutual agreement of the 1970s stands in stark contrast to the current dispute, with the threat of contract imposition drawing closer. What makes the current dispute all the more remarkable is that in 1975, only 56% of junior doctors voted in favour of industrial action, compared with 2015, when more than 99 per cent voted in favour of industrial action short of a strike and 98 per cent for full strike action.

The 1975 strike arose against a background of economic crisis and civil unrest among public sector workers. Reduced public spending from a growing national debt meant that the government of the day sought a loan to maintain economic stability; with a strict wages policy put in place. Amidst a lack of coordination within the BMA, it was the determination of junior doctors that led the government of the day to back down. Giving junior doctors a more powerful political voice has therefore been critical to their views being heard.

Changes in way in doctors are viewed by society weigh heavily on the Profession. Even in the 1970s, this was commented on by Douglas Pourier, President of the Medical Practitioners Union, when he said "...it is becoming increasingly apparent that doctors have continued to slip in the league tables of comparable professions...". This was probably more so for junior doctors, described as the "industrial anchor" of the medical profession. Both now and then, moving from medical sectarianism to a de-classed group of disenfranchised workers who have aligned themselves with Trade Unions has also left junior doctors feeling uncomfortable about the way in which their profession is viewed. During the 1975 doctors' strike, the sight on national news of white coated doctors carrying banners and leaving work at 5pm on the dot was a sight to behold. How could it be that these professionals of great integrity had taken it upon themselves to adopt the ways of the "militant?" A similar view echoed by the present government, describing junior doctors as having been 'radicalised'.

Doctors' working hours have remained high on the agenda for change for decades. In May 1976, the Liverpool Daily Post reported the death of a consultant anaesthetist who fell asleep at the wheel of his car after working 24 hours non-stop. No small wonder then that junior doctors now question the remote possibility of reducing maximum working hours at the same time as increasing their overall workload.

Other similarities also exist. In 1975, the newspaper of the Junior Hospital Doctor's Association remarked that 450 doctors per year were leaving the UK, this being equivalent to 1 in 5 of the total annual output of medical school graduates. This is not dissimilar to current exodus of doctors, particularly from Emergency Medicine. It is estimated that if all 482 junior doctors who applied to work abroad this month alone actually do leave the UK, it will be at a cost of £144 million to the taxpayer.

Several differences exist between this current contract dispute and that of 1975. The1956 Guilleband Committee reduced medical representation on government bodies from a near majority to fewer than 25%, with the role of doctors in senior decision making limiting their influence on negotiations. In 1973, junior doctors were granted an independent "craft committee" that meant a stronger voice in negotiations. Yet in 1975, a schism still remained between the Junior Doctors Committee and the BMA, compared to the unity of today between junior doctor and consultant bodies. In 1975, there was also no wish to expand service delivery.

The impact of today's social media towers above the standard television, radio and print media available at that time. The use of instant information sharing in 2016 is a far cry 1975. During the 1970s strikes, a managing director from an engineering company quipped to a junior doctor "There are two types of strike that never worry me--those that start before Christmas and those run by amateurs. Yours is both. You haven't got a chance." This is a world apart from today's carefully planned protests and e-petitions. Today's newly qualified doctors also differ from those in the 1970s, now carrying with them substantial debts from tuition fees, on-call accommodation fees, and increasingly unaffordable housing. Lastly, there is considerable support at present for junior doctors. In 1975, the public was sympathetic but many patients still hoped for a "just" solution to the dispute. Recent polls from Sky and ITV show almost overwhelming public support for junior doctors. A poll by one newspaper found that 93% of people put the blame for the dispute, firmly at the feet of the government.

So what, if anything can we learn from the 1975 strike? Although the government has now carried out a equality impact assessment and an admission that some groups of doctors may be financially disadvantaged, it is pushing full steam ahead with contract implementation. Above all, the 1975 strike has shown us that unity, peaceful protest, public education and rational challenges to flawed logic should rightfully win the day. The problem is that the government's door is closed and the key to unlock it remains with a public that is well informed by rational debate and not swayed by political spin.

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