As strike action by junior doctors continues, the government is apparently in quandary over whether it is 'imposing' or 'introducing' the new contract. Whichever they choose, the contract will currently apply only to new junior doctors: the current Medical undergraduates. Yet their voice has been peculiarly neglected in the debate. I requested statements from two undergraduates, both of whom requested anonymity, on the new contract for junior doctors, what it will mean for them and what it will mean for the NHS.
A View from Nottingham University
As an undergraduate, what impression do you get of junior doctors' experiences, and how does that affect you as you prepare to become one yourself?
As a medical student at Nottingham, I've spent the last half a year logging on to Facebook and seeing a new paragraph shared by a friend consisting of an overworked junior doctor's experiences and frustration at the injustice of the new terms. My friends regularly share petitions attacking Hunt's mismanagement of the NHS and many have attended protests in the city centre, so it was surprising to see how few people responded when asked about the contract directly last week in our group chat. Perhaps we're tiring of what looks like an fruitless, unending struggle. One did respond, however, and expressed her frustration at the fact that we'll bear the brunt of any changes, being relatively voiceless as cushy students yet destined to enter the workplace long after the debate over the contract has ended. As she pointed out, after 4 more years of medical school, "it'll be too soon for any changes by a new government to affect us".
Another problem is the complexity of the NHS. We are of course also rather busy trying to learn just how the body works without considering the myriad aspects of the NHS in any spare time. The only time staff did mention it was when an out-going lecturer noted that, though lecturers were not supposed to politically influence students, he was leaving anyway and felt it right to encourage us to go to the local demonstration.
What impact will the threat to impose the new contract have on you and your colleagues as you move into that stage of the training?
I've spoken to international students, who make up a significant portion of our year, and some are considering applying to train overseas. When putting a student through medical school costs £250,000 (far more than the fees suggest), there is a clear risk of both a brain drain and a financial drain being triggered by graduates leaving to work in other countries, not to mention the problems that exacerbated understaffing will bring to the NHS. Our politicians talk of making the NHS leaner as if ignorant of our ranking near Slovenia in terms of healthcare spending per capita (The US and Switzerland spend roughly double per person, incidentally). There really isn't much left to cut. For every overspending middle-manager used as an example of bloat, there are many examples of where the money should be redirected, rather than cut off completely.
What impact will it have on NHS services if there is a bottleneck in the number of junior doctors due to an exodus overseas?
I personally believe there is a lot to say for the idea that the government is trying to carry out a stealthy privatisation of the NHS. If the first stage involved the involvement of non-profits and external providers, the second seems to concern the discrediting of privatisation's opponents. Doctors are generally ranked highly among the professions people trust the most. Throughout the last few months, the public has rallied behind doctors' protests on the streets and through social media. The current government, in comparison, was elected with a 37% share of the popular vote. It, in contrast to the BMA, has very little to lose in engaging with a bitter war over this contract. As months go by without resolution, they know public support for doctors will fade. The media will start publishing articles about particularly unpleasant deaths on hospital wards, linking it to ongoing strikes and portraying doctors as ideological extremists. It is far easier to link deaths to strike action than make the case that not striking and accepting the terms would lead to overworked and incapable doctors causing far more fatalities. Whether or not you believe in privatisation, this is undoubtedly a deceitful and destructive path by which to advance it. People's lives depend on their ability to trust doctors, and any attempt to tinker with that for short-term gain must be fought.
Perhaps the greatest problem is that our first real experience of the Department of Health will cause a generation of doctors who distrust their employer, as a friend of mine observed.
A View from University College London
What is your view on the new contract? Do the undergraduates at UCL talk about it frequently?
The vast majority of students at UCL are massively opposed to the new contract. The reasons currently given for needing a 7 day NHS may seem just, but are based on invalid, inapplicable data. Mr Hunt insists that more people die on weekends, but this a blatant lie; in fact, more people die on Wednesday than any other day. While a 7-day NHS would be amazing, a true 7-day NHS cannot compromise on patient safety and quality of service. These proposed working hours are unsafe, because tired doctors make mistakes. Also, people are annoyed that he's basically cutting pay by increasing hours and increasing pay by a lower margin, rather than just being honest and cutting pay. In regards to the imposition of the contracts, people feel that it's rather unfair, and completely undemocratic. He's now compelling trusts to enforce contracts by withholding training funding from them if they don't impose the contracts. Lots of people are considering moving abroad now, myself included, namely to Australia and Canada. It's made people so angry that it's a frequent topic of conversation. I went to a London Medicine Schools comedy show a couple of weeks ago and every other sketch was taking a dig at the new contracts. Even the lecturers sometimes mock Jeremy Hunt. There's some worry about the future of the health service: a lot of people believe the Conservatives wish to rid of the NHS, but they can't take it directly, so this is their approach.
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