Over the past few weeks, we have seen remarkable events play out as a new generation of young doctors have been politicised and radicalised. This culminated in marches last month in London and several cities in which thousands of doctors poured out on to the streets to vent their fury against the government over the threatened imposition of a new contract for junior doctors. Amongst other things, this contract would redefine anti-social hours (such that working on a Tuesday morning would be deemed to be the same as Saturday evening) thus reducing pay banding for those hours. As a result, those specialties with a greater burden of anti-social hours, such as A&E, or a greater number of on-calls, would be adversely affected. It would also remove safeguards to prevent junior doctors from working hours in excess of the European Working Time Directive. The stand-off remains unresolved with the government refusing to re-negotiate the major sticking points whilst accusing the British Medical Association of refusing to come to the table. Industrial action amongst junior doctors now looks like a very real possibility with the BMA balloting its members.
The government's tactic is to smear doctors as being greedy and caring only about how much they will be paid as evidenced by recent Sun editorials rumoured to have been dictated direct from Jeremy Hunt's office - unsurprising when one considers the historical proximity between News International and Hunt. This tactic has not been nearly as successful as they would have liked with the public, which distinguishes between junior doctors and other groups, such as GPs or consultants, where the same tactic has been applied in the past.
Certainly, the naming and shaming of 'public sector fat cats' on this morning's Daily Mail front page seems to be the flavour of the month amongst the corporate media - perpetuating the lie that the problem with Britain's neoliberal political economy is a bloated public sector and not the dangerously out of control financial system. Certainly the threat of industrial action will up the ante - it may make it easier for the government to smear doctors as endangering the welfare of the public.
The media circus, scenting a potential kill in the offing with the scalping of a minister or even Health Secretary Jeremy Hunt, has jumped on the bandwagon with a significant amount of airwave coverage and column inches devoted to the issue. Despite having rolled on for several weeks, it does not look like this coverage is in danger of running out of momentum. However, we are now seeing the debate turn nasty with government privatisation cheerleaders wheeled out to highlight that the problem with this current impasse is, in fact the very concept of the NHS. Allister Heath, Deputy Editor of The Telegraph, writes that doctors are the victims of an NHS that's broken beyond repair. Meanwhile, in yesterday's Sunday Times, Mark Britnell, former Department of Health civil servant, who swished through the revolving door to work for KPMG and infamously advised a private equity conference that the "NHS will be shown no mercy", tells us that the NHS is sick and requires a radical overhaul. I will address both of these articles head on in my next blog piece as they warrant closer scrutiny.
Breaking the allegiance and loyalty of staff is one of the important strategies for attacking a public sector organisation. This is often achieved through policies that demoralise and alienate them. The predictable response of junior doctors threatening to leave the NHS if the contract is imposed is therefore entirely in keeping with the ideological intent of the government. Under the coalition, we saw reforms to pensions meaning staff will effectively have to pay more, retire later and get out less. There has been a year on year public sector pay freeze despite the independent NHS Pay Review Body recommending a 1% pay rise for all NHS staff in 2014. Jeremy Hunt rejected this recommendation. It is likely that automatic pay rises (linked to length of service in the public sector) and merit awards for excellence will be phased out.
New GP and hospital consultant contracts will likely follow, which will probably mean more work for less money. Starting consultant salaries are to drop significantly. A new sub-consultant grade will be created thus reducing the number of senior consultants. We are also now seeing the introduction of physician's associates - non-medical staff who will carry out many of the roles and responsibilities of doctors. This reduction in the skill mix is part and parcel of the deprofessionalisation of UK medicine - which started when Thatcher wrestled day to day running of hospitals from doctors and introduced management - and of course the deterioration of a high quality publicly funded healthcare system in preparation for privatisation.
Yet the parameters of the debate have been restricted to a dispute over pay and contract terms. There is no denying that this is a fundamental issue for future generations of junior doctors. However, it is part of a much broader agenda, which is the dismantling and privatisation of the NHS. And it is this agenda, which has not been receiving the kind of air-time that it deserves. Which is why the government may, in fact, be quite happy to let this dispute drag on whilst the real business of selling off the NHS continues unchecked. It is only when the fight over the junior doctor contract widens into a national campaign to save the NHS that the public will be won over.