Saturday saw a second demonstration in London over the unresolved junior doctor contract dispute between the British Medical Association and the government. Back in October, 20,000 doctors rallied in London with simultaneous marches in other cities. Today sees a second strike. This will be a decisive escalation of industrial action and may then lead to a third and unprecedented full strike encompassing emergency and routine care. Nursing students will also be joining doctors in protest at the government's proposal to axe the nursing bursary.
The BMA states that the new contract would remove safeguards protecting doctors from excessive work and could therefore endanger patient safety. It would mean more work for less money with the reduction of anti-social hours. This would especially penalise specialties, such as emergency medicine, in which doctors work plenty of anti-social shifts. Furthermore, the threat of imposition of the contract is being interpreted as tantamount to bullying. The government claims that the contract is cost neutral and Jeremy Hunt has offered an 11% pay rise - this has been reported verbatim. They are merely fulfilling an election manifesto pledge of a 7 day NHS because weekend services are less safe.
The reality is that it would mean a hefty pay cut for many doctors as they are paid according to the number of anti-social hours. The claims around weekend safety are based on a paper, in which the authors warned that the reasons for increased mortality 30 days following admission from Friday to Monday inclusive, are not clear and that to infer it was avoidable would be rash and misleading. The fundamental problem beyond this is that a 7 day service simply cannot be provided with the same resources and funding as a 5 day service.
Peter Stefanovic - a medical negligence lawyer - puts it succinctly in a video blog. He went on the streets and asked passers-by:- "How would you feel if your boss came in one day and said - Saturday is the new Friday. 7 till 10 pm is the new afternoon. I'll pay you less and if you don't like it, I'm going to force you anyway." Unsurprisingly, most people replied that they would tell their boss to stick it.
Doctors also have the trust of the public. Polling shows that two thirds back them. It appears that government and right wing media tactics of smearing doctors have not been successful. Yet, when I have asked members of the public what the dispute is about; they often struggle to identify the issues at stake. Why is this?
A simple, clear message has not been communicated to the public. The government's line has been consistent throughout. 7 day NHS. Even services. Patient safety. Every single government spokesperson has stuck to this line; never going off message. Renegotiating the contract is therefore all about a better, safer NHS. It sends out a bright, positive message. Hard to argue with. Except, as we have seen, this ignores many of the complex issues, which the BMA and doctors are dissatisfied with. But facts are often inconveniences to be brushed aside in modern politics.
Of course, doctors are at a disadvantage. They are accustomed to handling complex issues. Their moral imperative is to tell the truth however grey it is rather than a reductive or misleading black and white representation of reality. They are not media trained. They are at the mercy of a largely corporate media, which ruthlessly edits their comments and is often aligned with government and establishment interests.
We've seen this all before. The entire austerity narrative has been seductively framed in this manner with simple stories and strong images. The national debt is portrayed as a household, which has overspent. The nation's credit card has been maxed out. That's why the Conservatives now have to clear up Labour's mess. They have to fix the roof whilst the sun is shining. Of course, the crisis was due to a global banking crash not overspending, which is why you will struggle to find a mainstream economist to endorse this view.
The junior doctor contract will set a precedent. It is an attack on terms and conditions and aims to break the allegiance of staff to the NHS. It will pave the way for renegotiating Consultant, GP and potentially other healthcare professional contracts. It is part of a strategy of deprofessionalising medicine. The bigger picture here is, of course, the P word - privatisation with an ultimate goal of universal, private health insurance.
So what might a framing of the junior doctor story look like? Well, we will need to reclaim the territory that the government has marked out. We will need to address our audience - the public - and focus on both 'our base' but more importantly on those sitting on the fence. And we will need to be positive. Only by connecting with the public and getting them behind this movement can we hope to create sufficient pressure for the government to back down.
So we need to emphasise that this contract is dangerous. It does not value doctors, patients or our NHS. It will endanger patient safety and the future of our NHS. It will lead to a pay NHS. To take Jeremy Hunt's recent analogy with aviation safety - well imagine an airline extending its services from 5 to 7 days not only with the same number of pilots but also the same number of planes and support staff. If a surgeon is going to operate then he needs porters, nurses, anaesthetists. Going on strike is a last resort - grounding the planes until it is safe to take off. We want a contract, which is safe for patients and doctors in order to deliver a first class, free NHS for everyone for the future.
Twitter handle @ElGingihy & @NhsDismantling