#juniorcontract

Where do we go next?

With all the talk of EU referenda and the inevitable media hysteria surrounding it there will be little opportunity for us to be heard above the cacophony of indignation. But heard we must be.

I was at the meeting at BMA house on Wednesday evening and heard a relatively diverse (if not a little repetitive) set of arguments for the next steps. It was a little disappointing that there was no opportunity to debate the issues but I appreciate there were many people that wanted their say and  things could quite easily have gone on until the early hours of the morning if we’d let them.  

In many ways the most valuable comment of the evening came from Johann. He repeated the statement that if we don’t have unity we have no chance of meeting our aims. He is completely right in this assertion. If we divide, if we take divisive action and numbers dwindle, if we see ourselves taking different levels of action then we stand little chance of reaching our goal. Ultimately we all want the same thing, a fair and safe contract that values our commitment to our patients and doesn’t put us in a position where we can endanger them. We will only get there together.

One thing is unequivocal. If we loose the support of the public we have nothing. We can only win this battle if the public, our patients, think we are on the right side of the argument. No matter how clever we think we may be, not matter how pure our logic, we mustn’t forget that junior doctors alone will not be able to exert sufficient pressure on Government. We are up against ruthless and experienced politicians. Hunt, Cameron, Osborne play the numbers game. If they think they have the numbers then they will execute whatever plans that they wish to execute. They are early on in this political cycle and they have years for this to all be forgotten. But we mustn’t make it easy for them by public displays of disharmony. We must remain vocal, critical and determined with laser like focus.

Our position has been heard across the Country. The two days of industrial action we have taken to date have given us enhanced exposure but we must maintain this. There are a handful of extremely vocal, talented and committed leaders amongst us (you know who they are) who through social media, the printed and electronic press and airwaves maintain pressure on individual MPs, Lords, DoH, NHS England, NHS Employers and anyone else that has a role to play in this disaster. The rest of us must be equally active and continue to lobby, to speak to members of the public and to be clear in our objectives and why we are not prepared to roll over and see this the greatest institution of this country shredded into pieces. The ‘Meet the Doctors’ events in many ways is one of our strongest assets. We can’t just speak to ourselves or we loose sight of the bigger picture and the opinions of outsiders.

So where next? This inevitably leads to the question of ‘Full Walk Out.’  You might call this our ‘Nuclear Option’. Initially I had believed that this was inevitable, that we would have to play this card. But the more I reflect on it and the more I hear people call for it immediately and indefinitely the more I worry that it is an escalation too rapid and too extreme to be executed at this point in time. It is clear to us that support for it would not be unanimous even amongst those that have taken industrial action to date and those that have been vocal and public figures to date.

Do not misunderstand me, I am not saying there is no circumstance in which I wouldn’t be prepared to undertake full withdrawal of labour. What I am saying is that we have to better understand the implications and what it is that we are trying to achieve with regards to the level of disruption that cannot be equally successful with other action. Polling has already revealed that public support falls away if we undertake a full walk out. Yes people die everyday in the the NHS, and yes sometimes it is due to lack of resource more that anything but the Press and Government will crucify us if there is so much as a whiff of harm that comes to a patient because we didn’t go to work. I come back to my earlier point, without the public, we have nothing. Equally, our own ‘militancy’ in this regard has the potential to lead to legislative changes that outlaw our (medical professionals) ability to undertake Industrial Action.

So again I ask, what ‘physically’ is it we want to achieve with a full walk out? Cancellation of all elective work? Implications on waiting lists? General chaos? I’m not sure I’ve heard this stated. We must be clear in our own minds of what we want to achieve before we can begin to explain it to our patients on the wards and an Emergency Departments and to the members of the public on the streets.

For a full walk out to work we would have to have unequivocal support from every Consultant in the Trusts in which we work and frankly from their Executive boards. We have already seen that many are in favour of imposition even if some have backtracked and some are staying quiet but happy that we are where we are. Realistically full walk out will inevitably lead many Trusts to announce ‘states of emergency’ that mean we’d would have to return work and then we would ask ourselves ‘what did this actually achieve’.

Mass resignation of those with training numbers realistically will not work and I imagine would garner little uptake. We have already seen that HEE is just part of the political machine with its threats to withdraw trainees from Trusts that don’t implement the imposed contract. Deaneries (that don’t really exist) have no power, Royal Colleges have no power, we will not be protected, we will not be allowed to reapply. We will have shut the door to the speciality we have committed our lives to with little chance of return (in the UK at least.) A smarter move would be for those between stages of training to delay moving to the next level of training until this mess is sorted out but I guess that’s easy for me to say and many that have offers on the table may struggle to reject them.

To the suggestions disengagement of administrative tasks by not completing discharge summaries, VTE risk assessments, coding and the like . We would have to think whether or not the Trusts would be able to complete these regardless (with nurses, Consultants, those not taking strike action and administrative staff) and therefore question whether it is action that makes of difference or just creates more pockets of risk.

To this end, I personally would be in favour of increasing periods of ‘Emergency Cover’ on varying days of the week for increasing periods of time. This will have increasing implications of elective work and targets whilst keeping patients safe and ensuring specific activity (cancer surgery for example) can continue. With this pressure will come from Trusts on Government to end this.

I don’t pretend to have the answers, I don’t pretend to have any great wisdom, I just have where I am in my own mind at the minute. For some reason I felt I wanted to right down some of my thoughts and perhaps provoke a little more thought on some of the issues. We must debate these and others because we have to try and understand every variable and every consequence. Perhaps by the end of the day I will have completely changed my way of thinking but we won’t get anywhere unless we debate in a reasoned manner.

I have a final plea. There are bound to be disagreements between us all. Many of you that have got this far (well done) may well disagree with every single letter I’ve typed. I come back to my initial point. We have nothing without unity. Berating or insulting each other achieves nothing more than to do the other sides job for them. The Government are desperate to divide us, it’s how they operate. Jumping up and down and screaming at the BMA on the sidelines just gives ammunition to our critics. Believe me, I’ve been very critical of the BMA in the past but I think on this occasion they are acting with appropriate caution, consideration and analysis of all possible strategies.