Jeremy Hunt has repeated his threat of taking the “nuclear option” and imposing a new contract on junior doctors without their consent, as talks resume on trying to end to the dispute.
The government and the British Medical Association (BMA) resumed negotiations on Friday morning, three days after the first of a series of 24-hour strikes by junior doctors in hospitals across England.
Speaking to the BBC, the health secretary said it was legal and still possible for the controversial new contract to be imposed without the agreement of the BMA. “I’d rather it didn’t come to that. I’d rather we agreed,” Hunt said. But, he added: “We have said that if we can’t solve this problem, we have to deliver our manifesto and as a last resort we would move to the nuclear option … But we really hope this doesn’t happen.”
The BMA agreed to call off walkouts planned for 1, 8 and 16 December after the health secretary finally bowed to their repeated request to drop his longstanding threat to impose the new contract on England’s 45,000 junior doctors if agreement was not reached. However, talks broke down in early January and the BMA proceeded with the first strike on Tuesday, which had the backing of 98% of its members.
Doctors are planning a similar strike later this month and a third in February that would also affect emergency care, unless the dispute is resolved. Asked whether he could promise safety for patients during a strike affecting emergency care, Hunt said: “I can’t give an absolute guarantee but we are busting a gut to make sure every A&E department is able to function.”
Earlier this week, the BMA council chairman, Dr Mark Porter, said neither side wanted the dispute to go on indefinitely and urged the government to recognise the strength of feeling among junior doctors.
“We are prepared to speak to government at any time to try to resolve this on behalf of junior doctors,” Porter said. “But it is not just one remaining issue. There are some serious issues about patient safety and recognition of junior doctors’ contribution that need to be sorted here, and the very fact that government documents refuse to acknowledge those issues is one of the things that makes the dispute more difficult to resolve.”
Despite the rhetoric on all sides, the BMA, NHS Employers and the Department of Health are keen to find a way through the remaining areas of disagreement and are confident that a resolution is possible. There is widespread hope that Sir David Dalton, brought in by Hunt last week as the government’s chief negotiator, can break the deadlock.
Dalton, the chief executive of Salford Royal hospital NHS trust, is widely admired for improving patient safety and expanding seven-day services at the trust. He was involved in the process for the first time last Friday. However, those talks failed to head off this week’s walkout, despite the conciliation service Acas describing them as constructive.
The BMA was legally obliged to act on its mandate for strike by 13 January or face a re-ballot of its 38,000 junior doctor members, 98% of whom backed strike action in November.
One of the main obstacles to a resolution centres on how much of the week should be classed as a junior doctor’s normal working hours, and thus attract only basic pay. Currently, junior doctors – anyone below the level of consultant – are paid extra for working after 7pm on a weekday and at any point over the weekend. Under Hunt’s contract extra pay would not apply until after 10pm on weekdays and 7pm on Saturdays.
He has proposed an 11% rise in basic pay to compensate for this loss of overtime, but the BMA insists juniors would still be up to 30% worse off.
