The unusual sight next month of junior doctors picketing hospitals, in scenes not seen since the strike-bound era of the 1970s, will signal the start of a campaign in the court of public opinion as to whom voters – many of them patients too – blame for the three days of disruption.
The strikes will pit Jeremy Hunt, the well-groomed but tough-talking health secretary, against a succession of highly articulate junior doctors, such as Johann Malawana and Roshana Mehdian, on the nation’s airwaves. Both sides are convinced that the public will see things their way. But who will win the battle for hearts and minds?
The next few weeks will bring difficult questions for both sides. Are their respective positions reasonable? Why on earth do they both seem unable to actually talk to each other to try and avert strikes that no one wants? And with both sides saying they must prevail or the NHS will be the poorer for it, who is telling the truth?
In a letter to David Cameron this week, Heidi Alexander, the shadow health secretary, was sure that “If industrial action or a full walkout ensues, be under no illusion the responsibility will fall squarely at the door of the health secretary.” That is far from a given, though. Certainly senior members of the medical profession, including quite a few presidents of medical royal colleges, privately fear that strike action will rebound, with potentially very damaging consequences for junior doctors specifically, and the standing of doctors generally. They worry that doctors, who top most polls of groups of people the public trust, will be either seen – or at least portrayed in the media – as reckless and putting their pay packets ahead of their duty to patient care and safety.
People who work closely with Hunt say he is certain that his version of events will prove persuasive. In a letter two days ago to Malawana, the chair of the British Medical Association’s junior doctors committee, he prefaced arguments that we will be hearing a lot more of over the next few weeks – unless the dispute is somehow settled before the first walkout on 1 December, which at the moment looks unlikely. Hunt came across in the letter as emollient, conciliatory, concerned about how the strikes will affect patients, and convinced that his “clear, positive offer” is the right way to proceed.
Decoded, his letter said that he has offered to increase junior doctors’ basic pay, ensure no trainee medic is worse off financially and also reduce the maximum number of hours that a junior doctor can be expected to work in any week.
Resolving things is “a mission on which we can work together, including by negotiating a new contract which is fairer for doctors as well as safer for patients”, he said. But beneath the velvet glove of warm words and firm assurances there was also an iron fist. After three years of trying to agree the shape of new terms and conditions he was adamant that he would not give the BMA a veto over whatever final contract junior doctors eventually receive; in other words, talk to me now, without preconditions, or I will impose the contract that has sparked your North Korean-style ballot result.
However it is interesting that over the last few weeks Hunt, despite invitations, has refused to engage in a head-to-head debate in a TV or radio studio with Malawana or any other junior doctors’ leader. Is that a sign that he is not actually sure that his arguments will play well and withstand close scrutiny? Hunt may inspire widespread loathing in the medical profession but he is a skilled manipulator of the media.
The dispute has seen some newspapers display significant support for the junior doctors, notably the Daily Express, but others have been very critical of their case. How will newspapers’ sympathies crystallise now that the die is cast in terms of walkouts that will disrupt the usual running of the NHS, and will that help persuade either or both sides to compromise? Whether they heed the obvious common sense of the warnings from every quarter of the medical profession that the new contract would be disastrous for medical recruitment and significantly increase the number of young doctors choosing to further their careers elsewhere, notably Australia, remains to be seen.
The junior doctors have some strong arguments on their side, though will have to think carefully about how they convey them. The planned contract is unfair and unsafe, they say. Yes, they face the number of hours in any week in which they receive only basic working pay going up by almost 50%; and yes, their current pay system, which largely depends on overtime for working antisocial shifts, is being torn up. But with so many people in other walks of life already working long hours, often for no overtime, it may be hard to persuade people of the rightness of their cause.
Hunt will doubtless seek to portray junior doctors as dinosaurs in an age of changing working patterns. How doctors are paid now is fiendishly complicated and not easy to explain. To win the battle for public opinion the BMA will have to challenge – and refute if it can – Hunt’s argument that no junior doctor will be worse off. They will doubtless look for holes in the health secretary’s insistence that while basic pay may go up 11%, the overall cost of employing junior doctors will somehow not rise. How is that possible?
But the dispute is about much more than money. Another key worry for juniors is that the removal of financial penalties on hospital trusts that force them to work longer hours than they should will lead to a return to the bad old days of 100-hour weeks, especially with the shortage of doctors and growing demand for care. Hunt has sought to address that by saying that the Care Quality Commission, the health and social care regulator which already has so much to do, and which is about to reduce its workload because its budget is being cut, will stop that happening. Really? How will that happen, exactly? This is one of the weak points in Hunt’s offer.
Prof Sir Simon Wessely, the president of the Royal College of Psychiatrists, said that in 35 years as a doctor he had never seen such anger, frustration and disillusionment among the younger members of the profession as he had in recent weeks. What was at stake, he stressed, was the possibility that an already under-doctored NHS could “lose the current generation of junior doctors” to other countries, other jobs or life as an expensive-to-employ locum medic. Hunt has privately told some doctors’ leaders recently that he expects to tough out a series of strikes and to then impose the hated contract.
After almost unanimous approval for strikes and with hospitals now working out how to handle them, it looks improbable that David Cameron will be able to avoid getting involved in the standoff between the doctors in scrubs and the minister they no longer trust, perhaps by calling in a third party as an intermediary, as some are suggesting today.
