Blood on the Tracks

When David Cameron and health secretary Jeremy Hunt refuse to listen to the pleas of just about every doctor and patient safety expert worth listening to, you have to ask why. The Academy of Medical Royal Colleges (the AMRC) – which represents all of the 22 medical royal colleges and faculties – is the latest to urge the government to suspend imposition of the junior doctors’ contract and return to negotiation as the BMA is keen to do, but Hunt is not for listening. ‘That train has now left the station. The matter is now closed.’ Although it clearly isn’t.

Either Hunt and Cameron are living out the conspiracy that the NHS must be irreversibly harmed to break it up for a sell off. Or they refuse to be beaten by the BMA whatever the cost to patients. Or they’re in denial about the fact that the NHS has run out of time and money to recruit, train and pay sufficient staff to provide compassionate, competent care around the clock. Staff are already working dangerous hours to cope with vacancies, rota gaps and record demand, and the service is only just held together by altruism and good will. So to prolong an avoidable war with doctors in training represents one of the greatest acts of political idiocy in the history of the NHS.

The AMRC describes an ‘unprecedented crisis’ and is also against the all-out strike planned by the BMA for April 26-27, which includes withdrawal of emergency care. This will be covered by consultants, non-trainee doctors, nurses and trainees who don’t support an all-out strike, or who will come in if the consultants can’t cope with the demand. If the government still refuses to listen, the BMA could escalate to an indefinite strike, probably scheduled after the European referendum. Hunt is supporting Cameron and his job looks safe until June 23 unless serious patient harm occurs during a strike, which would also harm the BMA and could lesson public support for doctors. If Cameron wins, he may yet replace Hunt with – say – Michael Gove or Boris Johnson as a punishment. Few politicians get out of the NHS alive.

Hunt has at least published his proposed imposed contract, which has allowed the legal action to start. The BMA’s legal challenge over the government’s failure to undertake a timely EIA (equality impact assessment) is likely to be swatted away, although the EIA made interesting reading when it appeared with the final terms and conditions on March 31. The government admits that features of its contract may ‘disadvantage’ and ‘impact disproportionately’ on women, particularly those working part time, but believes it is lawful and ‘comfortably justified’ as a proportionate means of achieving the legitimate aim of ‘a truly seven day NHS’ – whatever that is. The majority of trainee doctors are women and many may simply refuse to work under a discriminatory contract.

Many male doctors (MD included) also end up working part time in the NHS because the workload is so unremitting it simply isn’t safe for them or their patients to practice full time in the long term. Many full time staff put in over 80 hours a week, part time can be 30-40 hours. The stress can be unremitting and tired doctors make mistakes. Most believe they can’t be stretched more thinly than they are by the new contract. MD and the Patients’ Association are supporting the more widespread legal challenge of Just Health, an independent group of NHS workers committed to a publically owned NHS. It crowd sourced £100,000 in donations in 4 days for a challenge by Bindmans LLP.

Bindmans has sent a 41 page letter before claim to Hunt arguing that he has no legal power to impose a contract on most junior doctors as he is not their employer. For the minority of those he can be said to employ (who work in non-Foundation Trust hospitals), he did not consult with relevant parties prior to announcing imposition. And the decision itself is legally flawed and will not achieve the aim of a 7 day NHS. Bindmans have also sent a letter to NHS Employers advising them they may seek an injunction to restrain them from recommending the contract whilst its legality is being challenged. The contract includes a clause 22 that would allow Hunt and NHS Employers at their ‘absolute discretion’ to ‘review, revise, amend or replace any term or condition of this contract and introduce new policies and procedures, in order to reflect and respond to the changing needs or requirements of the NHS.’ Clause 22 is a catch 22. Sign the contract and sign away control over your terms and conditions. Don’t sign it and don’t work in the NHS. Small wonder applications for junior doctor training schemes are at an all-time low, and applications for certification to work abroad are at an all-time high. Thousands of treatments have been cancelled but the public remains broadly supportive of junior doctors. It seems only the High Court or blood on the tracks can stop Hunt’s train. Serious patient harm would also derail the BMA. And yet all this harm could be avoided by returning to negotiations. It’s utter madness.