Wednesday, 7 September 2016

Junior Doctors are in danger of permanently ruining their reputation

On Monday I submitted my weekly Catholic Universe newspaper column, this time on the subject of the anticipated Doctors Strike, but by early afternoon the story had moved on and the column had rightly be spiked. For the purposes of completeness, here it is.

Thirteen years ago my father was entering the final stages of his long battle against bowel cancer. As is usually the case when you don’t find a malignant tumour early enough we, his family, had known that it was a battle he was never going to win. Just like the stories we hear of sieges from earlier times my father knew that the fight wasn’t about holding on for a possible but infinitesimally unlikely victory, it was about staying with his family for as long as he possibly could with a decent quality of life.

By the time the first weekend of May had come in 2003 he was faltering, nearing the end, and his GP had arranged for him to go away for two weeks ‘respite’ for my mother, a respite we knew would in all likelihood really never be needed. On the way to the cottage hospital where he would be cared for for the next fourteen days Dad experienced a seizure and the ambulance carrying him was redirected to the nearest general hospital.

When I arrived at the hospital with him in the ambulance I was told that with it being a Saturday, and especially a Bank Holiday weekend there was only the barest of oncology staff on site and that it might be possible to transfer Dad to a hospital where Saturday and Sunday's were better facilitated, of course I was warned he may not survive the transfer. My family’s other choice was to see him admitted to a spare bed in one of the orthopaedic wards where he would be provided for as best as the hospital were able.

In the end the staff that looked after him for the last two days of his life, as the vast majority of our NHS staff are, were amazing although a little bewildered, one nurse memorably telling me ‘we don’t have patients die on our ward’. But I often wonder what the outcome would have been if the NHS had been a real seven day a week service.

Would my father have survived longer? Would his last days have been more comfortable? Would he have been free of the pain that he was so obviously in? The answers to all of those questions may well have been no but precisely because there is a significant gap between NHS weekday and weekend operation his family never had the chance to find out.

There is very little doubt that significant portions of our health service are no longer fit for the way we live our lives today. People have never only got sick on days Monday through Friday but work and family commitments for countless millions now don’t stick to the nine to five routine which may well have been commonplace twenty or thirty years ago.

I would venture to suggest that you would not find one person who will wholeheartedly agree that the NHS hasn’t kept pace with the demands facing a modern Britain. The vast majority of us believe that we need a seven day a week service, but we also believe there should be more joined up care for the elderly and improved mental health services.

The simple fact however is that all of those things cost significant amounts of money and with a population seeing an increasingly large proportion of elder people, calls on reducing the numbers of contributing economic migrants and a rising cost of living all are significantly more difficult to deliver.

So, the government made a decision that in order to deliver a manifesto pledge of a true seven day a week NHS it would be necessary to renegotiate the contracts of thousands of junior doctors and that, many would argue, is where a dispute promising to cause significant damage to one of our greatest institutions originated.

In Britain the medical profession is, absolutely correctly, hugely respected. Doctors train for many years to do a job where on occasion a mistake can literally mean the difference between life and death. Time and time again in surveys we see Doctors topping polls of ‘most trusted profession’ with around 90% of us saying that we believe what they say, in comparison politicians usually poll way, way below even hairdressers. At the same time our medics, as they progress through their careers are paid handsomely for the work they do, I think very few of us begrudge it.

So far, so good. Being a card carrying member of the Labour Party I am predisposed to support my comrades who decide they are being unfairly treated by their employer, especially when that employer happens to be an ‘uncaring, incompetent’ Tory government and the people taking the draconian action of a rolling program of five day strikes are some of the finest public servants that there are.

I know I am supposed to be four square behind them, but I have a real problem. The five day walkout which junior doctors plan to commence this coming Monday just seems wrong, let me explain.

I know very little about the minutiae of the proposed junior doctors, why would I? But what I do know is that when the government put forward their plans to the medical profession it sufficiently incensed them to take unprecedented strike action. I completely support them for what they did.

But then the representatives from the Government and the doctor’s Union, the BMA, got round the table and discussed how a new contract could be improved, and indeed a significantly improved  offer was made by the Secretary of State, Jeremy Hunt. I know this because Dr Johann Malawana, then Chair of the BMA’s Junior Doctors committee, described the contract offer as “a good deal despite unbelievable odds.”

Dr Ellen McCourt, the medic who replaced Malawana following his resignation after the contract was rejected in a ballot of members, had previously described the offer as “safe” and “fair” during an interview on Radio 4.

It really is difficult to see how the rejection of a contract offer which had been recommended by the representatives of doctors themselves as being acceptable can now warrant an unprecedented program of five day strikes which will see thousands upon thousands of operations and appointments cancelled and potentially lives being lost.

It seems that junior doctors and their representatives, who we are told were split 16 to 14 on the nature of industrial action to be taken, have committed to strikes completely disproportionate from the nature of their grievance and the potential severity of their actions.

We know that there is significant concern from within the medical profession about the proportionality of the planned action by junior doctors. Last week the Academy of Medical Royal Colleges issued a statement saying “We know there are genuine concerns about the contract and working arrangements but we do not consider the proposed strikes are proportionate. Five days of strike action, particularly at such short notice, will cause real problems for patients, the service and the profession.”

Dr Sarah Wollaston, the highly independent ex GP, Tory MP and Chair of the Health Select Committee, wrote to The Times asking “Given that the BMA recommended acceptance of the deal that they themselves negotiated, they need to explain why have they decided on a series of five day walkouts…”

As a layperson there is a real concern that junior doctors are being poorly lead. I am sure that for many their concerns are very real but there is undoubtedly a growing concern that at least in part their dispute and the proportionality of the actions they plan to take is increasingly about political activism.

We have a huge trust in the medical profession but junior doctors are very much running the risk that that respect we have for them will be diminished if not to the level of politicians then much closer to that of our hairdressers. If they carry on with their actions who knows how long, if ever, it will take to rebuild?