The Immaturity And Cynicism Of The NHS Junior Doctors’ Dispute

Junior Doctors Strike - NHS - National Health Service - Vigil

The junior doctors lost the moral high ground when they decided to portray a debate about pay and conditions as a high-minded effort to “save the NHS”

James Kirkup has a great piece in the Telegraph in which he charges that the junior doctors’ dispute has reached an impasse not because of government intransigence but because many junior doctors are arguing an inherently political case from a position of naivety and political inexperience, and so will not concede the validity of any opinions other than their own.

Read the whole thing. But it is worth noting these excerpts in particular:

Some of this is about basic competence. The doctors and their leaders have done a very poor job of explaining why they are striking, offering a range of confused and changing justifications. Many doctors seem unaware of the position taken in negotiations on their behalf by their trade union (short summary: if the Government had agreed to pay more for Saturday working, the BMA would have settled and there’d be no strikes) and believe their strike is not about money.

This in itself is quite damning. All the high-minded talk about patient safety and “tired doctors making mistakes” suddenly begins to look a wee bit cynical when it turns out that the BMA would have taken the deal if only there was more money on offer. Was the extra pay all going to be spent on Pro Plus and Red Bull? Unlikely.

But this is the really interesting point:

Yet the doctors’ failure of understanding goes beyond tactics into something more fundamental, an unwillingness or perhaps just an inability to appreciate that politics is about reconciling the diverse interests and desires, that no one gets things all their own way.

Simply they don’t understand the conflict they’re in. Many, engaged in politics for the first time, cannot understand why the Government will not do exactly as they want; for them it’s unthinkable that others would not accept the doctors’ word on how to fund and structure the NHS as final. Any course of action but theirs is not just unacceptable but immoral.

As for those on the other side of this dispute, there is apparently no possibility that their motives could be honourable. Throughout this dispute I’ve not yet seen a junior doctor admit even the possibility that Jeremy Hunt, NHS Employers, David Dalton, Bruce Keogh or any of the main players on the employer side might also be acting in good faith, doing things they believe necessary and in the public interest.

Instead, Mr Hunt and his officials are routinely accused of venality and self-interest, and worse. I keep a little file of choice emails and tweets from doctors. It contains evidence of members of the profession making statements in public forums that Mr Hunt is psychopathic or suffering from various other clinical conditions. (There were also a number of homophobic slurs aimed at Mr Hunt, but that was a senior consultant, not a junior.) I can only conclude that the doctors concerned are so convinced of their own righteousness that they cannot admit that those who take a contrary view are anything but immoral.

Here we have Labour’s self-righteousness syndrome all over again, but this time the patient is not a political party but a large and vocal special interest group within the public sector. Just as was the case with those convinced that the Tories are evil vampires and that Ed Miliband was heading for victory in last year’s general election, so the junior doctors and their supporters seem convinced that the government is motivated purely out of malice, and that they are unambiguously in the right. And we all know what happened on May 7th.

Kirkup continues:

Other doctors display an almost touching lack of insight into how some aspects of their own working lives (a job for life, steep pay progression, huge pensions) are simply unobtainable dreams for most workers, even those who also got good A-levels and spent years studying at good universities.  One junior doctor (again, I won’t name him) last week reprimanded me for writing about doctors’ £1 million pension pots on the grounds that the retirement such funds deliver is “comfortable” but “not extravagant”.

Likewise the tendency to overlook (or simply not know) the fact that many of their problems (antisocial hours, weekend working, growing workloads and static or falling workforces) are common to many other professions and trades, many of whom do not enjoy the same benefits as doctors.

What the junior doctors (and those who support them) fail to understand is that nearly every public sector industrial action is fought on the grounds of public safety while really being about something else. Relatively well paid people (compared to the average wage) walking off the job in a dispute about money and working hours does not elicit as much public sympathy as casting themselves as the only people willing to take on the government on a grave matter of public safety, so simple self-interest dictates that any union (including the BMA and junior doctors) will emphasise the latter over the former.

Consider: how many striking junior doctors living in London would have tutted with frustration during the last tube strike called by the RMT, and fumed to their friends that tube drivers are incredibly well paid, should be grateful for what they have and get back to work, Night Tube be damned? The RMT’s dispute was based in large part on safety concerns, just like the junior doctors. Are the tube drivers lying while the junior doctors are telling the truth? Is there something inherently more virtuous in a doctor than a train driver?

This, too, is worrying:

Spare a thought here for the impact this outlook has on the doctors themselves.  Having become so utterly convinced of the rightness of their cause, many suffer genuine distress when their cause meets resistance or challenge.  Some, sadly, are not robust enough to encounter such pressures without experiencing genuine harm. That harm should weigh heavily on the consciences of the BMA leaders who have encouraged young and politically-inexperienced people to seek out confrontation in the harsh arena of public debate.

This rings alarm bells, because it is the same way that we now speak of Safe Space-dwelling students, grown adults who by adopting a toxic ideology have come to see themselves as perpetually vulnerable victims in constant need of protection from higher authorities. One could take this sentence – “some, sadly, are not robust enough to encounter such pressures without experiencing genuine harm” – and apply it equally to those wobbly-lipped students who are now killing academic freedom and free speech on our university campuses.

In fact, we may now be witnessing the first major conflict between the Safe Space generation (many junior doctors have only recently graduated university) and the realities of the labour market and public sector wage restraint – only everything is made doubly toxic because the dispute involves the one subject about which almost no Briton is capable of thinking rationally: the NHS.

This blog contends that the mere fact that national collective bargaining is still making headlines in 2016 rather than 1976 shows that Thatcher’s work is far from finished, and that if we were not still lumbered with a national health service we would not be facing the prospect of an all-out national walkout by healthcare professionals. After all, nothing about public healthcare mandates that it must be provided through a monolithic state-owned organisation, despite the best efforts of NHS apologists to pretend that our options are the status quo or the American system.

Maybe the doctors holding candles in an overwrought silent vigil for the NHS (see cover picture) are entirely genuine. Maybe they have convinced themselves that this dispute really is purely about patient safety and “saving the NHS”, and nothing more. But the junior doctors can no longer plausibly claim that this is about patient safety, or “saving the NHS”, because we now know that these are side issues brought cynically into the debate by the BMA and credulous activists in a well worn attempt to drum up public support.

This does not mean that each one of the Conservative government’s intended reforms are sensible. The idea of a 24-hour NHS is more slogan than policy, while statistics about weekend deaths have been cynically misrepresented – that much we can concede to the BMA. But when your pay dispute is with one of the largest organisations in the world, and by far the largest employer in Britain, then everyone who pays for that service gets to have a say, including (or even especially) a government elected partly on a manifesto to make changes to that health service, whether or not those changes happen to be smart. By taking the public coin the NHS is inherently political, and those working for it cannot complain when those outside the organisation seek to wield their own influence.

And from a purely tactical standpoint, James Kirkup is right – the junior doctors and their representatives in the BMA have bungled this dispute badly. With their overwrought, hysterical claims that a new national contract will somehow be the end of the NHS when it turned out that the final sticking point in the negotiations was over nothing more noble than Saturday pay, their credibility is squandered. And neither they nor their supporters should not escape censure for their part in what is to come.


Save Our NHS

Top Image: Guardian

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