It takes some skill to turn the BMA into the NUM – but Jeremy Hunt has done just that. It takes nearly as much skill to persuade the public that people on £53,000 a year are scions of the oppressed working classes – but the BMA, aided by Hunt, have done that too. How did we get to the point where there is any sympathy about pay levels of anyone who is in the top quintile of earnings? Obviously the strange quasi-religious role that the NHS plays in British life is partly to blame, but the government have played a strong hand appallingly badly.
First, they have told the wrong story. The government are making this about patient safety – they say that a move to a seven-day NHS is needed because too many people die at the weekends when they shouldn’t. This they attribute to the lower levels of staffing and assert that the solution is a change to junior doctors working patterns. There is a fundamental problem to this position. On the one hand, while there are what are known in medical jargon as ‘excess deaths’ related to weekend admissions, there is no evidence they are a consequence of staffing levels. And to complicate matters further, the ‘weekend’ for these purposes includes Fridays and Mondays. On the other, who do you suppose the public trust on matters of patient safety – doctors or politicians? Well, only one group of workers wears a white coat to work.
The better argument would have been the unassailable one that the world of work has changed. Mobile phones, tablets and laptops mean that for many white collar workers the boundaries between work and home life have blurred. Service industries offer seven-day access. And the millions of self-employed workers in the UK – a group now larger in size than all public sector workers – do not have traditional nine to five, five-day-a-week jobs. They work when the client wants or when the job comes through. The dividing line should have been modern life – that would have put junior doctors on the old-fashioned, protectionist, trade union side of the argument. They would have been portrayed as luddites, much like the rail unions who are trying to stop the 24-hour Tube.
Second, the government have chosen the wrong fight with the wrong enemy. You don’t need to make junior doctors work at weekends; they do that already. The staff who are actually needed at weekends to provide the same cover on Saturdays and Sundays are all the others – the staff who run diagnostics, do the blood-work and, of course, the consultants. The last of these groups are the ones who will fight against a seven-day NHS to the very last – the very last junior doctor. Why are consultants so anxious to back their junior colleagues? Because, as cruel NHS leaders put it, consultants want to spend more time playing golf. The government should have picked the fight with them. A change in their working patterns is essential to seven-day working. There are fewer of them, and they would have very little public sympathy.
Third, the government have made this a dispute between themselves and the junior doctors. This is a schoolboy error. The NHS is an independent arms-length body. The Tories have an electoral mandate for a seven-day NHS but they should simply have passed that on as a condition for the extra cash the NHS has received. The outcome should have been prescribed but the means left open to NHS England Chief Executive Simon Stevens, who has already made great strides in modernising the health service by allowing a range of variation across the country. If you can’t win a big fight then make it a series of smaller fights. If this was a hospital-by-hospital dispute rather than a national one, it wouldn’t make the headlines. There would be local battles not national demonstrations. And local solutions too.
The government are losing, and losing badly, because they have picked the wrong fight on the wrong grounds with the wrong people. If they seriously want to win they need a wholesale change in strategy and tactics.
John McTernan was Tony Blair’s director of political operations from 2005 to 2007. He was also a former chief of staff to Jim Murphy.