It is difficult to know where to start. I feel angry, disappointed and saddened in almost equal measure, although anger and disbelief predominate.
The long running dispute between the doctors (represented by the BMA) and the government has come to a head in recent months, and following the second day of industrial action on Wednesday, the government (represented by Jeremy Hunt) has taken the unprecedented step of deciding to impose the new contract.
The BMA has responded to this by declaring that it will fight on in opposition to contract imposition. It is unclear how this will end. Various surveys have suggested mass resignations, an exodus of junior doctors overseas, and an increase in doctors moving into other careers. Even before the latest souring of relations between the medical profession and the government there has been an increasing number of medically qualified people leaving the profession, with some knowing in the final years of training that they have no intention of entering clinical practice. Medicine is a highly competitive undergraduate course and prospective employers know that people with medical degrees will bring very high levels of personal and academic attributes to their businesses. A brief Google search brings up numerous sites offering advice on careers outside the NHS. I can envisage a situation similar to that currently obtaining in retail and the hotel and restaurant sectors. It is common to find that the staff who serve you in stores or restaurants have degrees, when 20 years ago they would have started work as school leavers. The graduates are over qualified for the jobs that they are doing (many of which offer no career progression) but because they cannot find work appropriate to their qualifications they displace lesser (but adequately) qualified people. In the same way those with degrees in medicine may displace those with degrees perceived as less desirable for highly paid jobs in business and the City. There is also of course a well documented exodus of UK trained doctors to other countries, most often Australia, New Zealand and Canada.
Morale is at rock bottom, and some junior medics feel unsupported by the most senior consultants who have only got their eyes on retirement, and are sometimes unsympathetic to the plight of the juniors (the “in my day we worked days and nights without a break, what are they complaining about” syndrome). Of course the working environment is totally different today. I worked 1 in 2 and 1 in 3 rotas (where you worked every day plus one in three nights and one in three weekends – day and night) but the patient turnover was much slower. People routinely stayed in hospital for 5 days after having an appendix out, ten days after a hip replacement. The number of tests available was fewer, and by and large patients were less sick. There was vastly less paperwork to complete, and the entire climate of medical practice was not dominated by the shadow of medico-legal threat.
As I have mentioned before, I can find only one explanation for the current situation. The BMA reported that just before the second strike day, the negotiations had reached a point of agreement between NHS England and the BMA. Apparently at this point Jeremy Hunt personally vetoed the agreement, knowing that this would precipitate the second strike day. The second strike day allowed him to rule that he would impose the contract. This suggests to me (and many others) that he intended to do this all along. he and the Prime Minister must know that this will not be the end of the matter, and indeed the BMA has confirmed that there will be further industrial action. This cannot possibly end well.
My explanation is that the government wants to end the NHS as we know it. It is known that Jeremy Hunt has for many years favoured a US-style insurance system, so he was a curious choice for health minister unless to preside over its destruction. The government equally knows that the NHS is treasured by the majority of the population regardless of political persuasion, so does not want to be seen as the instrument of its downfall. The situation that is now unfolding will see (fuelled by the media) the doctors portrayed as the selfish, money grabbing people who care more about themselves than about their patients. The government clearly intends that support for the medics will ebb away, but that by then the NHS will have eroded beyond the point of rescue. Its destruction will be claimed to be be the fault of the doctors not the government.
Like many who have spent much of their working life in the NHS I find this slow destruction incredibly painful to watch. I could never have trained as a doctor in a US-style system because the idea that quality of healthcare is dependent on the ability to pay, that lifesaving treatment can be denied because a person cannot afford it, is an anathema to all that I believe in and have worked for.
I hope that there might still be time to save the NHS, but I fear it is already too late.
14 February 2016