them and us

Twice in the past two days I have  found myself with tears rolling down my cheeks. I am not a person who cries easily, so why now?

NHS

Yesterday I walked back from the picket line of junior doctors outside our local hospital. I had taken them sandwiches and cakes as an expression of solidarity for their industrial action – now escalated to an all out strike for the first time in the history of the NHS. They were bright, cheerful despite the unseasonal cold, encouraged by the support from passers by. They were (at a glance) a mixture of men and women, black, white and asian, and all young (most junior doctors are in the 23-35 age range). They were united in their desire to be at work as normal, and their belief that the strike could easily have been averted if Jeremy Hunt had been prepared to talk to them (not these doctors individually, but the representatives of the junior doctors). He has not talked to them once.

It was as I walked home that the tears came, unexpectedly. I have been, and remain, a staunch supporter of the junior doctors, but my morning suddenly felt surreal. Picket lines are for other workers, not doctors, yet I had been visiting them. Images of the miners’ strike from the 1980s came into my mind, with women visiting their menfolk on the picket lines and taking hot tea and food for sustenance. It has been reported that this doctors’ strike is for David Cameron what the miners’ strike was for Margaret Thatcher. The politicians will not back down, will not give an inch. We know that the consequences for the miners and their communities were terrible and long lasting, leaving families and communities divided and plunged into poverty right up to this day. I think it was these thoughts that prompted my tears. Whatever the outcome of this dispute, medicine in England can never be the same again.

Personally I am  convinced, and have been for some time, that Messrs Cameron and Hunt would like to replace the NHS, a giant and cumbersome arm of the state, with some type of insurance based system. Jeremy Hunt said as much in a book that he wrote ten years ago. Ideologically the NHS does not fit well with the Tories, and as our population lives longer and there are more and more medical advances, so the financial demands placed on the state by the NHS increase. However, famously even Mrs Thatcher balked at the idea of dismantling the NHS, recognising how unpopular it would be. David Cameron and Jeremy Hunt may be cunningly arranging to devolve this unpopularity onto the doctors.

I believe that they will impose a new contract – it may have to be altered to conform with the law (they themselves admit that the currently proposed contract contravenes the Equalities Act as it discriminates against women with children and part time doctors). The most hope lies with the High Court action being brought on behalf of five junior doctors which challenges Hunt’s right to impose a contract at all. Even if this is won things cannot go back ‘to normal’. A rubicon has been crossed. Doctors have seen that, in the eyes of the government, they are no different from miners, or rail workers (who are also currently striking). Of course as people they aren’t, but as a profession medicine has always been regarded as a vocation rather than just a job to put a roof over one’s head and food on one’s plate.

I trained to be a doctor because I felt that I had a vocation – in old fashioned terms, ‘a calling’ – to do so. To a greater or lesser extent I think most of my fellow medical students did too. We were taught by senior doctors with similar values. As a junior doctor I thought nothing of staying late if needed. However, we were also respected by patients and by the nurses that we worked with. Most of all the government did not interfere at all with the working of the hospital, the business of the Royal Colleges, and our day to day working lives. A colleague told me recently that a junior doctor working for him had not been able to take a two week holiday since qualifying four years ago. I hear regularly of medical couples (junior doctors) who are completely unable to obtain annual leave at the same time. Since the introduction of the internal market in the NHS doctors are treated less and less like vocational professionals, and more and more like difficult workers to be micromanaged. Senior doctors are no longer able to do what they think is best for the patient in front of them; they have to conform to the wishes of their (non-clinical, often less well trained and qualified) managers. The very  concept of a ‘line manager’ just did not exist in medicine until a decade or so ago.

All this is relevant because it is against this background of low morale generally amongst doctors that the industrial action is taking place. Senior doctors are leaving general practice  and hospital consultant jobs as soon as they feel able to afford it. Cynics and critics say that this is only possible because of the generous final salary pension schemes available. In part this is true, but in fact many doctors are leaving in their 50s because of ill health caused by the stress of working in the NHS and taking much reduced pensions. At the same time as doctors are leaving at the ends of their careers it is becoming increasingly difficult to recruit entrants into to various specialties.

The crisis in general practice is so great that the government has announced a plan to deal with it – a plan that involves flying in 500 trained GPs from overseas and increasing the number of GPs being trained. I find this extraordinary. General practice requires a knowledge of the primary care system in this country and good communication skills, neither of which may be at the top of the list of attributes  of overseas doctors. (As an aside I find it amusing that at a time when the more right wing in our society are complaining vociferously about immigration they may find themselves reliant on an immigrant GP.) As for increasing the numbers trained in the UK, I suspect that if there was an easy way to attract more junior doctors into general practice we would be already doing it.

There are also problems recruiting into psychiatry, A&E, paediatrics, and anaesthetics, that I know of. There may well be more specialties in difficulty. From qualification in medicine to becoming fully trained as a hospital consultant takes around ten years, so whatever solution is proposed it will not be instant. The Royal College of Psychiatrists has been working hard to increase recruitment for some time and is starting to see results, but their work includes targeting school pupils before application to medical schools.

From first principles I would suggest that if you are going to pick a fight with a group of workers, and fight to the bitter end, you would do well to ensure that after you have sacrificed those workers to your principles you have others ready and waiting to take their place. Unfortunately for David Cameron and Jeremy Hunt this is not the case. Informal surveys show that even amongst preclinical medical students over a half do not intend to work in the NHS as a result of the current dispute. A number of newly qualified doctors are choosing to leave the NHS to work in Australasia or Canada. Some are moving into clinical work outside the NHS or are working as locums. Others are leaving clinical medicine altogether. The current shortage of junior doctors (and consultants) and ‘rota gaps’ is likely to get worse, not better. Under these circumstances it seems a little strange to pick a fight with workers that you desperately need.

The second issue that prompted tears is not completely unrelated. I heard the inquest verdict on the Hillsborough 96 yesterday with huge relief. Relief for the families who have struggled so hard for justice over the past 27 years, relief that the good names and reputations of the dead as well as the survivors has been restored, and relief that at long last people are going to brought to account for their corrupt and dishonest actions.

hillsborough

The tears came today as I read David Conn’s article in the Guardian. On a day when various newspapers shamefully ignored the Hillsborough verdict this article stands out as a powerful piece of writing that should stand as a tribute to the campaigners for justice, and an indictment of the police and politicians. I challenge anyone to read this account and remain unmoved by the heroism of the campaigners, the barbarity and corruption of the police, and the indifference to all of it of the establishment.

It is the willingness of the politicians to believe those of status over ‘the great unwashed’ that is common to both issues. Whilst junior doctors are not being treated with the awful degradation meted out to the dead, dying and surviving at Hillsborough, they are not being heard. A deaf ear is being turned wilfully, and an authorised narrative is being fed to most of the media and sadly the BBC. The message being given to our citizens about the junior doctors’ strike is the message that Jeremy Hunt wishes to be propagated, just as the message given about Hillsborough was the message chosen by the police and politicians. In both cases newspapers (with the honourable exception of the Guardian) and the BBC have followed the message of the establishment.

Finally the Hillsborough 96 and survivors have been completely exonerated. This has come at huge cost to all the families involved who have given 27 years of their lives to achieving justice. Even now they face the ordeal of waiting for the CPS to decide about prosecuting the key surviving policemen. Whenever everything is finally over, these families’ lives can never be the same again.

When the doctors’ industrial action is over things will never be the same again. The best that I can hope for is that the NHS is overhauled but remains true to its founding principle – that in the UK healthcare is provided for all, regardless of financial means, free at the point of delivery. All the evidence is that any insurance based system is less efficient and usually less equitable.

We are in a time of flux, where corruption and abuse of power are unearthed almost daily amongst politicians, police, priests, financiers and businessmen. The EU referendum may radically alter our place in the world; the arrogant behaviour of the politicians may end the NHS as we know it. State funded education is being eroded to the point of non-existence almost without notice. Historically such times of change have produced revolution, as the gap between us and them becomes intolerable. Maybe my tears reflect the loss of what was and trepidation about what is to be.

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