On Thursday 11 February, Tory health minister Jeremy Hunt announced that he had broken off negotiations with the BMA and would impose his new terms on junior doctors.
The new contract, which Hunt plans to impose from 5 August, aims to force junior doctors to work longer and even more unsociable hours, especially more weekends (the “seven-day NHS”), with a slash in their wage of up to 30%.
The new contract also removes barriers to prevent hospitals making their junior staff work overtime for no extra money. 14 out of 20 bosses of NHS Trusts, cited by Hunt as supporting the move to impose the contract, have said that in fact they oppose it.
BMA Junior Doctors’ Committee chair Johann Malawana responded by promising continued action. “Junior doctors cannot and will not accept a contract that is bad for the future of patient care, the profession and the NHS as a whole, and we will consider all options open to us”.
The junior doctors have come a long way in six months. Their combination of public campaigning activity, grassroots mobilisation and strong industrial action has had an impact. The stubbornness with which the Tories are running the NHS into the ground despite mass public discontent shows that any less active campaign could win little. The junior doctors need to keep strong industrial action — basically, strikes — at the core of their strategy.
Yet it is increasingly clear this is a political fight. A great strength of the campaign has been willingness to link the issue of the junior doctors’ contracts to the wider struggle to save the NHS, defend workers’ terms and conditions across the board, and stop austerity. That is not completely uncontroversial in the BMA, but the most active junior doctors argue that the temptation to back away from the political implications should be opposed.
Even if the new contract were perfect (rather than very bad, as it is), the junior doctors would be right to fight against imposition. To allow the government to make unilateral changes to the contracts would set a dangerous precedent and embolden the government in its drive against other health workers and indeed all workers.
The discussion at the BMA Junior Doctors’ Committee meeting on Saturday 20 February should include the following ideas for action:
1. To oppose both the currently proposed contract and its imposition as not safe and not fair. To highlight its impacts on Saturday working; evening unsociable hours; LTFT [part-time/flexible working] trainees; in counting as working hours, for doctors on call, only the hours actually worked; on first refusal on locum work.
2. To escalate industrial action. The action so far has been well supported, and junior doctors are more angry and determined after Hunt’s latest move. The direct employers, the NHS Trusts, are in difficult financial situations and do not want sustained periods of action. The BMA should set an escalating pattern of strikes, the details to be decided by the executive. Escalation should at some point soon include pulling out junior doctors working in accident and emergency and on call. Patients will be covered by consultants, meaning a greater impact on clinics and elective work. The action should also include a walk-out of all junior doctors on new work days the government wants to say are social, i.e. Saturdays.
3. The BMA should explore all legal avenues to stop imposition, without in any way relying on such avenues. Industrial strength and organised campaigning which will win this dispute. Legal action is an auxiliary.
4. Greater coordination with and support from the wider trade union movement. The BMA should ask all trade unions to discuss what they can do to support the fight. The junior doctors should organise a fringe meeting at Unison Health Conference in Brighton on 25-27 April, and will investigate organising fringe meetings at other upcoming union conferences. The junior doctors’ committee should campaign among members to stress the importance of actively backing and working with other workers in dispute, particularly health workers, and where possible coordinate industrial action. Junior doctors should speak to GP and consultant colleagues to look for ways to coordinate with their battles with the government. The TUC should also be approached to work with the junior doctors’ committee to organise a joint national demonstration against the imposition of the contract/in support of our fight, against the removal of student NHS bursaries, for an end to privatisation, and for the reinstatement of the NHS as a comprehensive, well funded public service.
5. To issue a public statement setting out this strategy. All unions in dispute should be supported. But this dispute especially.
The NHS is vital for all working-class people. Support from other workers who can hit profits directly is important for NHS workers to win disputes; and the junior doctors’ initiative can be built on to crystallise the widespread anger against the Tories’ sabotage of the Health Service into an active movement to save the NHS.