Oh God, another junior doctor strike. That seems to be the feeling of the country and of the junior doctors I’ve spoken to. Certainly it’s the feeling of the consultants, like myself, who will be covering for them.
Why the BMA has called another strike is clear. They haven’t got what they wanted, and their current mandate expires in early January. What is less clear is whether they should be striking at all. During the last strikes I wrote that the majority of juniors weren’t striking chiefly for a pay rise, but because their jobs and prospects of career progression are being allocated to foreign doctors who, data shows, perform worse on average.
The usual voices blame the poor performance of foreign doctors on systemic racism, but the real moral failing is holding foreigners to lower standards. That we have started giving them the apprenticeships of domestic graduates is insane
That there seems no serious interest in solving this problem is hard to explain, just as it’s hard to explain why militants (who really are striking for another massive pay rise) are in charge at the BMA. But explanations are needed, because these phenomena are not unique to medicine. Our country seems unable to run anything competently, and persistently hobbles us with self-defeating laws and regulations, then declares it can’t possibly do anything about them. These days militants and fools seem to rise to the top everywhere, from the BMA to the Oxford union to the cabinet.
Why do lunatics of one idea, or egotists with the moral and cultural depth of spilt milk, do so well? They didn’t always use to. I recently watched an old episode of Parkinson in which Kenneth Williams argued with Jimmy Reid about whether unions should strike. The level of debate, and the level of interest even from the audience, was remarkable. It was a reminder that fools have also taken over the BBC, and that the licence fee should be scrapped not chiefly for bias but for abandoning the public service of intelligent broadcasting. I disagreed strongly with a lot of Jimmy Reid’s opinions, but of his grown-up thoughtfulness there was no doubt.
Junior doctors demanding unaffordable and rapid pay rises right now are not being serious. Those demanding that the government doesn’t give their training posts to overseas graduates are. Many foreign doctors are superb but overall they perform worse, with objective evidence found in the statistics of GMC sanctions and test performance. This is despite the fact that, if you look at the exam most take in order to work in the UK, the top 10 per cent go on to perform at a level indistinguishable from domestic graduates. Why we admit the others deserves far more attention. The usual voices blame the poor performance of foreign doctors on systemic racism, but the real moral failing is holding foreigners to lower standards. That we have started giving them the apprenticeships of domestic graduates is insane.
Juniors are right to be concerned about their pay having dropped – it has, and so has their ability to buy a house, a problem which bites no less hard for also biting others. Many juniors accept, more readily than they should, being priced out of giving their kids the childhoods they enjoyed themselves. What they won’t accept is watching their jobs being given to foreign doctors who aren’t as good. This is not a difficult problem, but Streeting has instead offered a small increase in the number of training posts overall, like a surgeon congratulating themselves for prescribing paracetamol when they should be fixing the broken hip causing the pain.
Junior doctors are generally serious people. Medicine is a craft, almost never an art, and the hallmark of being fully trained is finding most of what you do routine because you are dealing with problems you have seen a thousand times before. An airline pilot excited to see how his plane handled would not be comforting. Experts are always world weary; only incompetents find their work perpetually surprising. The company of the juniors, so often of high intelligence and admirable work ethic, is what keeps a career as a hospital consultant rewarding.
Historically, the BMA is not a militant organisation. I suspect its quality has declined for the same reason standards have fallen at the Oxford union and in the cabinet. We unfailingly attract the worst people to the top jobs, and part of that is because the best people are repulsed or have given up and now concern themselves only with their private lives.
Something has gone badly wrong when we are so often unwilling to solve straightforward problems that are of our own making and entirely under our own control. The triumph of incompetence and shallowness is everywhere. These strikes are unnecessary, and it is tempting to hope that a few disenchanted junior doctors go into politics instead. But the incompetence that lets the strikes persist is the same that drives people of substance away from public life. The doctors who go into politics will probably be the ones who shouldn’t.
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