The BMA needs to think carefully about its next steps. In recent weeks, it has become abundantly clear that there is more to this than just the junior doctors’ contract, or indeed the rate of pay for Saturday daytime work.
The union can walk away with the deals brokered by Sir David Dalton – which include major concessions on pay and hours – and start to work with the NHS on the wider issue of morale. Or it can continue to do its part to make junior doctors feel worse. Only one of these options will help the NHS meet the very real challenge that it faces.
Sadly, peacemakers tend not to prosper within the BMA election process. So instead they pursue macho posturing, and build up whoever is the health secretary as a hate figure.
This damages the NHS’s ability to make the changes required of any health system. Instead it lurches from battle to battle, creating alarmist headlines and huge animosity. The BMA has cried ‘crisis’ too many times. This is a lesson that it seems unwilling to learn. In 1984 its chairman declared the ‘end of the NHS’, simply in response to a government decision to impose a blacklist of substances, including Flora margarine, which should not be paid for by the NHS. The BMA rightly suffered media ridicule for its posturing.
Few will forget the BMA poster campaign in 1989 which attacked the health secretary, Kenneth Clarke, as someone who didn’t follow medical advice. Even the BMA chairman later acknowledged that this was counterproductive. But it does not stop. In 2007, during a period of huge spending increases (and dramatic pay rises for doctors) the BMA described the NHS as being ‘on its knees’, and once again held the health secretary personally culpable.
Some have compared the junior doctors’ strikes to the miners’ strikes of the 1980s. There is no comparison. Mining was on its knees. The National Union of Mineworkers was fighting to save a dying industry and the communities that depended upon it. In stark contrast, healthcare will continue to grow, because the NHS is one of the few areas of public spending still receiving new investment. A far better comparison is the battle that Ronald Reagan fought to liberalise the US air transport market in the 1980s. The sector had great potential, but could only realise it if the whole industry became efficient and innovative. In order to achieve this Reagan fired 11,000 air traffic controllers who had gone on strike over a new contract. All Jeremy Hunt has done is gradually introduce a contract after three years of negotiation, and with most of it agreed.
The NHS is in the midst of a very tough time. It must adapt and transform in order to meet the country’s changing health needs. Vitriolic arguments over details of contracts are a hugely damaging diversion from this task. Having whipped up the medical profession into a frenzy over the contract, only the BMA can now restore relative calm. It must move on, out of duty to the NHS and its patients.
Dr Tony Hockley is a former adviser to the Leader of the Social Democratic Party (SDP), and was Special Adviser to Virginia Bottomley and to Stephen Dorrell at the Department of Health. He teaches within the Department of Social Policy at the LSE, and is Director of the Policy Analysis Centre
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