For the first time since the 1970’s junior doctors have taken industrial action in protest against a new contract, which they say is unfair and unsafe. On their side David Cameron and Jeremy Hunt claim that a new contract is needed to deliver a ‘7 day NHS’. You will of course hear greatly differing versions from the two sides of what is being offered and the grounds for rejection. Junior doctors say:

• The contract will force doctors to work longer and later with fewer safeguards. This threatens to compromise patient safety
• The 11% pay rise is more than offset by a drop in pay for working antisocial hours
• Doctors pay starts below the national median – starting salary is £21,000, for an ASDA manager £22,000. Doctors also have to pay for registration, legal protection, insurance and exams
• The new contract would penalise those who take time out to have a family or who work part time.

The government proposes that normal working hours should now be from 7 am – 10 pm Monday to Saturday (please note MPs have just cut their own hours and increased their own pay). The reduction of hours that attract extra pay is a red line in the sand for the government, because if they can redefine them for junior doctors they can redefine them for other NHS staff too…

On the government’s side, Hunt and Cameron have used their ‘manifesto promise’ of a 24/7 NHS to justify their imposition of the contract but it is important to remember:

• We already have a 24/7 NHS. No-one is sent home with a broken leg or a burst appendix on a Saturday afternoon. Almost all NHS clinical staff work out of hours to provide emergency and urgent care, as Hunt was reminded by the twitter storm #ImInWorkJeremy
• We can’t afford a routine 24/7 NHS While the government have refused to define what they mean by ‘a truly 7 day NHS’ they have indicated that they mean routine care available 7 days a week. Pilots show that patients don’t want this and Hunt certainly can’t afford it. Routine care requires not only doctors but all the support staff of nurses, radiographers, porters, admin staff etc. It would mean extending an already overstretched service across 7 days instead of 5.
• A new contract is not needed to improve out of hours care. Emergency and urgent out of hours (OOH) care always needs improving, but this does not require a new contract for junior doctors. The devolved nations are not imposing this contract (and indeed are already looking to recruit disaffected English doctors) and there are trusts in England which have improved their OOH care without the need for a new contract.
• Leaked document reveals Jeremy Hunt’s own officials doubt his evidence on seven-day NHS plans more here so just who actually backs him?

What Cameron and Hunt say…
Both Cameron and Hunt have repeatedly misquoted statistics about increased mortality in relation to weekend admissions despite being publicly contradicted by the authors of the paper they quote and by the editor of the BMJ.  What’s more Hunts misleading claims about the dangers of being admitted over the weekend mean that 53% of people are now afraid of going to hospital out of hours, in itself a dangerous state of affairs. And ironically it has already been reported that Hunt’s treatment of the juniors has led to clinical initiatives to improve out of hours (OOH) care being derailed

As for the government’s accusation that junior doctors have been misled by their ‘irresponsible’ union – these are for the most part not people just out of medical school. ‘Junior doctor’ means most hospital doctors below the consultant grade, so that many of them will have years of experience on the wards, young families to consider – and a good understanding of their contracts. Of the 76% who voted, 98% supported industrial action, a percentage that political parties can only dream of (the Tories won the last general election with a vote of 36.7% on a 66% turnout).

Hunt has accused them of putting patients in danger but while junior doctors are striking patient care is being provided by highly experienced consultants and associated specialists (and it is well documented that mortality stays the same or actually drops during doctors’ strikes). It is true that some patients will have had their operations postponed, but while Hunt wrings his hands about this no-one has mentioned the fact that 70,000 operations were cancelled last year, due to NHS underfunding eg bed shortages, lack of staff and theatre time. This dwarfs what has happened during the 2 days of industrial action but there has been no mention of it in the mainstream media.

Current status
Cameron and Hunt have now taken their own ‘nuclear option’ and imposed the contract, the first time this has ever happened. Imposition, apart from seriously upsetting the very doctors who are the backbone of hospital care, could have serious consequences for recruitment and retention of doctors. 14 out of 20 CEOs have already withdrawn support from a letter in which they supposedly backed Hunt. Meanwhile Hunt – while claiming to have an open door – has dodged not only numerous invitations from the media to state his case but doctors themselves, running away from any confrontation. An event for which junior doctors had bought tickets was moved elsewhere at the last minute, and doctors who did manage to get there were screened out at the door. It is a damning indictment when the Health Minister is afraid to face his own staff.

Hunt and Cameron know that the public are overwhelmingly behind the junior doctors and the NHS in general.

What YOU can do to help put pressure on Cameron and Hunt
If you want to help then there ARE things you can do and some of them will only take a few seconds of your time and all will help raise the profile of all the issues.

1. Please read about what is happening to the NHS and its staff  and think about joining a campaign or a local patients group.
2. Practical action could also include writing to your MP and to national and local papers to support the juniors, turning up at the picket lines on days of action
3. The continued use of social media to dispel the lies put out by the government
4. Share this post with friends and family
5. Join the campaign – Keep Our NHS public
6. Read up on the privatisation of the NHS at NHS for sale
7. Follow and rt @keepnhspublic
8. Sign the petition Consider a vote of No Confidence in Jeremy Hunt, Health Secretary
9. Sign the petition Jeremy Hunt to resume meaningful contract negotiations with the BMA
10. Sign the petition Labour Party and TUC – call a national demonstration to support the junior doctors!

The fight that the government has picked with junior doctors is just part of the present attack on the NHS and its staff. Cameron and Hunt are using the vague promise of ‘a truly 7 day NHS’ to impose a contract on junior doctors, in the hope and expectation that if they win they will roll out these changes to other NHS staff. They think the public’s interest and support will wane but we must not let this happen. This is everyone’s fight, NHS staff and patients and the public, and it is surely the government that is now taking risks with patients’ lives. Don’t let apathy win, every little thing helps.

Thank you for supporting OUR NHS.

Originally published: Dr Jacky Davis (The Complaining Cow  – Guest Post)

Jacky Davis is a consultant in North London, a founder member of the campaign Keep our NHS Public and a member of the BMA Council. She is the co-author of two books about the NHS – NHS SOS, how the NHS was betrayed and How We Can Save It, and NHS For Sale. The final chapter of NHS SOS is entitled ‘What you can do to save the NHS’ and contains much practical advice about what the public can do to fight for the NHS.

Follow her at @DrJackyDavis for up to date news about the NHS.