Government braced for 2-day doctors’ strike

At 8am today, junior hospital doctors began a 48-hour strike – wondering whether it would be third time lucky as they attempt to defeat government attempts to change their contracts.

Doctors had already staged two one-day strikes, after negotiations between the British Medical Association and the Government over the new contracts broke down. The Government appeared not to be impressed and announced that it would impose the new contracts anyway. There seems to be a deeply ingrained belief in Government that the public detests all strikes and any group of workers which goes on strike will soon lose public support and be crushed. So far, this has not happened with the junior doctors – with recent opinion polls showing support holding solid and people blaming the Government for the impasse.

The doctors are taking action because the new contracts threaten their pay and working conditions – but also because they would undermine the NHS and its ability to deliver services.

On the surface, it looks like it all began because just before the last General Election David Cameron noticed some statistics going round that said that patients were more likely to die at the weekend than on weekdays. He announced this must be because there were not enough doctors around over the weekend and he promised the next Tory Government would end this problem and ensure that England had a “seven day a week NHS”. Once the promise was made, and the Government was in, he had to deliver.

His assumption that the increased death rates were due to a lack of doctors was immediately questioned. Appointments for minor ailments take place during the week, whereas A&E attendance goes up at weekends. The death rate among the first group is lower than among the second, which shows up as “more people die at weekends”. It’s no good having doctors in if you don’t have technicians to run scanners and similar devices, process blood tests, make the beds and clean up after the patients. If you were going to have a “seven day a week NHS”, you would need all kinds of NHS staff on duty, not just doctors. Above all, with NHS Trusts dipping in and out of the red, how were any of them going to afford to pay for a seven day a week NHS and the increase in the number of patients and treatments it involves. A seven day NHS on five day money wouldn’t work.

How could a Prime Minister not see the obvious? Of course he could see the obvious. He could also see that the NHS costs a lot of public money – much of which stays in the public sector rather than delivering profits to the private sector like other public spending does (like the housing benefit paid to landlords does, for example – and spending on weapons). The market response to a situation like this is to reduce the number of outlets – but it is politically unacceptable for waiting lists to rise too much. The answer, therefore, is to reduce the number of outlets (hospitals), but to get more work done in each of them. In other words, a seven day a week NHS spreads the building’s overheads over a larger number of patients, making each patient appear cheaper to treat.

There are two hurdles which must be overcome: the cost of doctors, and the cost of other staff.

At the moment, the basic starting salary of a junior doctor is £21,000. Increments are added each year, so it will reach around £38,000 after seven years’ work, for example. To earn this salary, the doctor has to work 40 hours a week between the “social hours” of 7am to 7pm Monday to Friday. Doctors who take the shifts outside the “social hours” receive a supplement for working during “anti-social hours”. The supplement varies, depending on how many anti-social hours are worked and when they are.

In this dispute, doctors are not saying that they are poor and need a huge salary increase. They are just saying that they want their salaries to stay the same. The Government is proposing to cut the supplement paid for working during anti-social hours, particularly on Saturdays and after 7pm on weekdays, while increasing basic pay rates by 11% as a token compensation. This is the core of how the Government would pay for the “seven day a week NHS” delivered over fewer sites: make more days normal working days, paid at a normal rate.

The next step would be to revise the contracts of other staff, making them come into work over the weekend for no appreciable extra pay. If the Government can see off the protests of the junior doctors, which other category of workers is going to risk fighting change?

The new contract falls somewhat short of providing a full seven day a week NHS, but it would certainly deliver a six day a week NHS – if extended to other groups of staff after being imposed on the doctors. The NHS is a massive employer. If it were working a six day week, there would be a great deal of pressure put on other public sector employers to follow suit. Why should librarians or caretakers get extra pay for working on a Saturday? Private employers would also love a six day week: for every five employees, they would get the work of a sixth employee for the cost of five days more pay but not the further on-costs which individual employees incur. Their balance sheets would look much rosier if their overheads were spread over six day working, not five.

The junior doctors’ strike today and tomorrow is the key watershed of this Government – whether it is able to continue the austerity agenda of turning public spending into private profit, or not. The doctors didn’t choose to be on the front line, defending the NHS and defending, ultimately, many other workers’ terms and conditions – but they will need wide support if the action is to be won.

•March to support the doctors!
5pm, Thursday, 10th March
Gather at the Royal London Hospital and march to St Paul’s.

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