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| Junior doctors' strike has become the mother of all deadlocks | Junior doctors' strike has become the mother of all deadlocks |
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| After two days of all-out strikes unprecedented in NHS history, what will happen next in this bitter, long-running and politically significant dispute? The last 48 hours have seen 12,711 operations cancelled, 112,856 outpatient appointments postponed and junior doctors protesting outside 150 hospitals. Jeremy Hunt made his umpteenth Commons statement on it and the airwaves were dominated yet again by those for and against the contract these NHS workhorses loathe but are due to fall under from August. This is now the mother of all deadlocks. | After two days of all-out strikes unprecedented in NHS history, what will happen next in this bitter, long-running and politically significant dispute? The last 48 hours have seen 12,711 operations cancelled, 112,856 outpatient appointments postponed and junior doctors protesting outside 150 hospitals. Jeremy Hunt made his umpteenth Commons statement on it and the airwaves were dominated yet again by those for and against the contract these NHS workhorses loathe but are due to fall under from August. This is now the mother of all deadlocks. |
| The next move is up to the British Medical Association. Its junior doctors committee will decide on Saturday week, 7 May, how it plans to ramp up its protests against the contract, which will significantly extend the hours counted as part of the normal working week for junior doctors in England and will include Saturdays for the first time. But ramp up the protests it will. | The next move is up to the British Medical Association. Its junior doctors committee will decide on Saturday week, 7 May, how it plans to ramp up its protests against the contract, which will significantly extend the hours counted as part of the normal working week for junior doctors in England and will include Saturdays for the first time. But ramp up the protests it will. |
| Related: Jeremy Hunt doesn’t understand junior doctors. He co-wrote a book on how to dismantle the NHS | Frankie Boyle | Related: Jeremy Hunt doesn’t understand junior doctors. He co-wrote a book on how to dismantle the NHS | Frankie Boyle |
| Two options being seriously considered, as leaked emails last week revealed, are an indefinite all-out strike – an open-ended maximisation of this week’s action – and a mass resignation of junior doctors. The intense anger and desperate desire to thwart Hunt, or at least force him to reopen negotiations, which broke down in February, and the militant mood among many committee members, means that either tactic could easily become policy, despite the obvious risks inherent in both. | Two options being seriously considered, as leaked emails last week revealed, are an indefinite all-out strike – an open-ended maximisation of this week’s action – and a mass resignation of junior doctors. The intense anger and desperate desire to thwart Hunt, or at least force him to reopen negotiations, which broke down in February, and the militant mood among many committee members, means that either tactic could easily become policy, despite the obvious risks inherent in both. |
| Behind the scenes the doctors’ union is in a terrible mess. Public opinion is still behind them, but they are in a weak and weakening position. Junior doctors’ anger means they have to hurt the NHS and inevitably patients in seeking to win the battle, but doing so risks alienating the public, or, far worse, contributing to any deaths in hospital during an all-out strike that may be blamed on their absence. Consider this: 1,200 people die in hospital in England every day. | |
| The BMA represents, sometimes uneasily, three types of doctors: GPs, consultants and junior doctors, most of whom work in hospitals. But while the juniors are keen to prolong their campaign, as this week’s high strike turnout shows, many of the BMA’s hierarchy – experienced, senior doctors – are ill at ease, both with the withdrawal of cover in life or death areas of care seen this week or, worse, any tactic even more radical than that. BMA leader Dr Mark Porter’s still private but deep concerns about the wisdom of all-out strikes, and the potential damage to the public’s high regard for the medical profession, are well known inside the union’s HQ. | The BMA represents, sometimes uneasily, three types of doctors: GPs, consultants and junior doctors, most of whom work in hospitals. But while the juniors are keen to prolong their campaign, as this week’s high strike turnout shows, many of the BMA’s hierarchy – experienced, senior doctors – are ill at ease, both with the withdrawal of cover in life or death areas of care seen this week or, worse, any tactic even more radical than that. BMA leader Dr Mark Porter’s still private but deep concerns about the wisdom of all-out strikes, and the potential damage to the public’s high regard for the medical profession, are well known inside the union’s HQ. |
| The NHS blogger and analyst Roy Lilley wrote this week: “The BMA? Stuck with a Plan A that hasn’t worked and a Plan B that means more strikes and disruption. You can’t dignify it with the word strategy. More strikes, more disruption? More risk to reputation, careers, public patience? The union have led their members into a cul-de-sac.” That is unfair, and takes no account of Hunt’s increasing belligerence. But it does sum up their dilemma. | The NHS blogger and analyst Roy Lilley wrote this week: “The BMA? Stuck with a Plan A that hasn’t worked and a Plan B that means more strikes and disruption. You can’t dignify it with the word strategy. More strikes, more disruption? More risk to reputation, careers, public patience? The union have led their members into a cul-de-sac.” That is unfair, and takes no account of Hunt’s increasing belligerence. But it does sum up their dilemma. |
| Quite a few NHS bosses, senior doctors and health policy experts think that Hunt will move elsewhere in the reshuffle after the EU referendum in June, which will magically lead to a resolution. That is unlikely, however. Hunt’s policy is the government’s policy, as David Cameron made clear this week. Hunt is no lone wolf. Changing the minister won’t change the policy, and by late June many junior doctors will already have had to sign the new contracts or decide to do something else with their planned medical career. How many will resign and not become specialist trainees? That may be fewer than this week’s sound and fury suggests. | Quite a few NHS bosses, senior doctors and health policy experts think that Hunt will move elsewhere in the reshuffle after the EU referendum in June, which will magically lead to a resolution. That is unlikely, however. Hunt’s policy is the government’s policy, as David Cameron made clear this week. Hunt is no lone wolf. Changing the minister won’t change the policy, and by late June many junior doctors will already have had to sign the new contracts or decide to do something else with their planned medical career. How many will resign and not become specialist trainees? That may be fewer than this week’s sound and fury suggests. |
| In February the BMA rejected the government’s “best and final” offer on the new contract. Despite it being “final”, those involved on the government’s side admit they would have granted one further, major concession – to only make Saturday up until 1pm part of the standard working week, not the 5pm then planned. Senior figures in the NHS, MPs sympathetic to the junior doctors and even some at BMA House believe that in hindsight not settling on those terms was a mistake, though the strength of junior doctor anger means the grassroots would probably have rejected that. | In February the BMA rejected the government’s “best and final” offer on the new contract. Despite it being “final”, those involved on the government’s side admit they would have granted one further, major concession – to only make Saturday up until 1pm part of the standard working week, not the 5pm then planned. Senior figures in the NHS, MPs sympathetic to the junior doctors and even some at BMA House believe that in hindsight not settling on those terms was a mistake, though the strength of junior doctor anger means the grassroots would probably have rejected that. |
| With such fury on one side, and such determination in the government to press ahead with imposition, the war of attrition will continue for some time yet, with more strikes that no one wants but everyone seems powerless or unable to stop. | With such fury on one side, and such determination in the government to press ahead with imposition, the war of attrition will continue for some time yet, with more strikes that no one wants but everyone seems powerless or unable to stop. |