Strikes have no winners – and the junior doctors’ dispute is no exception

https://www.theguardian.com/commentisfree/2016/may/19/junior-doctors-strike

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Most strikes end sadly, and some – like the miners’ – very badly. Junior doctors have yet to vote on the peace terms agreed by their leaders on Wednesday, but the odds are that most will accept. Yet they will stay angry, and with good reason.

After eight strike days, the public has stayed staunchly supportive of their cause, even when they walked out of A&E, and even when tens of thousands of operations were cancelled. But there is an ebb and flow, a rhythm in the emotional rollercoaster of a strike, and the time feels right to call it a day – before public support wanes, and when the junior doctors know their point about life within the NHS has been well made.

But nearly all strikes end with a painful sense of giving in, by a workforce driven back to work – even when they have won important concessions. The rhetoric, the political passion, the indignation all have to be toned down, in ways that make the workforce feel they are swallowing more pride than the employers are. It hurts – and the bitterness lasts.

That’s why strikes are usually a bad thing, a last-resort breakdown in relations. The thrill of rebelling is intoxicating, but usually ends in burst-balloon disappointment.

I have covered hundreds of strikes, but rarely seen happy workers marching back in with a sense of victory. The latest I wrote about was the well-justified strike by National Gallery staff: settlement didn’t leave them a happier workforce.

Jeremy Hunt provoked this strike, possibly deliberately, imagining he would emerge a hero to his party for taking on the “vested interests” of the public sector. But he ended up the political loser, with the public understanding the doctors’ alarm at the state of his NHS and the rising pressures on all who work in it.

Digging through the details of the actual deal, neither side won. It looks more like a stalemate, with some changes around the edges. Hunt’s claim to have got seven-day working – but with no new money, inside the same pay envelope while conceding on some of the more extreme antisocial-hours issues – looks like magical accounting.

Besides, during the course of this long strike, the original research suggesting 11,000 more patients die after admission at weekends has been decisively shredded: it’s all in the different case-mix at weekends. Nor, if there are genuinely extra deaths at weekends, is there any evidence that junior doctors, who work more weekends than other staff, are the key. Nor, say health economists, is there any evidence that heavy investment in extra weekend staff delivers good value for money in lives saved, compared with other spending.

But health is politics. Hunt wanted a fight, and he got one, but it has ended any leadership hopes he once had. No tears shed there. Far worse is the long-term effect this will have on the junior doctors themselves.

Many more are likely to flee abroad or go into some other occupation after experiencing the grinding exhaustion and high anxiety of their job being met with such cynical political ingratitude and incomprehension.

The shortage of doctors is acute, and some specialisms can’t fill their rotas. Nurses too are in critically short supply. Why anyone would think this is a good time to end bursaries for trainee nurses is a mystery.

The NHS itself is now registering its worst ever results since waiting times were recorded: for A&E, operations, cancer treatment and ambulance times. As the situation worsens, this strike, with its popular support, will have helped place the blame firmly where it belongs – with a government that pretended to promise ringfenced funding, but which has given the NHS its lowest increase over the last six years than at any time since 1948 – 0.8% against an average 4% rise to cover a growing and ageing population. The UK is tumbling down the international league table for health spending.

Frankly, the wonder is how well it has managed, when many health economists predicted it wouldn’t. But the pressure building up in lack of staff will blow the lid off, as overstretched managers try to keep the wheels turning while repairing the unfathomable organisational mayhem caused by the 2012 Health and Social Care Act.

Even if they vote to accept the deal, even if they feel deflated, as all strikers do, the junior doctors will have scored an important victory in telling the public exactly what’s happening inside the NHS.