Johann Malawana Chair of the BMA JDC has just delivered the most INSPIRING speech via facebook.
Thought that I should share this with you
This week has been a roller coaster of events and emotions. When I came into this job 5 months ago, I came into it because frankly I was angry at how I felt my friends, my colleagues and I were being treated. I absolutely could not stand the idea of having something being imposed upon us by a government that has no clue what it is we do.
Over the last 5 months I have felt like many of you in our need to moderate our language, I know that my job is not to simply represent my frustrations, but to stand up for all of our collective interests whether junior doctors or the patients we look after. JDC members are often the same, they represent the views of their regions with a passionate resolve to do the best for the doctors they have in their patch. I have seen the same from representatives across the board this year, whether they are college trainee groups or specialty organisations. I have seen junior doctor leaders put aside previous silo competitive traditions and work together in a way that none of us have seen before. One thing I hope beyond everything else is that as a profession this has a longer term effect on our generation of doctors. We will work together in a collaborative way for the good of our profession, patients and the whole NHS in a way I have not seen previously. Over the last decade I have seen the bastardisation of the concept of clinical leadership by the department of health, turning it into a method of control where professionals are trained simply to follow instructions and kept in line simply out of fear of a loss of influence or position. This week we have seen the outcome of that agenda, when clinicians stand up for themselves, their patients and what they think is right, the answer is aggression, bullying and being effectively screamed at, that the will of a politician or a government will simply be imposed on those that disagree. So much for independent clinical leadership or professionalism.
On Tuesday I met with Sir David Dalton at his request. I have been clear throughout the last few months that last minute offers in general are highly inappropriate as the government has had three years to make fair offers. We have tried to talk, to negotiate in good faith. We have represented our members, but we have also been of a clear view that our members believe in a sustainable NHS. Retention of the doctors in the UK is our number 1 priority as without the talented individuals that deliver the frontline of the NHS, it is our patients that ultimately suffer. I notice in the latest HSJ article, Sir David has misrepresented that meeting and the clear view I expressed that I know I heard from many doctors throughout the NHS. We are always happy to negotiate, but a negotiation has to involve recognising both sides views and priorities. We had spent a huge amount of time and effort consulting with you our membership, looking at the stated aims of the government in terms of priorities, but also using our experiences of the frontline so solve the contractual dispute to the satisfaction of all parties. We understood compromise was necessary, however we also assumed that compromise was needed from both parties.
The issue regarding out of hours has been attempted to be boiled down to simply about pay. When we constructed our structure of pay, we also took into the implications and considerations of the needs of the NHS. If you simply move money into basic salary and undervalue the out of hours components of the salary structure, you create perverse incentives as the relative value of time out of hours diminishes. This has a knock on effect as it creates a driver that devalues specialties that have heavy out of hours commitments relative to others. This could have a further destabilising effect of the delivery of those services as already overstretched services become less popular due to their relative lack differences. Therefore we wanted to create a system of pay that valued time appropriately especially when we want to retain and recruit staff into those specialties. The issues regarding front loading and flattening of the pay scale were specifically trying to square a circle of a treasury red line of the removal of automatic pay progression from the public sector and a desire to ensure that we did not penalise or perpetuate the gender pay gap. We also wanted a system of pay that ultimately benefited the next generation of doctors that ensured that the wage inflation compared the to cost of living inflation benefitted the doctor starting out on their career and considering the debts students now qualify with. If nothing else, this structure showed our absolute attempts at addressing competing interests that many felt were insurmountable. Our structure of pay involving appropriate rewards for unsocial hours was also staff group specific. With the majority of the staff group being at a stage in life when families and childcare was inevitable, it was important that appropriate account was taken or this to try and retain highly trained staff as they balance competing interests of family life and professional responsibilities.
On the issues around NROC, we identified early that this was an area that was particularly of concern. We have experience of NROC on our negs team, however the full extent of the varied and diverse working structures meant we were absolutely clear we wanted to consult further on this area. However we were also absolutely clear that the government position of continuously comparing the roles of junior doctors with more senior staff where the range and types of responsibilities are different does not make sense. percentages of values that are so very different also have an impact, and where the financial barrier to rostering practices that have the potential to take advantage of junior doctors cannot be sanctioned. Again there was an absolute refusal to understand the concerns we described and the “needs of the service” were always paramount - a concept we can all sign up to if those needs are not so dangerously overstretching staff that doctors and patients are forced into dangerous situations. We suggested a proper consultation and testing of positions, however this has now obviously been rejected.
The experience of all negotiators over the last three years have been of negotiating partners that continuously introduce new objectives very late in the process, - 7 days services (June 2015) First refusal on medical time (January 2016) to name two, and yet cry foul if we attempt to suggest that these involve a requirement for additional resource or that they are undeliverable due to the current overstretched staff. There is also a continuous disingenuity in that compromises made are often rowed back on and so promises can never be trusted. Add to this toxic mix continuous political interference for objectives that have nothing to do with the service or patient care, but entirely focussed on soundbite politics and a constant need to look like there is a political victory to be had. You see why this whole sorry episode has been a lesson for the NHS and the medical profession in all that is fundamentally wrong with our current system. The department and NHSE in particular, fundamentally entered this whole negotiation with seemingly the attitude they had to teach the medical profession a lesson and put them in their place following previous negotiations.
So the contract that has been described has several aspects that are fundamentally unfair, the distribution of resource across the whole week, the first refusal on medical time, the nature of NROC, the ultimate safety mechanisms in the contract and the confidence we can have in them, the delivery of many of the mechanisms that are reliant on collaborative working, the ultimate appeals mechanisms for dangerous activity. There have been a hell of a lot of gains as a result of our attempts to outline what junior doctors do from modifying the flawed pay structure, some of the safety limits, making a fundamentally unworkable safety mechanism have some resemblance of what could work if there was any trust left in the system. However there is so much still flawed with this system. If this was about comparing what we currently do, its easy to misrepresent the situation. But its the nature of the services and distribution of staffing projecting forward and overstitching those staff that is so flawed. There is an absolute finite staffing resource. You cannot deliver a 7 day service when the current 5 days is falling apart and is dangerous.
Several times over this process we have tried to suggest that it’s in no ones interest to have this damaging fight, however that is not simply solved by the medical profession being “taught a lesson”. In November despite an incredible mandate, we called on the government to enter Acas to find a solution, in December despite last minute interference again to try and prevent a deal being found, we were able to find the starting point for negotiations and we stood down despite significant mistrust and strength of feeling. In January despite every attempt to find a solution to the problems we all could see, giving Sir David Dalton the space to come in and pulling more industrial action to give us all the space to find solutions, we still faced this intransigence and absolute unwillingness to compromise for political reasons. We had suggested that for the last few weeks that the whole situation has got out of hand and it would be in everyones interest to step back from the abyss and try and solve the issues of morale amongst junior doctors. Build trust back in the system and try and solve some of the educational shortcomings in the current system. Unfortunately once again machismo and political interference took precedence and rather seeing that we had one opportunity to try and find stop a damaging course of events, the day after junior doctors across England going out on industrial action and feelings being elevated, the Secretary of State decides now is the appropriate time to show how deeply muscular the government is. Obviously burying bad news about waiting time figures - the first time ever that the target for routine operations has been missed, or that the departments budget has been exceeded due to massive mismanagement and requires a treasury bailout, I am sure had nothing to do with making a political announcement to destroy the last vestiges of morale in the junior doctor workforce in this country.
What next is what every junior doctor and the wider profession is asking? Well the government has published a very short summary of the some aspects of the contract they intend on “imposing”. We need to truly look at this and the implications. We can already see significant shortcomings that mean this proposal is not something junior doctors have stated they would sign up to. But unlike the government, the JDC and the BMA do want to actually listen to our members. Below is a list of open meetings I will be attending:
Monday 15th Norfolk and Norwich Hospital Mess meeting 12.30pm
Monday 15th East of England RJDC, Clinical School, Addenbrookes, 7pm
Tuesday 16th Bristol for joint RJDC/Bristol Divisional meeting 7pm
Wednesday 17th East Midlands RJDC meeting TBC
Thursday 18th South Thames RJDC - BMA House 6.30pm
Friday 19th West Midlands RJDC - Birmingham Chamber of Commerce 75 Harborne Road, Edgbaston Birmingham B15 3DH 7pm
There are also open RJDC meetings:
Monday 15th Northern RJDC Royal station hotel Newcastle 6.30pm
Tuesday 16th Oxford RJDC - John Radcliffe Lecture theatre 2, 6.30pm
We will look much more into the detail of the proposals should we get detail and look at where these will need to be challenged. We will seriously now have to consider every option available to JDC and consider what is in the best interests of our generation and the next of doctors, our wider profession, the NHS and our patients. Ultimately we cannot sit by and watch the government alienate a generation of doctors and thereby destroy the NHS we work so hard every day to make better and protect. The governments aim maybe to teach the medical profession a lesson, but in doing so they have shown their willingness and almost eagerness to destroy our NHS. The government often whispers about this as their miners moment. What happened with the mining industry? Is that what this government envisages for the NHS?
It is time for us all the take stock. The staff of the NHS never asked for unfair payrises, we never destroyed the financial system, we didn’t abuse our positions for personal gain. All we want is to be treated fairly and to not have the organisation we love and dedicate our lives to be destroyed by a government that puts their personal gain above the people they are supposed to represent.
I will say one last thing, its very easy to make this about Jeremy Hunt. But fundamentally, deep down, I think we need to squarely lay the blame at David Cameron. He has stood by and ensured that ultimately the NHS he claimed to want to protect has been systematically destroyed since being elected by attacking the very staff that sweat blood and tears trying to protect it, work for it and love it.
ps you will hear from me in due course…".
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