The junior doctors’ strike is about the existence and future of the NHS

I’d like to clarify a few points raised in the LDV comments thread related to the Doctors strike and Tim Farron’s remarks about it. First, I will state my potential conflict of interest: I’m a doctor (retired) a life-long member of the BMA (yes, I do still pay my union subscription) and my daughter is also a junior doctor.

The strike is happening because Jeremy Hunt has stated that he will impose a new contract on juniors against their will in August 2016. Negotiations, which have been conducted over the last three years with the BMA, have broken without any agreement and, thus, junior doctors are withdrawing their labour, as a last resort.

There has been a complete breakdown of trust between the profession and the government, which has been simmering for some time. That breakdown stems in part from the imposition of the Health and Social Care Act 2012 on the NHS against the almost unanimous views of doctors and, indeed, most of the healthcare sector. This was not in the Conservative 2010 manifesto, the evidence base for the Act was non-existent, yet doctors have been forced to implement this Act against their better judgement and at great expense in both time and money. This has happened against a backdrop of serious budget cuts within the service, the so-called Nicholson challenge to save £5 billion a year, each year from 2010-2015, which was largely achieved. The service and the staff have been squeezed and squeezed and we are now at a tipping point.

The new government now comes with yet another demand –the so-called 7-day NHS.

We already have a 7 day NHS for emergencies and, contrary to the Tory mantra, it is likely that patients admitted at weekends get more, not less, attention from the doctors on duty because they can focus on emergency admissions rather than ward rounds, outpatient clinics, teaching sessions, routine operating lists and all the other weekday activities.
Consultants are always available 24/7 for advice and to see very sick patients in person as required, it’s in their contract because they have legal responsibility for the patients.

We do not know why mortality seems to be higher in patients admitted at weekends but this pattern is seen in some other countries with advanced healthcare systems. Most countries do not know if this is a problem for them because they do not collect the data. If excess mortality exists, it may be due to specific patient characteristics or different healthcare-seeking behaviour of patients admitted at weekends. More research and analysis is needed.

Mortality may also be worse on Mondays and Fridays, and to a lesser extent on Tuesdays and Thursdays, so perhaps we should be campaigning for a one day NHS and only treat patients on Wednesdays, supposedly the ‘safest’ day to be in hospital – clearly ridiculous. The data are complex, they may even be wrong. The government could fund further research, which would be very useful, maybe compare the blood alcohol or blood sugar levels between patients admitted in the week and at weekends, obesity levels or smoking habits, even compare their incomes. We know poverty kills, there’s plenty of data to support that, even though it’s politically inconvenient, but no evidence that the presence or absence of doctors has any effect on patient outcomes – we are probably not that important.

For many of us what is going on now feels a lot like the 1980s when the Thatcher Tory government tried to crash the NHS by starving it of resources, and came within an ace of succeeding. We would not have an NHS today if Labour had not won the 1997 election and two years later (after sticking to Tory spending cuts for the first two years) started pouring money into a service which was on its knees. The recovery took a decade.

The last strike, in 1975 was in very different times, the NHS itself was not under direct threat, the juniors were not backed by the consultants who had a different agenda. This time we are one profession and stand together. It’s not just about the juniors’ contract, it’s about something much more fundamental, it’s about the existence and future of the NHS.

Practical advice to the person whose child has diabetes; I expect your child is seen regularly by both a GP and a paediatrician, both are trained and expert in treating diabetes. If you consider your child needs to be seen by another specialist you can simply request your GP to make a referral if there is a medical need. It will not cost you a penny – that’s the beauty of the NHS, access for all according to need. It’s definitely fit for purpose.

* Catherine Royce is a retired medical doctor, Lib Dem activist, member of the Lib Dem Women Exec and ALDES member