29th April 2016
By Chris Kane, Junior Doctor
Junior Doctors: Honesty and Clarity is needed from both sides
I don’t understand why this dispute has turned into such a mess
As someone who has committed their life to helping people in the last stages of theirs, if there’s one thing I’ve learnt it’s that it’s not what you say but how you say it. I’ve seen people talk about death with relatives and it result in a heated argument on the ward, and I’ve seen people talk about the exact same thing and it end in an embrace between all parties.
That’s why watching the junior doctor dispute has been so interminably painful for me to watch.
I want to lay my cards down on the table from the start, I believe this contract is unfair, but I also believe both sides could have done so much more to avoid it ever getting to this point.
Advanced communication is like a game of chess, you need to work out what the agenda of the person you’re communicating with really is, not what they’re saying. In my day job this is normally about someone’s fear of dying pain or their sorrow at the loss of independence, but in this dispute it’s been much harder to discern.
From the government perspective their stated aim is to reduce weekend mortality by making it cheaper to staff weekends. However it’s a rarely stated fact under the current contract having a doctor work every weekend costs exactly the same as having one work one in four.
In order to reduce weekend mortality they need to recruit to acute specialties the ones with the most out-of-hours, so disincentivising out-of-hours work seems entirely counterintuitive to that aim.
It’s clearly not really about a 7 day NHS.
An educated guess tells me that it’s about making workforce expansion cheaper. If the workforce increases then the cost of this expansion will be considerably less under the contract than the current one. I also think it has become about proving that they “won’t be bullied” by trade unions; in other words preaching to their core vote. I don’t think this was the original intention but they have seen the BMA’s position as an opportunity and grasped it with both hands.
From the doctors’ perspective it’s a little more complex. It may not seem it at times but it’s a much more heterogeneous group. There’s the doctors themselves and then there’s the trade union, the BMA.
Openly both these groups have the same stated aim:
* A fair deal for doctors
* A safe deal for patients
I think these are good aims and if the essence of this message had been communicated then things could have been de-escalated long before this.
The safety argument is important so let’s deal with it. The original proposal in the firm offer from NHS Employers in November 2015 contained no protections for working hours. Given the lack of trust between employers and employees this did leave the door open for abuse and therefore posed a risk. Much has changed since then and the new safeguards, if implemented correctly (and that’s a big if) should help to prevent that. Ultimately though the reason this contract may be unsafe is because it can’t recruit people to do the job.
In terms of a fair deal, this has really been an expression of a feeling over the past decade that increasingly as a workforce we are stretched to the absolute maximum. It has been very difficult for juniors to express that feeling due to the nomadic role they play in the NHS and this contract has finally given a focus point to express that.
For some time junior doctors have felt isolated. We move so often from post to post it can often feel like we’re not valued or listened to. We don’t have time to make positive change and it feels like things are imposed on us at ward level without consultation. Ultimately this started with Modernising Medical Careers in the 2000s and will be exacerbated further by the Shape of Training review currently being implemented.
So looking at the real agendas:
- The government wants to expand workforce numbers more cheaply.
- The doctors want to feel valued and no longer at breaking point.
I’m sure many of my colleagues will disagree but ultimately these are the core aims of both sides. As you can see the aims aren’t that far apart and with some honesty and clarity about the true objectives it shouldn’t have been difficult to reach a deal.
Unfortunately there is too much rhetoric to pick apart and trying to distil a clear message has become impossible. That’s a shame, as when you understand the real agendas you can usually bring about resolution, and that’s when you avoid the shouting match in the middle of the ward and instead end up embracing each other in a shared purpose.
By Chris Kane