Indefinite strike is the only way to win this dispute

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The BMA is once again gearing up for a further set of strikes in an aim to force the government’s hand and restart discussions over the contract with government. In all, it is a similar scenario to one that played out only earlier this year with a contract that led to a halfway house which was soundly rejected. The current strategy seems to be more of the same, with an escalation to 5 day strikes to repeated monthly in the hope that this will bring the government back to the negotiating table. The stakes are higher and we have a change of face, but that seems to be the only difference.

The press has once again whipped up a similar response in support of the government labelling doctors as lazy and overpaid, whilst also simultaneously militant and looking to overthrow the government. The government themselves have responded in shock, seemingly failing to realise that an unsolved issue can actually cause problems (cough, Brexit). Furthermore, May’s comments that doctors are “playing politics“ serves only to indicate that they intend to play this out.

So the big question is, will the BMA win this time?

The BMA’s strategy appears to be an escalating series of strikes aimed at maximising public support whilst pressuring the government to concede. The problem is of course, that a strategy of this sort assumes that the government actually wants to negotiate, and that there is a common ground between the two groups. This is what I fundamentally do not believe to be true and hence, the situation thus becomes futile.

The BMA assumes that the government must have public’s best wishes at heart, otherwise, attempts to win the public over how medics are maintaining a moral high ground would be nothing more than grandstanding.

The government has shown on numerous occasions that it does not have the public’s interest at heart. First of all, since the 2012 Health and social care act, the health secretary has had no responsibility whatsoever for the running of services. The bill to revoke this, the NHS reinstatement bill, has failed to pass twice, with neither conservatives, or the majority of labour MPs choosing to support it.

Secondly, the government approach to bad news appears to be to ignore and bury the bad press rather than act on it. The Leveson inquiry made a clear point that poor staffing levels lead to poor care, and that there should be mandatory publishing of nursing staffing levels. This was ignored. The threats that child poverty was on the increase were buried by changing the definition of poverty. The deaths numbering thousands caused by a department of work and pensions that sadistically targets sanctioning of benefits for the sake of figures have also been quietly forgotten. All in all, we seem to have a system that cares more about numbers rather than lives.

If the government doesn’t care about the people it is ruling over, then what does it care about? Chasing votes is an obvious answer, and this appears to be via claiming that any of the numbers it is reporting as improving as the best markers of positive governance. Up until now, this has been the deficit, which even George Osborne had to accept has been an utter failure. The deficit is the difference between government spending and income which also has no real relevance to most people’s day to day lives. Now, no matter how deluded these beliefs are, they are nonetheless what this government has chosen to pursue. In order to achieve this, either revenue has to increase or co
sts have to fall. As money does not grow on trees, increasing revenue requires either raising more taxes or having more things to tax, i.e. by investing in the economy. However, as taxing the rich or spending money for long term gain are not things that conservatives believe in, these options are dead-ends. This leaves the only option as culling government spending. This has been used as an excuse to cut innumerous services at a time when people are increasingly out of work and have greater needs precisely due to a faltering economy.

It is in this light that we need to view the current dispute. Staff wages are a cost which are stopping the government becoming more ‘efficient’. Staff are nothing more than a number that need to be reduced in order to fulfil targets. The real cons
equences that come as a result are irrelevant. Obviously this wouldn’t sound great so the fictional 7 days services issue has been magicked up in order to counteract what is a blatant pay cut.

Now, the BMA has made good efforts indicating that this entire issue is non-existent, in spite of the entire right wing media deciding that doctors are public enemy number 1. On this front the BMA has undoubtedly made a PR success in framing the issue in terms of patient safety.

However, the issue now lies in negotiation. First of all, prior discussions have led to contract that has been soundly rejected in a vote by junior doctors. This is where the issue lies. The government are clearly unwilling to drop their demands for a 7 day service on completely fictitious grounds. This has been made consistently clear by Jeremy Hunt.

Therefore there can only be one solution if negotiation is not an option, and that is going for a complete rout. The BMA’s strategy thus far has been increasingly loud sabre rattling with limited striking and overly long build up periods. This is a calculated strategy which would be good in the expectation that the government does not want escalation. This has however, clearly been proved not to be the case., with Jeremy Hunt’s ceaseless triumphalism at every corner.

This leaves only one option: indefinite strike. The government strategy has in essence been to play the BMA for chumps and wait for morale to break down in the membership so they just roll over and accept the contract. Previous strikes have come with expiry dates, allowing the government to simply wait until the strikes are over and then continue business as usual. This remains a flaw in the current strategy by the BMA to pursue limited action. Indeed the recent decision to stall action further strengthens the government’s hand.

There are of course risks involved with patient safety. However, consultants are capable of managing wards if other clinical duties are removed. An alternative could involve alternate full strike days and emergency cover days could reduce the pressure on consultants as well as alleviate financial issues for members.

Either way, this dispute has gone on for long enough. The time for words is over, and in the absence of effective leadership by the BMA, there can only be one winner.

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