The BMA proves that democracy without leadership is doomed to fail

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The Thick Of It

Would more PR have won it? Image source: The Thick of It, BBC

After a strangely timed leadership election, the BMA have once again called off threats to strike. Whilst the BMA remains ‘opposed’ to the contract, it is due to be imposed on Monday to O&G trainees as part of a ‘trial’. The BMA currently remains silent on how the decision came about (perhaps their press don’t work the weekends) as anger from junior doctors continues to mount at the continual dithering of the BMA.

The question does remain of course, how in the absence of a striking can we prevent the imposition of a contract? Previous strikes have already proven that they are at least enough to get the health secretary back to the table, though still insufficient to get an acceptable contract for the membership.

One problem is that the BMA seem to only want the ‘best deal’ rather than an objectively good deal (which at this point includes the current status quo). The fact that previous negotiations led to the BMA caving in on its fundamental arguments on 7 day working and giving a weak compromise wholly in the health secretary’s favour that it then went on to promote was hardly a confidence inspiring act. What are the principles of this ‘best deal’?

The BMA has spent copious amounts of time polling doctors on what we think the best course of action should be. And to an extent, this has been useful in producing soundbites for the media. However, this now seems to have lapsed into polling for almost every decision the BMA makes. Whilst this could be a sign of the BMA’s commitment to the democratic process, it could also equally be the sign of a leadership lacking in both vision and strategy. The BMA has become the doctor that treats by ordering countless investigations rather than making a firm diagnosis and managing the disease appropriately.

The entire manner of the BMA has been a mishmashed approach closely resembling political parties. The belief that polling voters to obtain the optimised set of policies to appeal to everyone. The problem of course is that the BMA is not here to win an election but to overturn the imposition of a contract by a zealous health secretary.

This approach also ignores the fact that the BMA has the ability to change the terms of the debate. If you asked Junior doctors 2 years ago that they would be on strike in a year’s time, most of us would have laughed and expected it to be a joke. And yet, initial votes in favour of industrial action totalled 98% in support. There was also engagement with the public, revealing support for both healthcare professionals as well as the decision to strike. Clearly we had a great opportunity to turn the debate in our favour.

Instead, we had a weak series of one off strikes as well as numerous interviews claiming industrial action was not political. The BMA walked a middle road, and like Blair, began to haemorrhage support. The BMA chose to deny this was a political dispute in spite of the fact that this is the union versus our monopoly employer, the government. It also chose to ignore and downplay any of the other widespread issues impacting the NHS such as an inefficient market system, creeping privatisation and the fact that the health secretary still has no responsibility for health under the health and social care act.

Repeated calls for unity under #IstandwithJohann quickly became a rallying call to stamp out dissent as the BMA strategy began to unravel, coming to a head as faith in Johann collapsed when the disastrous negotiated contract turned out to be a declaration on the scale of Chamberlain’s “Peace for our time”. With the collapse of the cult of Johann, leadership has taken along the lines of The Thick of It, with flip-flop strike day being the only punchline of the entire shambles.

This unsatisfactory course of action is now reaching mutiny amongst members with calls to quit the BMA and re-affiliate with other unions such as Unite. There are even calls to form a separate union from disgruntled doctors, though this will of course come with disadvantages such as lack of experience in the trade union movement (though this is equally true of many members of the BMA). Indeed, one of the few successes has been from doctors moving outside of the BMA with Justice for Health successfully funding a court case against Hunt’s imposition, results pending next week.

The simple reality is that Junior doctors are much like the rest of society, becoming increasingly disillusioned with representatives that don’t seem to doing much representation. The rise of grassroot movements aiming to take back control of democracy is a trend that has been seen throughout the West in this turbulent period, as people feel increasingly disempowered. The BMA is another force that has failed to produce a vision and instead tried to follow the winds of public opinion. Whether the contract can still be stopped will likely soon be set in stone. The question is whether the BMA will survive.

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