The BMA and the government have reached a provisional agreement over the junior doctor contract dispute. The contract will be published at the end of this month. It will then be submitted to a ballot of 45,000 junior doctors.
This ballot – or ‘referendum’ - is in fact non-binding. The BMA’s Junior Doctor Committee will take an executive decision regardless of the result.
But junior doctors will be inclined to vote no to the contract, going by the initial reaction of many junior doctors yesterday. On the Facebook junior doctor contract forum (with over 60,000 members), there was a mixture of anger, bewilderment and frustration.
Why has the government has allowed this damaging dispute to drag on over several months? On other controversial and unpopular proposals like tax credits or compulsory academisation of schools, they’ve U-turned. But in this case, they have been prepared to expend huge amounts of political capital and popularity in order to ram this through.
That should tell you a lot in itself.
This is about the restructuring of the workforce to bring down the wage bill to increase profit margins for corporates. It is of course part of a bigger picture of NHS privatisation ultimately leading to the introduction of a private insurance system consistent with the direction of travel of and the various statements of influential policy-makers over the years.
In other words, the government is prepared to do whatever it takes in order to get this through because opening up the NHS oyster of over £100 billion to global capital is a massive project. This is why government insiders have compared this struggle to the defeat of the miners in the 1980s. Theirs is an ideology of market fundamentalism, which believes that market forces should run everything for profit. It is absurd to suggest that the NHS will be spared.
Jeremy Hunt announced yesterday that the government has stuck to its red lines. Nowhere is there any mention of increasing funding in order to extend the NHS from a five day into a seven day elective service.
Two of the most contentious areas were the redefinition of anti-social hours and the removal of hospital safeguards to prevent doctors working excessive hours. The former would mean that late evenings and Saturdays would effectively be paid the same as normal social hours. The latter would potentially lead to tired doctors and compromise patient safety.
The new deal suggests that pay for weekend hours will be linked to number of weekends worked, with a bonus of up to 10% of salary if one in every two weekends is worked. On the second point, there appears to be some tightening of provision around the monitoring of hours. Elsewhere, non-resident on-calls is currently paid as premium pay, and this would still be massively reduced in some cases to levels barely above the national minimum wage. Incremental pay or automatic pay progression will be converted into a series of nodal points based on the attainment of milestones. However, this would exclude periods at which doctors are not on training programmes but still working.
We have reached the anticipated compromise between the BMA and the government. This reminds us that no hierarchical organisation will save the NHS from being opened up to global capital. All conventional channels to effect change have been blocked. The privatisation programme has been enabled through a cross-party consensus. The corporate media have been largely complicit. New trade union legislation will make it much harder for all workers, including doctors to strike.
History is transformed by mass movements - from the suffragettes to civil rights in the US. So a mass movement is needed to prevent the NHS privatisation programme and preserve the NHS as a public, universal healthcare system. Only a mass movement can pressure the establishment into changing its line. This is why an event is taking place this Sunday called Act Now to Save Your NHS aiming to launch a mass movement of rank and file health workers, campaigners, patients and citizens. Join us.
How to Dismantle the NHS in 10 Easy Steps is available from Zero books.