Images: Health workers striking in 2014. Rights: Roger Blackwell/Flickr.

Jeremy Hunt has vaulted over the BMA to write directly to every “Junior” Doctor about the government’s attempt to impose a new contract, dangling an 11% rise in basic pay.

Junior doctors (any doctor who is not a GP or a Consultant, whatever their age or experience), have responded furiously to Hunt's bypassing their union and to his blatant spin. BMA junior doctors’ committee chairman, Johann Malawana, declared: “In short, there is nothing new in what the government is putting forward. That is why our decision to ballot our members still stands...”

But even as junior doctors put up fierce resistance to government attack, the government is trying to push through the Trade Union Bill. Its Third Reading takes place today (10 November).

The timing of the dual attack is more than a coincidence.

For junior doctors, the fresh offer, as reported, leaves several aspects unchanged: the attacks on “unsocial hours”, pay progression, and on effective safeguards on hours worked. Doctors would be paid at the normal daytime rate until 10pm on weekdays, rather than 7pm. Experience on the job would not result in higher pay through annual progression; pay would only rise in line with training. Current safeguards to prevent excessive hours and ensure sufficient rest and breaks would be removed.

The doctors will decide how significant these and other unresolved issues are for their own contract. But Hunt’s attack on doctors’ terms and conditions also threatens knock on damage to the rest of the NHS workforce – just as the Trade Union Bill undermines all health workers’ ability to fight back.

Last December, in a submission to the Pay Review Body, the Department of Health argued that in order to finance 7 day working in the NHS, health workers’ pay should be “reformed”, i.e. attacked, through changes to “unsocial hours” and pay progression. Agenda for Change (AfC) is the framework covering pay and conditions for most NHS staff, including nurses, midwives, paramedics, allied health professionals (e.g. physiotherapists), admin and clerical staff, porters and domestics, all of whom are required for an integrated safe service, and all of whom are rightly called health workers. The Department of Health said the current national contracts for NHS staff were “a barrier to the delivery of sustainable seven day services”, saying they had been “in place now for many years and agreed at a time when many services were delivered only during the week”.

The Department cited the retail sector as a benchmark, as if the NHS were a shopping mall. They argued that “the treatment of Saturday at plain time appears to be the norm for many employers, which seems out of line with AfC where working Saturdays is considered comparable to working nights.” The DH suggested that “In line with retail, the police, and most housing and social care services, premium pay rates for working Saturdays could be paid at plain time and night shifts could begin at 10pm rather than 8pm.”

The AfC system of annual increments, under which staff only earn the correct rate for the job when they have worked long enough to reach the top of their pay band, is also under attack from the Department of Health. They consider annual increments “unaffordable”. Instead they propose “A more modern and sustainable pay system which is better able to target pay resources around performance and premium pay rates”. In other words, a bonus scheme to reward selected staff, instead of fair pay for all.

The NHS already operates 7 days a week, as #ImInWorkJeremy pointed out, with medics posting photos of themselves at work on a weekend, and causing a widely reported Twitter storm. But any attempt to raise the level of provision at weekends requires a full complement of health staff, not just doctors, and it is their pay which the Department of Health is so concerned to cut.

Health workers are not highly paid. Since 2010, pay has declined by over 12% in real terms. For many nurses, enhancements for night work and weekends are an essential component of the wage.

Pay and working conditions affect morale and stress and the ability to do the job, which then impact on services to patients. As the Royal College of Midwives wrote recently, “Protecting working conditions is important because midwives’ and maternity support workers’ working conditions are women’s birthing conditions.”

The RCM were giving evidence to Parliament on the Trade Union Bill, the second component of the government's agenda. Should the Bill become law, industrial action by health workers would require a 50% turnout with at least 40% of all those eligible to vote, voting “yes”. For example on a 50% turnout, an 80% yes vote would be required. Abstentions would be effectively counted as ‘no’ votes.

Apart from these absurd thresholds, in reality removing the right to strike for health workers, the Bill directly affects safety at work by attacking facility time - paid release for trade union duties - which include health and safety. The Fire Brigades Union pointed out, in written evidence, that this would undermine the Serious Accident Investigations triggered by the death of firefighters on duty, since SAIs are carried out in trade union facility time. Vital health and safety work is also a trade union duty for NHS staff.

Hunt's immediate agenda is a two pronged attack, aiming to confront health workers with a new contract for Junior Doctors and a Trade Union Bill to muzzle any response from the NHS workforce when Agenda for Change comes under attack.

But is any of this really necessary? Even the case for providing the same health service on Sunday as on Tuesday is unproven, with GP pilots being withdrawn for lack of patient interest. No-one else thinks the NHS should be a supermarket. And, if the decision is taken to expand staffing levels at weekends to enable a stronger service, does that require driving down wages and conditions? With billions squandered on procurement, re-disorganisation exercises, and the private finance initiative PFI / PF2, costs directly associated with a healthcare market have escalated. Rolling back the market would save far more than attacking doctors and health workers pay.

The longer term agenda appears to be: make the NHS unworkable, demoralise NHS staff until they emigrate or change careers, and convert the NHS into an insurance scheme, or a basic service which people with money can and will bypass.All of us, healthworkers and patients, should be glad the Junior Doctors are balloting. We don't want medics and other NHS staff forced to work when they're tired, or keeping quiet about problems they notice to protect their performance related pay. We want healthworkers who are strong enough to fight collectively for their pay, their working conditions, and our health service.

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