Image: Junior doctors protest - Not fair, not safe.

Finally, junior doctors have taken to the streets in protest. In Manchester and London, thousands of young doctors marched last week against the Conservative government's plans to change junior doctors' employment contracts. These changes redefine “unsocial hours” such that any work between 7am and 10pm, Monday to Saturday, will be paid at only standard rates.

This move would sweep away the “average work week” first set out by the 1850 Factory Act, and defended by decades of activism since. The result would be a 20-40% pay drop for junior doctors like me.

Jeremy Hunt tries to justify the changes by saying that he wants a “7-day NHS”, as if anyone would argue with consistently high standards of care throughout the week. Of course, we too believe that the quality of our care should not dip during evenings and weekends, but this does not mean that our wages should remain flat then too.

Nine Royal Colleges have issued an unusually fervent response, jointly denouncing the proposed changes as “a real and immediate threat to…the recruitment and retention of front line staff and the provision of services across seven days”.

An attack on workers

We should have seen it coming. Austerity (a euphemism for public sector cuts) corrodes society slowly, from the bottom up, starting with the least well-off. But eventually even the middle class feels the burn – including doctors. The Conservatives have taken two swipes at health workers, one per term in office: first came the effective freezing of the salaries of nurses, paramedics and other paramedical staff; and now this latest attack on the working conditions of junior doctors.

What we are witnessing is not merely an attack on doctors, but just the latest part of an attack on workers of all stripes, and accordingly it must be challenged by all of us—together.

A junior doctor strike has overwhelming public support, with 95% of those polled saying that they are approve. But do we deserve their backing? UK doctors have only gone on strike twice since the NHS was founded (once, in 1974, to protect their private incomes; and once in 2012, to protect their pension package). Where were the marching white-coats when other healthcare workers were striking in October last year? Where were the angry and co-ordinated open letters from our medical establishment in opposition to the damaging Health and Social Care Bill? With one or two notable exceptions, most of the Royal Colleges effectively muted their opposition and – through a lack of action – effectively rubber-stamped the 2012 Act.

The need for solidarity strikes

A successful junior doctor strike would need to be a broader campaign—both in terms of the participants and the objectives of the strike. They’ll need support from the upper reaches of their own profession - backing from senior doctors who have permanent positions and thus carry more clout than junior doctors who are often viewed as relatively disposable commodities by hospital management. Will they strike in solidarity with their juniors, the buzzing brains and hurrying hands that power their teams?

Once senior backing has been guaranteed, junior doctors also need to persuade their fellow health workers to hold strikes in solidarity with the junior doctors' cause. But why should they? Last year, the BMA (the doctor's union) failed to do the same when nurses, paramedics and radiographers were striking. So why should paramedical staff support junior doctors—who will have far higher lifetime earnings than they will—in their struggle?

What should our demands be?

This protest needs to be about more than protecting our salaries—it should be about defending the entire health service. I fully support a junior doctors' strike, but our organisers must make demands broader than those about doctor’s salaries alone. If we succeed only in forcing a promise maintaining our own contracts, then we will not have succeeded at all. We will only confirm the public's fears that we are a profession serving ourselves, whilst our fellow workers and patients suffer as a result of the violent transformations occurring in our NHS.

Our strike must make demands for broader systemic change in our health service—meaning better working conditions for all health workers, better care for our patients, and a rejection of privatisation—and couple itself to ongoing and future actions by other health workers.

In order to do so, it is not enough to strike only when our contracts are at risk. We doctors must use our substantial privilege and power to launch a sustained and multi-pronged attack on all the threats to the NHS.

So we must fight against TTIP, a trade deal that will entrench the creeping privatisation of the NHS. We must demand an end to the Private Finance Initiatives (PFIs) that are forcing our hospitals into debt. We must support the NHS Reinstatement Bill, and all efforts to reject the privatisation of the NHS. And we must oppose the Trade Union Bill (which is already at the committee stage in the House of Commons), which will restrict the ability of NHS unions to organize legal strikes, making it nearly impossible for future generations of health workers to even contemplate strike action in the first place.

Fixing our malunion of unions

Healthcare strikes have worked before, as I discussed last year. And our sheer numbers—1.6 million of us work for the NHS—should give us a great deal of bargaining power. But the fact that NHS workers are splintered into so many smaller unions—UNITE, UNISON, GMB, BMA, MPU, BOS, BDA, CDNA, FCS, SOR, SCP, RCM, RCN and UCATT—does none of us any favours, and demonstrates everything but unity among NHS staff.

We must refuse to think in silos, and resist acting selfishly about issues that solely affect our own sub-professions and specialties. Rather, we must regularly talk to one another and act in solidarity when our working conditions are threatened. A threat to one worker is a threat to all workers. Only by genuinely uniting under the banner of “workers” will we succeed in protecting our rights. Without such unity, the proposed junior doctors' strike, and any subsequent health sector strike, will fail to meet its potential.