While the talks may be a welcome sign that the pressure of regular and escalating strike action is finally forcing movement from the DOH, without serious concessions there are no grounds currently for demobilising the strike.
While the DOH narrative has been of doctors unwilling to negotiate, the fact is the Junior Doctors have gone out of their way accommodate the DOH. They have made a number of significant concessions, with the main redline being extra payments for Saturday shifts, and the discrimination against women that will result from the contract.
The Junior Doctors even sat outside the DOH for days leading up to the strike practically begging Jeremy Hunt for talks. This became a propaganda coup as Hunt's refusal to talk with the doctors - despite them sitting outside his office for 12 hours a day - made him appear even more unreasonable and singleminded to the public.
Hunt's reluctance to talk shouldn't be taken as a personal failing of his alone, in truth its a representation of the governments commitment to drive through its conditions on the contract, no matter what the opposition. Entering talks is only a tactic utilised by the government when it wants something, or when it is forced to by popular pressure. The pressure on the DOH has been immense, coming from all the Royal Colleges and numerous Trust boards.
Why this steadfast commitment to forcing through Saturday working? As this graphic below illustrates, the DOH plan isn't really about dealing with the supposed "weekend effect" (which has been shown to be false anyway) but about engineering a crisis in the NHS which allows the government to more easily facilitate its privatisation.
|Jeremy Hunt's plan for the NHS|
By driving doctors out of the NHS, services will be degraded, and in extreme cases, shut due to lack of staff. This loss of NHS capacity will create new markets for the private health sector to expand into, to fill the gaps in service provision. This can be spun as the private sector coming to the rescue of a failing NHS, as they pick up lucrative contracts to do profitable elective surgery at new private hospitals currently being built right next door to existing NHS hospitals around the country.
This is why doctors must stick to their redlines and continue fighting no matter what. Any concessions on Saturday working or discrimination against women will be abused by NHS trusts to make doctors work schedules inhumane, driving them out of the service. This may be done with the best intentions, due to wanting to maintain NHS services at all cost and stop them closing, but the effect will be the same; doctors will leave, and services will close.
The only option is to keep striking till the whole contract, or at least the parts relating to Saturday working, are withdrawn. Anything less will be a defeat.
Solidarity strike action
Its a huge ask for doctors to keep fighting on their own. While they have generated a huge amount of public support and staged some magnificent demonstrations and successful strikes, this alone may not be enough to force the government to back down, when huge amounts of their NHS privatisation project relies on the successful imposition of this contract.
What would improve the doctors situation immeasurably would be active support and solidarity action from other trade unions in the NHS. The doctors have made clear they are fighting for the NHS, its time the rest of the NHS fought for them. The main health unions - UNISON, Unite and RCN should be mobilising their members in support of the junior doctors struggle.
They could be organising public rallies and demonstrations in support of the doctors, encouraging members to join the doctors pickets on strike days, and exploring how solidarity action could be organised to bring more sections of the NHS workforce out on strike in order to put more pressure on the government.
Sadly there has been little of this active solidarity from the national health unions. While local branches have organised solidarity with pickets and joint meetings to make members and non-medical staff aware of the dispute, and support among staff has been evident from the proliferation of the turquoise junior doctor badge on everyone from security guards to lab technicians, little concrete action has been organised at a national level.
The NUT has actually done more, by trying to coordinate its strike action with junior doctors than the health unions have at this point.
A motion even went to the Unite Health National Industrial Sector Committee on the 21st April arguing that the union look into coordinating strike action with the doctors. The NISC chose to interpret the resolution narrowly, as a motion to strike alongside the doctors on the 26th and 27th (an impossibility given the timescale and the trade union laws), and the motion received little support. It was put to a vote, but fell, with more abstentions than either votes for or against. The apathy on the issue is worrying.
Reps and activists need to get the issue on strike action on the agenda of regional and national committees and move debates on the issue. Solidarity strike action is illegal, so the unions will need to find other reasons to strike in unison with the doctors. They could put in pay claims, dispute the 1% pay rise, ask for guarantees that unsocial hours payments won't be cut, or take issue with ongoing cuts to the NHS services around the country. While a difficult task this is doable, and if the work is started now, strike action in solidarity with doctors is possible during the summer.
Tactics for the DocsWhile the rest of us work on trying to mobilise our unions, what steps can the junior doctors take? A number of tactics are open to them, the basic issue is to keep escalating the dispute.
Mass resignation/Boycotting the new contract
One option is for a mass resignation of junior doctors over the issue. While a risky move, what this does is bring forward the staffing crisis which will result from the new contract, from a few years down the line, to the present. This will make it Jeremy Hunt's problem, and force him to act to fix it. If even several thousand junior doctors resign en mass, this will cause a massive crisis that will pile pressure on Hunt to drop the contract, or at least the Saturday working clause. If this is done collectively, across trusts and is organised by local junior doctor committees it could create pressure without putting patients at risk. Doctors would coordinate handing their notice in on the same day across the country, the the DOH would only have the doctors notice period (4-6 weeks) to resolve the matter.
Holding protests, "resignation rallies" and reiterating that doctors will only come back to work when the contract is withdrawn would force the issue, and help to guard against the government spinning this as the doctors threatening the NHS.
A survey has been launched to find support among medical students for refusing to sign the new contract, in effect a boycott. This would also be worthwhile tactic to pursue. Non-compliance and refusal to take up jobs now, forces the future staffing crisis into Hunt's lap, and links it directly to the contract.
Escalating the strikesDoctors have successfully staged a total withdrawal of labour for two consecutive 8 hour days. This could be escalated to cover the full twenty four/forty eight hour period, or the number of days could be increased from two, to three, four or five. This would force consultants to cover more shifts, and the system would quickly reach the maximum it could take. There are only enough consultants to cover forty eight hours of an all our strike by junior doctors. Any longer and the hospitals will struggle to staff shifts and keep services running, and Trust Boards will have to pressure Hunt to end the dispute of face their hospitals being unable to run even emergency services.
These may seem dangerous actions, but doctors hands are being forced. The government has refused to listen to their concerns, and pressured them into serious industrial action. The DOH under Hunt has shown it does not respond to reasoned argument, only to pressure. Only by piling the pressure back on the government can the doctors hope to win concessions, and possible withdrawal of the contract.
Coordinating the grassrootsThe junior doctors committee has not declared more strikes, a worrying sign that pressure from the Royal Colleges may be reducing their willingness to escalate the action. Its imperative that doctors and other NHS staff organise themselves to campaign for the above tactics. If the JDC won't lead a campaign of escalating action, or won't coordinate a mass resignation campaign, doctors and supporters must begin doing so themselves. Likewise, if the unions keep dragging their feet over solidarity action, union activists in RCN, UNISON and UNITE need to organise to pressure their unions into action, and begin developing the links between different unions and hospitals to make any actions as widespread and effective as possible.
Now is a good a time as any for a national meeting of junior doctor and NHS staff activists to plan concrete steps to turn these ideas into action.