At least Jeremy Hunt got his ‘consultant-led service’ after all


“I’ve nothing much to offer.

There’s nothing much to take.

I’m an absolute beginner.”  (David Bowie)

If Jeremy Hunt were worried about ‘never becoming the story’, Jeremy Hunt had ‘lost’ years ago. If the current dispute gets the scalp of Hunt, it is not undisputed that he would have gone anyway. After all, he has been in post a long time. A bit like the argument that crime is falling anyway.

Strictly speaking the line that ‘it doesn’t matter if the strikes go ahead’ is true if Hunt doesn’t mind sticking two fingers up at what the BBC loves calling “the doctor’s trade union”. Relationships between the medical profession and the BMA have never been great. So much so, people have mysteriously been discussing why the BMA have opposed this move, but did not oppose the NHS reforms. How ironic.

The line is a truism in that I understand that the contractual terms could be unilaterally imposed anyway, unless the workforce acquiesces ‘en masse’, resigns in protest, and then apply for their previous jobs. There might be some inevitability about this, in the best spirit of ‘there is no alternative’. This, from Jeremy Hunt’s vantage point in Richmond House, is his ‘first ever strike’. Hunt’s “first ever strike” is probably held with the nostalgia I had for my ‘first ever on-call’ with a few symbolic similarities: like will the cardiac arrest go off?

Jeremy Hunt, to all intents and purposes, in this context is an ‘absolute beginner’.

I was in a meeting of the research and evaluation committee for Dementia UK, and somebody commented that as such the NHS ‘was not on its last legs’, but definitely having a few ectopics. Imposing a new contract would be totally consistent with harmonising the NHS with a free international market, which is what is being done anyway through TTIP and the ISPS clauses.

But the ‘ectopics’ are quite significant.

The rationale for the new contract is supposedly the ‘7 day service’, but the war over the safety of a new 7-day service requiring this new contract is currently being waged on the evidence pages of the British Medical Journal. But this policy-based evidence may be insufficient to overturn the political argument that David Cameron actually won an election so feels that he has to deliver on this election promise: in his words, he has “to do what’s right”.

Statistically, the starting point is that there is bound to be a day of the week is slightly lower on average than the others; but the question is whether it is significant or meaningful. The irony of today’s first skirmish of the #juniordoctors strike is that the Consultants indeed were working flat-out to deliver a consultant led service. Never have so many Consultants fought off the clerking sheets for so many. The Consultants, pardon the phraseology, were some of the worst ‘casualties’ of today, but so true inevitably were those experiencing cancelled outpatients clinics and cancelled operations.

Ultimately, Jeremy Hunt, not being a socialist, does not wish to have anything like a ‘wages policy’ either presumably. From his end, he views that most doctors are not losers, some are in fact winners, and that being paid for unsociable hours is an inequity, and so are seniority payments. This is an oversimplification, before you feel compelled to deny.

But if indeed you can hear a bedpan fall in Whitehall on this occasion, it is traditionally argued that what you get paid to work for the NHS does not depend on your postcode (unless your postcode happens to be in London, or something). Left to a totally free market, and if price were properly a market signal, the ‘out of hours’ slots could be held up on a lottery basis like tickets for the Olympics, and those doctors wishing to do the antisocial hours get paid extra.

There is of course one massive flaw in this: that the Department of Health does not want to pay for any mechanism which could see Doctors being paid for at markedly increased levels compared to currently. For longer than time began, think tanks such as the King’s Fund have been wetting themselves on the notion that the NHS is able to ‘control wages’. That is, except it doesn’t. When it aggressively pimped out services under s.75 Health and Social Care Act (2012), the risk was that the private sector could make the taxpayer pay more whilst the NHS logo was being used.

This inequity of risk is of course familiar territory to anyone who has followed NHS policy under the halcyon days of New Labour and the Conservatives.

We are all still reeling from the contracts under the Private Finance Initiative, where in fact risk was kept in the public sector, but profit skyrocketed in the private sector. New Labour loved PFI, first introduced by John Major. But it had continued under Osborne – unfortunately the problem with the ‘buy now pay later’ philosophy is that you soon enter the ‘pay later phase’.

I don’t happen to believe that this is Hunt’s ‘miner’s strike’. There are notional differences, in that the strike is being held in winter months when the service is least resilient; compared to the miners’ strike were seasonal variation meant usage of coal was not that critical. Or, for example, whatever your views on the Trotskyite champagne-swilling leadership of the doctors, they are better organised, arguably, than Arthur Scargill. And as such there’s no single hate figure amongst the Doctors, even if Prof Sir Bruce Keogh’s sexing up of a warning put Keogh somewhat in the firing line. And anyway Keogh knows which side his bread is buttered on. Keogh, in no sense at all, is another Scargill.

The end game has always been to make the NHS harmonised with the private sector in every conceivable way. This would mean theoretically reducing arbitrage in wages of staff – but remember when the NHS ended up paying extra for agency nursing staff because it did not plan properly for the future? Leaving it up to the market means that you cannot nationally plan, arguably. Planning for the future, in whatever vehicle possible such as #DevoManc, might threaten the NHS Foundation Trust policy so beloved of New Labour, like never before.

And ‘in place of fear’, there have been chinks of hope, for example the solidarity inter-generationally between consultants and their juniors. The general feeling is that the #JuniorDoctorsStrike represents massive uproar about the contract, but the contract per se might be the straw that broke the camel’s back. Without the junior doctor workforce, the NHS cannot function, but Hunt is relying on the fact that the junior doctors, consistent with their professional regulatory obligations, do not wish to put the public at risk safety-wise. Rather different from Harold Wilson’s seamen (please note spelling.)

I strongly suspect TULCRA be applied by the Government for an ‘all out strike’ though, but I am no astrologer. TULCRA, despite having never been tested as a consolidating act (to the best of my knowledge), would be ripe for testing here from the Government lawyers.

If the end-game is that the NHS is one of many State deliverers of service, organised around the private insurance system, rather than a state provider, then in future Hunt will see the NHS been tuned into the frequency and wavelength of the private insurance markets. This would be, really, out of the frying plan into the fire. But any neoliberal party, including the Conservatives, could argue that this comes from an election mandate which wants NHS funding to be secured, and for the NHS to be free at the point of delivery.

All of this is factually true, but a half truth, in that social care is on its knees, and the transfer of assets into the private sector has had rocket fuel in the terms of outsourcing of contracts, selling off of NHS property, and PFI loan agreements. All of this while the Conservatives vigorously denying privatisation. That is at the heart of the Conservatives’ discrediting of ‘left wing tactics’ about the #JuniorDoctorsStrike, that it is a general whinge, and not about the contract at all. But short of a national referendum specifically on the NHS, it is sad that there has been no outlet thus far for a ‘general whinge’.

But in the meantime Jeremy Hunt got what he had long sought for, for today at least – a Consultant-led service.

Be careful what you wish for?CYhDnWhWsAEQBQH

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The author @dr_shibley is on Twitter, and is an enthusiast in English dementia policy.