On Hunt’s latest latest letter

On 17th November, a mere 14 days before the BMA’s first day of proposed industrial action, Jeremy Hunt has again written an open letter to Johann Malawana. The dispute over the new junior contract finally seems to be showing a little progress, but with strikes looming, the pressure is on Hunt to provide sufficient assurances to bring the BMA back to negotiations.
Again, I thought I’d offer my thoughts on Hunt’s latest tome. I welcome your comments, thoughts, and criticisms.

“I want to… restate the assurances I have given you. I remain firmly of the view that a strike by junior doctors is entirely avoidable and we should both do all we can to avert any action that risks harm to the patients we serve.”

A change of tone here. It is certainly welcome that Hunt believes that both sides have a responsibility to try to settle this dispute. Previous press releases, both from the Secretary of State and the Department of Health, have squarely laid the blame and responsibility with the BMA. The idea that strike action “risks harm to the patients we serve” is debatable; previous strikes by medical staff have led to lower mortality, due to reduced elective activity. One could also argue that all medical care, by its nature, risks harm to patients. However, industrial action will almost certainly cause disruption and distress to non-emergency patients. With support from non-BMA juniors, consultants, and allied health staff, I am confident that patient safety will be maintained.

“You have talked repeatedly about the government holding numerous preconditions… As I have made clear… there are no preconditions to talks whatsoever. We are prepared to negotiate about anything within the current pay envelope – but I am sure you understand that we have to reserve the right to make changes to contracts if there is no progress on one of the issues preventing a truly 7 day NHS, as promised in our manifesto and endorsed by the British people at the last election.”

The lack of preconditions is welcome. I am not going to argue about whether preconditions ever existed or not, although Sarah Wollaston MP and Caroline Lucas MP clearly believed that they were real and an obstacle. If there are now no preconditions to restarting negotiations, I am willing to accept that. I believe that Hunt has realised that he needs to back down, and is trying to do so with as little embarrassment as possible. If we are genuine in our desire for negotiations, I believe we should let him do that.
Hunt maintains that negotiations must take place within his metaphorical envelope. Whilst I understand this, and accept that we live in trying financial circumstances, I still don’t understand how Hunt plans to expand services for no extra money, without worsening conditions for doctors. For me, the maths still doesn’t add up. I hope this will become clearer during negotiations.
With regards to Hunt’s mandate from the British electorate, I have a few issues. Whilst I am pleasantly surprised by any politician actually sticking to their manifesto, I don’t believe that the Conservative manifesto mandates his current course of action.

 The pledges are incredibly vague, with no mention of doctors’ contracts. Hunt still hasn’t expanded on what his “7 day NHS” will look like, so I cannot ascertain whether his proposed changes will help to achieve his vision. This is a shame, as junior doctors would be a fantastic resource for service transformation if Hunt chose to engage with us constructively.
Sadly, the threat of contract imposition is still here. This is, I feel, the last sticking point which is preventing the BMA from re-entering negotiations. True negotiation cannot take place whilst Hunt maintains that his contract will come into effect, with or without agreement, in less than 9 months’ time. I appreciate that the BMA’s current position of wanting a withdrawal of all threats of imposition is probably unrealistic; it is as realistic as Hunt seeking assurances that we would never go on strike. However, I would suggest that a more realistic timetable of seeking implementation by 2017 would be far more likely to lead to constructive dialogue.

“I repeat our guarantees that no junior doctor working within legal limits will see their pay cut and that none will be required to work longer hours – in fact, to improve doctors’ working conditions we are reducing the maximum number of hours that can be worked in any one week.”

I’m not going to go over this again; if you’re interested, I talked about it in an earlier blog after Hunt’s previous open letter.

“I would be very happy to restart discussions as soon as the BMA wishes to do so. We have set out a clear, positive offer as the basis for these discussions… This offer is informed by the 22 recommendations of the independent DDRB, which I said needed to provide the basis for talks but which of course leave further scope for negotiation. They are not 22 pre-conditions.”

I’ll ignore the semantic argument about the difference between a “precondition” and a “recommendation which needs to provide the basis for talks”. I welcome Hunt’s willingness to talk, and I really hope that he is also willing to listen. The “clear, positive offer” from November 4th remained a deeply-flawed contract, with a shrinking pay-envelope in the future, increased working during antisocial hours, a lack of proper safeguards, and a lack of provision for training. Also, this “offer” had an implementation date of August 2016; hardly a basis for negotiation. In its current form, it is unfit for implementation, either in August 2016 or at any other time. It needs extensive change, and I hope that Hunt is willing to negotiate on these “recommendations”.

“I know from my own direct conversations with trainee doctors that we need to engage on these important issues if we are to improve working patterns and patient care, including Saturday pay-rates, safe hours limits, support for medical researchers, flexible work allowances and improvements to training, and I remain happy to talk to you.”

Agreed. We need to talk to Hunt, we really do. It’s welcome that he has been speaking to doctors (although bypassing the BMA, I might add!), and I truly hope that he is starting to appreciate the wide range of issues that need to be resolved, and the concerns and feelings of all junior doctors. We are not in this dispute because of money. We are in this because of genuine concerns and fears over the safety of both patients and doctors, and the threats to training and the sustainability of a career in medicine. If Mr. Hunt appreciates and accepts that we still have legitimate concerns over the latest contract, then he should do the right thing; cancel the implementation date of August 2016. Get the BMA back to the negotiating table, and let’s make this contract work for everyone involved.
I await the BMA’s response with interest. I suspect that industrial action will still go ahead as long as Hunt maintains his timetable for implementation. This isn’t over yet.

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