Trusts and learned helplessness

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As the junior contract dispute rumbles on, with no sign of either the Government wishing to negotiate any further, or the BMA backing down, the Trusts are finding themselves in an increasingly difficult position.  The industrial action will continue to escalate, clinics and operations will continue to be postponed, and junior doctors will continue to be demoralised.

One of the things that has been striking during the dispute has been the inertia of the Trusts.  They have looked on, impassively, as their staff have been bullied and pushed around by the Department of Health.  But why?  The Trusts have as big an interest in this dispute as anyone else.  It is affecting their ability to provide elective services, will deeply affect their staff, and will have huge implications in the future for the sort of services they’ll be able to provide, and the sort of workforce available to provide it.  So why so “hands-off“?

As previously discussed, our Trust look like they will be imposing the new contract in August 2016.  Last week, the interim Chief Executive wrote to us all to update us on the situation.  The letter strikes a good tone, explaining why they feel they have to impose the contract, and why they feel they must use the new contract.

FullSizeRenderThe Trusts have been warned by Health Education England (HEE) that refusal to use the new contract could lead to a loss of their junior doctors.  For a Trust, this would be disastrous, so it is completely understandable why we have acquiesced to this thinly-veiled threat.  Whether this is appropriate behaviour from Professor Ian Cumming of HEE is explored in this blog from Roy Lilley.

Whether this threat is real or just bluster, it still doesn’t explain why Trusts feel quite so impotent over this dispute.  They have both a strong interest in this, and real power should they choose to exercise it.  Short of refusing to impose the contract (which, I maintain, is a real option that they could consider), even a public opposition to either the contract, the imposition, or the equalities impact would be hugely significant.  Our Trust is a strong, trusted name, both within the local media and the wider health media, and our voice matters.

Psychologists often speak of a behaviour called “learned helplessness“.  Organisms (people, animals, or even NHS organisations!) that have endured repeated painful stimuli from situations that they cannot escape from have been shown to fail to try to escape from future painful situations, even if they would be able to escape easily.  They have “learned” that they are helpless in the face of these situations, and therefore don’t try to get out of them.

The NHS has, for several years now, been feeling the pain.  Social care cuts, chronic underfunding, increasing demand, increasing rota gaps; the Trusts are being squeezed from all directions, and in ways that they have very little control over.  It’s important that we, as a Trust, haven’t learned to be helpless in a painful situation where we could make positive steps to escape from it.

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