The latest junior doctors’ 24-hour strike has come and gone, bringing with it another day of curtailed or completely abandoned surgical activity in most of our units. It is not the intention of this publication to adopt a stance one way or another as far as this stand-off is concerned, nor would it be easy to do so, not least because of the fact that large parts of the argument have involved both sides accusing each other of economy with the truth. What is indisputable, however, is that unplanned loss of operating time is significantly damaging to hospitals for whom non-compliance with 18-week waiting list deadlines is not an option in our target-driven culture.
Now that Mr Hunt appears to have tired of the concept of consultation and has gone for the so-called nuclear option by scheduling non-negotiable imposition of the new contract for August of this year, it is frightening to hypothesise as to the level of clinical disruption that will result if doctors do, indeed, vote with their feet and decamp en masse to the Southern Hemisphere to seek out what they believe are more favourable terms and conditions.
The consequences of a widespread and permanent walkout by medical staff are potentially cataclysmic, not just for the NHS but for any administration that is held responsible for it, such that it can only be assumed that the Department of Health has reached its decision on the basis of a comprehensive and robust appraisal of all the issues that are at stake here, rather than as a result of a complete misreading of the current climate within the medical profession.
If it turns out that the latter is the case, we may all be finding ourselves with a lot more time to be getting on with that statutory/mandatory training we tell our managers we’re too busy to get round to.
The manner in which the “negotiations” between the Government and the BMA have reached what Mr Hunt hopes is an endpoint may be symptomatic of the fact that a consultation exercise within the NHS is not always what it makes itself out to be. In my own Trust, for example, it has been widely accepted by a generation of Cardiac Directorate employees, rightly or wrongly, that when senior managers engage a staff group regarding a proposed change to working patterns or management structure, what they are often really saying is: “We have already decided what we are going to do with this, but we need you to think that you have been part of the decision process.”
The exception to this general rule occurred towards the end of 2014, when all of the different specialties within Cardiac Surgery here in Oxford were asked to consider a proposal to create an extra elective NHS operating list to be performed every Saturday in order to enable the Trust to meet its contracted activity targets. The prizes up for grabs for management were to die for: roughly 100 extra cardiac cases per annum, plus the distinction of being one of the first directorates within the Trust to introduce elective six-day working for a major specialty.
In the presence of a general feeling that what was being suggested to us represented little more than a fait accompli, it was with an air of hope rather than expectation that I put together a departmental response to our erstwhile Clinical Director in which I opined that the proposal was essentially unworkable in terms of safe staffing levels and recruitment and retention considerations (to mention just two of the areas that I thought were key), and that the desired extra activity could be achieved more equitably via judicious scheduling of occasional consultant-driven three-case operating lists during the normal working week.
Not long after the submission of my response, the end of the consultation period was marked by the convening of a Directorate meeting for all of the specialties involved, during which we were thanked for our participation in the process and informed that elective Saturday operating was not now considered the way forward, at least for the foreseeable future. Later that week, a senior nurse who has been employed by this Trust for even longer than your Editor told me that this had been the first occasion during her time in Oxford that she had witnessed the failure of management to steamroller through a flagship initiative, regardless of staff-side opposition.
While it would be wholly inappropriate for me to suggest that a figure of my relatively lowly stature within this Trust’s hierarchy could have significantly influenced the outcome of this exercise, may I nevertheless point out that if anyone at the BMA would like me to intervene on their behalf with the Department of Health while their contract dispute rumbles on, they had better get their skates on, because I plan to retire at the end of June.