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2015 junior doctors contract dispute in England

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A junior doctors contract dispute in England led to industrial action being taken in 2015 and 2016. A negotiation between NHS Employers and the main UK doctor's union, the British Medical Association (BMA) had been overshadowed by the Secretary of State for Health, Jeremy Hunt threatening to impose certain aspects. The BMA balloted members in November 2015 and industrial action was scheduled for the following month. The initial action was suspended, although further talks broke down. Junior doctors took part in a general strike across the NHS in England on 12 January 2016, the first such industrial action in 40 years. Junior doctors again withdrew their labour for routine care on 10 February. On 26 April 2016, junior doctors withdrew from emergency and routine care, the first time this had happened.

Junior doctors support badges

Proposed new contracts

Since 2012 NHS Employers and the BMA had been in negotiation towards a new contract for junior doctors. These talks ran into serious problems when the BMA rejected the proposals from the Secretary of State for Health, Jeremy Hunt, who wanted the contracts to reflect commitments made in the Conservative 2015 election manifesto upon junior doctors in England.[1] In September 2015, Hunt proposed new contracts for junior doctors which would scrap overtime rates for work between 7am and 10pm on every day except Sunday while increasing their basic pay. Hunt claimed that this would be cost neutral, but the union responded by saying that NHS Employers had been unable to support this claim with robust data.[2][3] The union argued that the contract would include an increase in working hours with a relative pay cut of up to 40%,[4][5][6] and refused to re-enter negotiations unless Hunt dropped his threat to impose a new contract and extensive preconditions,[7] which he had refused to do. The Department of Health responded, saying "We are not cutting the pay bill for junior doctors and want to see their basic pay go up just as average earnings are maintained."[8]

On 26 September the BMA announced that it would ballot its members.[8] By October, a survey showed many junior doctors would consider leaving the NHS if the contract was forced through.[9] Hunt later tried to re-assure the union that no junior doctor would face a pay cut, before admitting those who worked longer than 56 hours a week would face a fall in pay.[10][11][12] He said that working these long hours was unsafe, claiming that existing pay arrangements were known colloquially in the NHS as "danger money", although a Facebook survey carried out by one doctor showed that 99.7% of 1,200 respondents had never heard of the term.[10][13]

On 3 November 2015 Hunt said he would offer a basic pay increase of 11%, but still removing compensation for longer hours.[14][15][16] In response, the BMA junior doctors committee chair, Johann Malawana, said: "Junior doctors need facts, not piecemeal announcements and we need to see the full detail of this latest, eleventh hour offer to understand what, in reality, it will mean for junior doctors. We have repeatedly asked for such detail in writing from the Secretary of State, but find, instead, that this has been released to media without sharing it with junior doctors’ representatives"[17] and "The proposals on pay, not for the first time, appear to be misleading. The increase in basic pay would be offset by changes to pay for unsocial hours, devaluing the vital work junior doctors do at evenings and weekends."[18]

Balloting of BMA members

On 5 November 2015, the BMA began its ballot of over 37,700 of their members in response to Hunt's contract proposals.[19] On 19 November 2015 the result of the strike ballot was announced, with more than 99% in favour of industrial action short of a strike, and 98% voting for full strike action. 76% of eligible doctors voted with 99.6% of doctors voting for action short of strike and 98% voting for all out strike.[20] After five days of talks between the government and BMA, conciliation service Acas confirmed that agreement had been reached to suspend the strike action that had been planned for December.[21]

First period of arbitration

The BMA council chair, Mark Porter appealed to the health secretary to resume negotiations.[22][23] Hunt said the strike was "very disappointing", but declined the appeal for arbitration at this time.[24] He was criticized for failing to answer MPs' questions about the strike, with his deputy claiming he was too busy preparing for the strike.[25]

He was also criticised by statisticians Prof David Spiegelhalter and David Craven, by Dr Mark Porter, by an NHS England spokesperson, and by Heidi Alexander, the shadow health secretary, for, again, making misleading statements about weekend hospital treatment. The Department of Health confirmed his 10% figure actually related to the entire week, even though Hunt specifically said it was for weekend-admitted patients only.[26]

Hunt eventually agreed to discussions overseen by Acas and withdrew his threat to impose a new contract without agreement, and the first day of strike action was called off hours before it was due to start (too late to avoid some disruption), with later days suspended.[27][28][29]

Appeal for further arbitration

On 24 December 2015, Johann Malawana gave a 4 January deadline for the talks to result an acceptable outcome, or industrial action would be announced.[30] An agreement was not reached by this deadline and so the union announced that a strike would go ahead, blaming "the government's continued failure to address junior doctors’ concerns about the need for robust contractual safeguards on safe working, and proper recognition for those working unsocial hours".[31][32] On 8 January, it was revealed that a supposedly independent response to the initial strike plans from Sir Bruce Keogh, Medical Director of NHS England, had been strengthened by Department of Health officials and approved by Hunt.[33][34] Subsequently, more than 1,000 doctors called on Keogh to resign complaining that Hunt had exploited him for political gain.[35]

Strikes

Support for the junior doctors dispute from a GP surgery

On 12 January 2016, Junior Doctors in England took part in the first general strike across the NHS, the first such industrial action in 40 years. Emergency care was still provided.[36] Hunt claimed it was "unnecessary", that patients could be put at risk, and that many junior doctors had "ignored" the strike call and worked anyway, but the BMA responded that many junior doctors were in work maintaining emergency care as planned.[37][38] There were claims that Bruce Keogh, had used performance target levels to justify and encourage NHS trusts to declare an emergency situation, forcing Junior Doctors to work despite the strike, a move to which the BMA condemned.[39]

Junior doctors again withdrew their labour for routine care on 10 February 2016, leading to the cancellation of around 3,000 elective operations.[40] On 26 April 2016, junior doctors in England embarked on the first strike where they withdrew routine and emergency cover.[41]

In July 2016 the BMA balloted their members, who voted 58% to 42% against the deal. Johann Malawana resigned from the position of chair of the JDC on 5 July 2016.[42]

Compared with the weeks preceding and following the strikes, there were 9.1% (31,651) fewer hospital admissions, 6.8% (23,895) fewer A&E attendances, and 6% (173,462) fewer outpatient appointments than expected. Altogether during the strikes hospitals cancelled 294,844 outpatient appointments. There was no significant effect on the number of recorded deaths.[43]

References

  1. ^ Wintour, Patrick (4 November 2015). "Jeremy Hunt: I cannot negotiate on manifesto promise of 24-hour NHS". The Guardian. Retrieved 3 January 2016.
  2. ^ "Junior doctors:Contract proposals for junior doctors". British Medical Association. Archived from the original on 20 October 2015. Retrieved 31 October 2015.
  3. ^ Denis Campbell (17 October 2015). "Leader of NHS junior doctors urges Jeremy Hunt to reopen negotiations". The Guardian. Retrieved 17 April 2017.
  4. ^ Campbell, Denis (18 September 2015). "Junior doctors condemn new contract they say could cut pay by 40%". the Guardian. Retrieved 17 April 2017.
  5. ^ Johnson, Sarah (21 September 2015). "A new deal would cut pay by 40% and increase the number of antisocial hours. What do you think?". The Guardian. Retrieved 17 April 2017.
  6. ^ "Why the new NHS junior doctors' contract is pushing me to Malta".
  7. ^ "'Step in right direction' on juniors contract".
  8. ^ a b Association, Press (26 September 2017). "Junior doctors to be balloted for strike action, says British Medical Association". The Guardian. Retrieved 10 October 2015.
  9. ^ Denis Campbell (20 October 2015). "Junior doctors: 7 in 10 to leave NHS if Hunt pushes through new contract". The Guardian. Retrieved 17 April 2017.
  10. ^ a b Mason, Rowena (30 October 2015). "Jeremy Hunt angers junior doctors by saying some are paid 'danger money'". The Guardian. Retrieved 17 April 2017.
  11. ^ Stone, Jon (29 October 2015). "Jeremy Hunt admits junior doctors who work the longest hours will actually have their pay cut". The Independent. Retrieved 17 April 2017.
  12. ^ Lind, Sofia (29 October 2015). "Health secretary rolls back on claim that no junior doctors will lose out". Pulse. Retrieved 17 April 2017.
  13. ^ "Jeremy Hunt thinks I'm a dangerous doctor".
  14. ^ Campbell, Denis (3 November 2015). "Jeremy Hunt offers junior doctors 11% pay rise in bid to end dispute". The Guardian. Retrieved 17 April 2017.
  15. ^ "Payrise Offer A PR Stunt, Say Junior Doctors".
  16. ^ Buchanan, Rose Troup (4 November 2015). "Junior doctors claim Jeremy Hunt's 11% pay rise will be a 'pay cut' of 26%". Retrieved 17 April 2017.
  17. ^ "BMA responds to Guardian story on Jeremy Hunt's offer to junior doctors" (Press release). British Medical Association. 3 November 2015. Retrieved 17 April 2017.
  18. ^ Campbell, Denis (4 November 2015). "Junior doctors reject 'misleading' pay offer and criticise Jeremy Hunt". The Guardian. Retrieved 17 April 2017.
  19. ^ Triggle, Nick (21 October 2015). "Junior doctors to vote on strike action - British Medical Association". BBC News. Retrieved 17 April 2017.
  20. ^ Campbell, Denis (19 November 2015). "Junior doctors overwhelmingly vote for NHS strikes". The Guardian. Retrieved 3 January 2016.
  21. ^ Cooper, Charlie (1 December 2015). "Junior doctors strike called off to grant more time for talks". The Independent. Retrieved 3 January 2016.
  22. ^ "Junior doctors vote overwhelmingly for industrial action as BMA approaches Acas for conciliatory talks with the health secretary" (Press release). British Medical Association. 19 November 2015. Retrieved 17 April 2017.
  23. ^ Stone, Jon (19 November 2015). "Junior doctors overwhelmingly vote for NHS strike next month with 98 per cent in favour". The Independent. Retrieved 17 April 2017.
  24. ^ "Junior doctors: Jeremy Hunt says strike vote 'very disappointing'". BBC News. 19 November 2015.
  25. ^ Dathan, Matt (20 November 2015). "Jeremy Hunt an 'absolute disgrace' for refusing to face MPs' questions on junior doctors strike". The Independent. Retrieved 17 April 2017.
  26. ^ Kirkland, Faye; Campbell, Denis (19 November 2015). "Jeremy Hunt statement on weekend hospital care is misleading, experts warn". The Guardian. Retrieved 17 April 2017.
  27. ^ "Disruption expected as junior doctors' strike called off".
  28. ^ Campbell, Denis (30 November 2015). "Doctors' strike called off after Hunt lifts threat to impose new contract". The Guardian. Retrieved 17 April 2017.
  29. ^ Cooper, Charlie (1 December 2015). "Junior doctors strike called off to grant more time for talks". The Independent. Retrieved 17 April 2017.
  30. ^ Campbell, Denis (29 December 2015). "Junior doctors likely to strike as government talks falter". The Guardian. Retrieved 17 April 2017.
  31. ^ Campbell, Denis (4 January 2016). "Junior doctors in England to strike next week after talks break down". The Guardian. Retrieved 17 April 2017.
  32. ^ Stone, Jon (4 January 2016). "Junior doctors announce they will strike next week". The Independent. Retrieved 17 April 2017.
  33. ^ Cooper, Charlie (7 January 2016). "Junior doctors: Whitehall edited letter from 'independent' medic to build 'hard-edged' case against strike". The Independent. Retrieved 18 April 2017.
  34. ^ Rowena Mason (8 January 2016). "Jeremy Hunt accused of politicising Paris attacks in doctors dispute". the Guardian. Retrieved 8 January 2016.
  35. ^ Charlie Cooper; Oliver Wright (8 January 2016). "Sir Bruce Keogh: More than a thousand doctors demand resignation of NHS Medical Director". The Independent. Retrieved 8 January 2016.
  36. ^ Triggle, Nick (12 January 2016). "Junior doctors' strike: Treatments postponed amid walkout". BBC News. Retrieved 2016-01-12.
  37. ^ Stone, Jon (4 January 2016). "Junior doctors' strike live: Jeremy Hunt brands strike 'unnecessary' as poll shows high public support for stoppage". The Independent. Retrieved 17 April 2017.
  38. ^ "Junior doctors' strike: Get back to negotiating table - Hunt". BBC News. 12 January 2016.
  39. ^ "Striking doctors could be ordered back in, in move which sparks fury". Telegraph. Retrieved 2016-01-12.
  40. ^ "'Operations hit as doctors strike again". BBC News. 10 February 2016.
  41. ^ Triggle, Nick (26 April 2016). "Junior doctors' strike: All-out stoppage 'a bleak day'". BBC News. Retrieved 18 April 2017.
  42. ^ Triggle, Nick (5 July 2016). "Ministers 'looking to impose doctor contract'". BBC News.
  43. ^ "Junior doctor strikes had 'significant impact' on healthcare". OnMedica. 20 February 2018. Retrieved 2 April 2018.
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