The only thing that puzzles me about the junior doctors walk out is that anyone is puzzled by it. It was obvious from the start that the dispute would end in tears.
The Tory manifesto makes it clear; 7-day services are on the to-do list. An election promise, is an election promise; that’s what the voters put their tick in the box for.
Delivery is a bit more tricky.
As there is no more money for extra wages or people, the seven-day ‘thing’ has to be achieved within the existing cash envelope. Very tricky.
And, it is not just junior doctors. To support them in their work a raft of other professionals are going to have to become ‘weekend blind’; just like Marks and Sparks, B&Q, Sainsbury’s and all the rest.
Diagnostics, pathology, imaging, consultants, porters, managers, catering, security the whole shebang. Everyone involved in emergency cover and admissions.
Changes to the junior docs contract are just the start. A lot of people are going to have get used to working differently. As GPs are finding out. Illness and accidents do not respect the day of the week.
For the NHS to become a truly seven day service would have been a world-first achievement. So far, making it happen has been a world-class cock-up.
Instead of inspiring the NHS to show the world what good looks like, we have provoked the back-bone of the workforce to stand outside hospitals watching ambulances arrive.
It is because the 7-day ‘thing’ is a work in progress that the DH, whoever the Secretary of State may be, cannot give-in to the unions. To concede to the BMA is to become a soft touch for the rest of the groups that are likely to rail against inevitable changes to their working practices.
The government cannot give in. They cannot have their election pledge blocked by a trades union.
The junior doctors have never been the enemy. Their union is…
The BMA find themselves in a similar bind. Recent elections to the BMA Council have moved them to the left; they are no friend of this government. This is not about gaps in a rota or a premium for weekend working. This is about the cost of losing a strike.
In the same way the Trusts are the by-standers in this row; picking up the pieces, making the best of too few staff, too high locum costs and too little money, so the junior doctors, their career and reputations will be the collateral damage in a battle the BMA have been quite happy to see them fight.
There are 54k junior doctors and at any one time I expect about 20% of them to be involved in emergency services. There are 44k consultants. With careful planning, cancellations and a willing consultant workforce, fingers crossed, the NHS will struggle though the next couple of days.
The real question is; what happens next.
In total the strikes will have claimed around 100k out-patient appointments, 70k elective operations and procedures and good deal of angst, pain, inconvenience and worry for patients, relatives, carers and friends, that a plastic apology from young, fit and healthy doctors and their union, gets nowhere near being sorry enough.
Neither side can move forward. So, again; what happens next?
A new SoS? Forget it. The Tinkerman and Number 10 are in lock-step until the referendum. If the ‘Remains’ win, he stays. If they lose expect the Cabinet to shift to the right. Ouch…
The BMA? Stuck with a Plan A that hasn’t worked and a Plan B that means more strikes and disruption. You can’t dignify it with the word strategy.
The strike will be won or lost by the opinions of the last people to be asked and the first people to suffer. The public will decide the outcome.
If grandad gets bumped off the waiting list again, for what will be portrayed as a row over weekend working and the newspapers get busy, the junior doctors won’t be able to get back to the safety of the hospital quick enough.
Clever Trusts will have the work-force Guardians in place, be talking, on the ground to JDs about civilised working schedules, new doctors will sign the new contract and to the relief of both sides, I expect the whole brouhaha to fizzle out.
But, I could be wrong!