"We want England to be the first nation in the world to provide a truly 7 day NHS... with hospitals properly staffed, so the quality of care is the same every day of the week...."
That's it. That's all it says. Nothing about junior doctors nor their labyrinthine contract of employment.
Several Trusts already deliver seamless 7 day services, within the existing contract framework. The DH negotiator in chief, St David Dalton, manages it at his hospital. Doing it across the NHS will require a realignment of junior doctors hours and a redistribution of the salary budget. As a nurse pointed out; 'We don't get paid extra for weekends, why should the doctors?' Err, tricky question. So will be sorting out the terms and conditions of a lot of allied health professionals and their rota arrangements. The NHS is a whole system and one huge team.
The big story has passed; 'Would the junior doctors really go on an historic strike'. We have the answer. So, another day of strike action is no longer headlines. Where does the BMA go from here?
The talk on the picket line was about an imposed settlement. The frozen pickets I met on Westminister Bridge seemed resigned. They didn't have a Plan B beyond going to work in Australia. In the bitter wind, it seemed an enticing proposition!
Public support is key. Right now, according to a very small survey by Ipsos, there is only a very slight diminution but probably within the margin of error. Call it 'unchanged'. Holding up, probably. A full strike, withdrawing emergency cover, will almost certainly start an erosion. No doubt the BMA's private polling would have told them that, hence they've pulled back from the brink.
What else can they do? Strike for two days instead of one? Probably. It causes upheaval in the Trusts, but all the time the consultants agree to facilitate the strike by providing cover, nothing too terrible is likely to happen. The docs can strike to their hearts content.
The invisible damage is being done to elective lists. Patients caught in the cross fire. One of the junior doctors I met said lists get cancelled all the time so it's OK to cancel a few more. Of course this is piffle. Treatment delayed is treatment denied. When the public cotton-on to what is happening there might be a sea-change. We will soon approach 10,000 cancellations.
You would have thought the Patients Association would be leading the opposition to the strike. They are all but mute; far too close to the establishment and their once influential President Robert Francis now little more than a footnote in history, his key safe staffing recommendations side-lined. When Mum's Net, SAGA and the Consumers Association wade in, and a net-savvy disgruntled daughter, whose Mum has had her op' cancelled, takes to social media, things will change.
What are the prospects?
The Tinkerman's gamble; public opinion will eventually turn on the doctors. He is yet to get his press office to the races. The doctor's claim that their hours have been extended and their pay cut are patently not true. They may have reservations about policing the arrangements but I can't see their claims stack up?
Last Friday's letter from St David, to every Jnr Doc, makes that and most of the other disputed issues, crystal clear. Is Dalton a liar? There is no one in the NHS that believes that. He is a man of the utmost integrity. I doubt he has ever had a parking ticket. We are left wondering just what is the BMA's beef? We are in the realms of trust and miscommunication.
The juniors have become the lightening rod for every one disaffected about funding, bursaries, the reforms, parking charges and the price of chips in the canteen. There are 200 weeks before the election. Time to impose a contract, ride-out the grief and bung the Trusts enough money to square any waiting list dramas by polling day.
On the other hand the BMA may carry on with strike-lite until the contract is imposed and then go for broke; an all out strike and hope to take the consultants along. Some RCN members may be sufficiently exercised over the bursary issue to force a strike and join in.
Trusts might wake up to the fact they have the freedom to offer their own pay and conditions. Frustration on both sides may tempt better organised Trusts to give it a try; with the knock on effect of pulling the rug on national pay bargaining and dividing the workforce.
Trust Boards are sick of being passengers on this bumpy ride. They either accept what ever cobbled together compromise is handed to them or define their own destiny.
No winners are there? Such a pity, a seamless, safe 7 day service is something we could all be proud of. It's a tragedy it has caused such a row. Is it beyond us?