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The Royal College of Psychiatrists Improving the lives of people with mental illness

Planned strikes by Junior Doctors

This morning’s papers are full of the news that the Academy of Medical Colleges has issued a statement saying that it is ”disappointed at the prospect of further industrial action by junior doctors”, and that RCPsych has signed up to this. As far as I know only one College did not.

Until now our position has been to be supportive of our juniors in terms of the goals they wish to achieve, but to refrain from taking a position on the tactics being employed; in other words industrial action.   In various fora I have made it clear that I strongly believe that the causes of the obvious dissatisfaction felt by so many juniors (and of course not just juniors) are wide ranging and have been a long time coming   On Wednesday of this week, before the crucial meeting of BMA Council, I had a piece in the Times,  again outlining what I saw as the many serious issues affecting morale and well-being which would not be addressed by industrial action.

Many seem condemned to spending years rootlessly shuffling from one place to another like lost luggage, buffeted about by a promotion system that seems to be little more than a lottery.

Whilst terms and conditions are not issues for medical Royal Colleges, training, standards, morale, safety, health, satisfaction and so on definitely are.   Royal Colleges are also concerned with not just the welfare of psychiatrists, but also the welfare of those who we treat – our patients.  Sometimes those words sound like empty slogans.  How many times I have I heard “we must put the patient at the heart of everything we do” used as a clichéd rhetorical device to justify something that has at best peripheral relevance to patient care.

But a five day strike must inevitably threaten patient safety.   And to be fair, those who have been advocating industrial action accept this.  After all, if such a prolonged withdrawal of labour did not affect patient safety, one might wonder what on earth are we all doing for a living anyway?

So patients may well be harmed.  Perhaps not in such obvious and eye catching ways as might happen in Accident and Emergency departments, intensive care units or operating theatres – but our patients may also suffer.  We can be sure there are members of the media keenly waiting for the first death in order to unleash a wave of synthetic outrage.  The stories are already written, all that is missing is a name and face.  Even if a year and one public inquiry later it is concluded that such an event was not related to the strike, the damage will be done.  Unlike journalists and politicians we are trusted – trusted not to harm our patients – but we should remember that trust is earned, not a right.  It can be lost swiftly, and then take a generation to recover.

I have seen some social media postings saying “there is no pain without gain”, or “you need short term pain for long term gain”.   That pain is going to be felt by patients.  I don’t think that doctors should be making those arguments.

I have also seen other messages saying “if you are not with us, you are against us”.  I reject that.  It is specious and false. One can be with you, share your aims and cause, but still disagree with the tactics employed.  We remain as committed as we ever were to the long term ambitions that we all share. We all want to improve the working lives of our members, knowing also that unhappy, demotivated doctors who no longer feel in control of their careers or lives, deliver poorer care to patients. 

We all know that the NHS is also facing the biggest crisis in its history.   We know that promises that have been made such as increased funding have yet to be honoured   We know that demand has increased, sometimes unavoidably, but sometimes by  eye catching initiatives that turn out to been based on quicksand – chief amongst these being the “7 day NHS” - uncosted, untested and understaffed.    

None of that has changed.

So as before, you will make up your own minds.  I can only ask you to consider whether or not a prolonged industrial action is the best way to achieve our shared objectives. I can only ask that you consider the serious risks that such a path runs, to our patients, and our profession.  If you do decide after sober reflection that this is a risk that you are prepared to take, then so be it.  You will still be valued members of this College, and we will continue to do our best to support you.  In psychiatry we have a tradition of vigorous debate and dissent, whilst still remaining loyal to each other and proud of our profession.  Disagreement is not the same as division, and never more so than today.


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Re: Planned strikes by Junior
The President of the RCPsych acknowledges the complexity of the situation. He does not advocate industrial action, and yet fails to make suggestions as to what otherwise may be done. This does give the impression of standing aside, commenting from the sidelines.
When he claims terms and conditions are not issues for the medical Royal Colleges, he separates them falsely from training, standards, morale, health, safety, satisfaction and so on. Of course they are all connected.
I call on the RCPsych to step away from it's hands-off stance, to acknowledge it's connection and responsibility towards our junior colleagues and, if it decides not to support them in industrial action, then at the very least to offer ideas for effective alternatives.
Re: Planned strikes by Junior
Thanks for this. It sets out the complexity of what is at stake - beyond the contract - and need to move beyond binary divisions, There are much wIder issues of how to support our juniors now the old structures of Firms and living in have gone - the profession must look to other sectors to understand how to achieve this, and need government and management support make medicine the best profession to work in.
Re: Planned strikes by Junior
I am very angry that the RCPsych has intervened in the junior doctors dispute. The arguments you put for doing so are put at naught when the College of Paediatrics havent joined you. I want you to know that you do not have my consent for this and I think you should have sought the consent of the members of the college in such a contentious matter before doing so.
Re: Planned strikes by Junior
....that last comment about the intervention in the junior doctors dispute was by me. I am a Consultant and Fellow of the College.
Re: Planned strikes by Junior
Well said Simon. I totally agree with you.
Re: Planned strikes by Junior
Thank you for shedding some light on a debate that up to now has only produced heat. Wise words and I thank you.
Re: Planned strikes by Junior
Your stand is wise and balanced and deserves to be widely shared and seriously considered by one and all likely to be affected by this action
Re: Planned strikes by Junior
I totally agree with the President on this. I add that this strike is unethical, seems to be politically motivated, is fundamentally about an employment dispute and not the wide NHS as it is claimed, and will not bring any support from the public that is going to suffer as a result.
A CAMHS Consultant
Re: Planned strikes by Junior
I am a retired consultant and Fellow of the College. 'Junior doctor' status in the UK is almost twice the length of that in other countries due to restrictive practices by the 'senior doctors'. Several problems would be solved overnight if training requirements followed the example of other countries in this.
Re: Planned strikes by Junior
If strike action is unacceptable then what is the choice? If, as I do, you believe patient safety will be harmed by the imposition of this contract, then if we deny ourselves the option of striking, why should government listen?
Re: Planned strikes by Junior
For some reason, the security verification doesn't work, this is my 3rd attempt. A very disappointing response to say the least. We used to be told that tcs were the domain of the BMA not the College so why intervene now? To say that the dichotomy of either you're w/ us or against us is irrelevant is @ best naive - look @ today's papers. If the College can't help, it should've stayed silent. This press release was not in my name.
Re: Planned strikes by Junior
I agree with the President. This is too big an issue for responsible members of the medical profession to keep quiet. I consider the proposed strikes unprofessional as they will put patients lives at risk. As a now N H S retired consultant I have experienced junior working conditions of ridiculous hours which has been changed, however several other health service changes were imposed against our will - and we adapted and survived. The NHS is underfunded, always has been, but is still the best health service in the world. Dedication to patient care is still an essential requirement for anyone privileged enough to work in it, and in my view the current generation for the most part, appear to be deficient in this quality. I do hope this is all a bluff by the BMA and urge members to take action to stop the strikes unilaterally.
Re: Planned strikes by Junior
Just to reiterate - it is all very well to criticise junior doctors for voting to take industrial action without suggesting what constructive alternatives there are - I personally know of 2 excellent junior psychiatrists who are so disillusioned that they are planning to leave the country or the profession - surely this potential harm to our profession has to be balanced against the potential harm to the public of industrial action - i do not think the govennment has given the junior doctors or employers any alternative.
Re: Planned strikes by Junior
Dear Sir Simon Wessely,

I am writing in response to your blog about junior doctor strike action which I woke up to this morning.

You wrote in your blog that 'a five day strike must inevitably threaten patient safety' and therefore that the Royal College of Psychiatry has signed up to the statement from the Academy of Medical Colleges saying that it is ”disappointed at the prospect of further industrial action by junior doctors”.

Personally I am conflicted over whether to take part in this strike action as I don't believe that it will bring about any change and the government will continue with their plans for a '7 day NHS' whether we strike or not , given that they have not listened to the voices of junior doctors so far.

From a wider perspective however junior doctors can see how the NHS is crumbling around us and how this contract imposition will only contribute to this further. It is not feasible to thinly spread current resources over 7 days and the more junior doctors that leave the NHS as a result of the new contract, the worse things will become. In this respect I think that history may judge us for not acting against imposition, and striking ensures our voices are heard.

In terms of weighing the risk to patients from strike action vs the risk of not striking I agree with Prof Neena Modi, the president of the RCPCH, who said the academy was wrong to suggest that junior doctors were compromising patient safety by opting to strike, when the government had imposed “crippling problems” on the NHS. Many of the consultants I worked with last year in general medicine said that medicine by its nature is a risky business and that hospitals are often unsafe everyday already. This will only worsen with contract imposition and with more staff shortages. Between the hours of 8-5pm on strike days the hospitals are probably more safe than usual given the number of senior doctors covering, and I'm sure this is why the president of the Royal college of paediatrics has faith that patient safety will not be compromised in paediatrics.

I think that at this important time 'junior' doctors should be trusted to make up their own minds about the best way forward. I think it is important that they feel valued and supported by 'senior doctors', and I hope that the current news headlines do not compromise this too much.

Re: Planned strikes by Junior
As Psychiatrists we should be well placed to weigh up multiple risk factors in complex, changing environments...most of us do it on most days of our working lives. We often manage this by breaking it down into categories such as short-, medium- and long-term risk. I hear a lot of concern about the [short-term] risk to patients of several strikes, but I hear much less about the cumulative [long-term] clinical risk to patients of years and years of disaffected and tired junior staff (or no staff...).
We (Psychiatrists) are also well used to scenarios which are high-risk whatever action is taken. Yes, strike-action may involve short term clinical risk, but I doubt it is anywhere near as great as the total long-term accumulated clinical risk to patients if the government goes ahead and imposes the new contract.
I fully appreciate there is also another category, that of political risk, to be weighed in the balance, with a likely range of opinion. But please, if we are going to talk as clinicians to the public and media, let us be very clear about short-term AND long-term clinical risks attached...patients will feel the pain of both, and doctors should be clearly alerting them to both.
Re: Planned strikes by Junior
As a junior doctor in psychiatry I am incredibly saddened at the Royal Colleges, particularly ours, choosing to condemn junior doctors for undertaking industrial action against imposition of a damaging contract, rather than firmly urging the government to call off imposition and listen to their concerns. If the royal college spent more time lobbying politicians to reconsider rather than berating colleagues, the course of this dispute could be radically different. With regard to comments above from a retired colleague questioning junior doctors' commitment to patient care.. I am frankly appalled and deeply offended. We, like you, have sacrificed much to dedicate ourselves to the profession, and will continue to do so in the future. This kind of attitude simply makes overworked, tired doctors feel more undervalued and demoralised. I urge you to reconsider.
Re: Planned strikes by Junior
I took an oath to do no harm. Not to do less harm than the government or Hitler or some ideology - or to do just a little harm - for the 'greater good'. This is about agency and about choice. I have heard specious arguments that 'we have no choice'! This is about personal choice, about our humanity, our values and our vocation.
Re: Planned strikes by Junior
I find the statement made by the president today short-sighted and disappointing at best whilst offering no alternatives for industrial action. In an age when we struggle to recruit and more importantly retain into psychiatric training places it is clear to see that this contract will only exacerbate this. Throughout my training I have watched as gaps in rotas have increased and those that are left work harder to plug these. Spreading trainees more thinly over 7 days instead of 5 will be devastating to rotas and compromise patient care. I have seen the draft rotas and this isn't just a worry it is reality. As others have said I weigh up risk every day. This risk in my opinion far outweighs that of industrial action which will be planned and covered by our senior colleagues. I feel I would fail to uphold my ethical and moral duty to my patients and future colleagues if I stood by and let this contract go ahead without fighting.
Re: Planned strikes by Junior
Very disappointed by the stance taken by the president. Imposed contract is the worst you could achieve for your juniors by this. Your stance will divide the profession and poses a risk for the long term future of psychiatry. I understand that royal college is not a trade union to support an employment dispute but shouldn't have colluded with the right wing media to bring this on against our juniors. Disappointed!!
Re: Planned strikes by Junior
When the strikes take place, as a consultant I shall reprioritise my commitments and cover the gaps as best as I can. I imagine all my consultant colleagues and any non striking junior colleagues will do the same. I will do my uttmost to explain the matter to patients and carers who may be affected.
As a forensic psychiatrist, I am used to managed risk taking. I am not sure the juniors doctors' decision to strike is a good example of 'best practice' in managed risk taking. Taking on the government is akin to entering a court room for a forensic practitioner: a different arena where the rules are not based on clinical care. I wish my juniors all the best but my judgement is that they will will not achieve their desired outcomes.
To paraphrase Yeats, "a terrible beauty will be born".
Re: Planned strikes by Junior
I agree with Dr Moore and leaders should be talking about alternatives....
Re: Planned strikes by Junior
My daughter is currently an inpatient in a mental health unit. I worry about the effect the strike will have on her care. She has no choice about being there, you hope as a parent that at least her care and safety will be prioritised. I know it' a difficult issue, I have a choice of employers, doctors in general can only work for the NHS. However I can't get care from anywhere else for my daughter, and inevitably if junior doctors strike, care on the ward will suffer.
Re: Planned strikes by Junior
I am grateful for the clarity and courage of your comments, Simon. Those of us who support the long term aims and objectives of the so-called juniors need to be mindful of the importance of the tactics used , and not just the rightness of their cause. 5 day strikes are the wrong tactic. They will hand victory to Hunt. I write as a consultant who has twice stood on the picket lines earlier in this dispute
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Professor Wendy Burn

Professor Wendy Burn FRCPsych


Professor Wendy Burn became a consultant old age psychiatrist in Leeds in 1990 and now works fulltime in a community post. Her main clinical interest is dementia.

She has held a regional leadership role in this area from 2011 and was co-clinical Lead for dementia for Yorkshire and the Humber Strategic Clinical Network between 2013 and 2016.