It’s not over. Not by a long way. There is much more to
do. But we have definite
progress. As you all know the most recent negotiations
between the BMA Junior Doctors and the Department of Health have
ended. We understand that a deal has been reached and that this is
going to be put to a full vote of the membership.
Just as the College didn’t advise our junior doctors whether
they should or should not strike, we are not going to tell you how
to vote. As before, you will make up your own minds. I can
however make one or two observations that may assist.
No negotiated settlement ever gives anyone everything that they
want. There is always compromise. Dr Malawana, who has
clearly negotiated long and hard, has delivered more than most
people can have expected. Of course he won't be happy with
everything and I suspect nor will you. I understand that ,
but I would remind you this is not the end.
I also know just how much effort you have all given to get this
far. I know from talking to many of you that no one wanted to take
industrial action, either partial or full, and those that did chose
that path without enthusiasm and with a sober realisation of what
that could mean for the public and our patients. That has not
If this offer is accepted then most of you will, like myself,
feel a sense of relief. This will be shared by the vast majority of
the public and our patients and carers. The level of support for
you has been extraordinary. Within the profession I have never
known such solidarity, and it is clear that the public too was
largely behind you. We cannot know what might happen should the
action continue and I fervently hope we will never find out. But
even if the offer is accepted and the industrial action comes to an
end, this is not the end.
From the start I have said this strike was never only about
terms and conditions. It was about much more. At some stage,
perhaps not immediately but soon, we need to look at all the issues
that have brought us to this place. We need to look at the way in
which your training has developed since the advent of Modernising
Medical Careers which, not for nothing, was also known as Mangling
Medical Careers. We need to see how this can be improved and how
you can regain control of your careers and work/life balance. We
need to look at how your efforts are rewarded, and I do not mean
financially. All of this still needs to be done. I think that the
industrial action has now paved the way for a fresh look and a new
settlement in these areas.
There is also a wider agenda.
We all know, because we work in the system, that the NHS is
facing a critical financial crisis. We know that we are expecting
too much for the funding that we have. We cannot deliver a service
that is, as some say, the envy of the world on the resources that
are deployed. We know that the NHS is the most cost effective
health care system in the world, but it cannot continue in the face
of rising demand and falling funding: 10.1% of GDP in 2010, 7.3% in
2014 and projected to be 6.6% in 2020.
We know also that we do not have enough staff to deliver what is
now being asked. That is not an issue restricted to psychiatry, it
is across the NHS. The Government’s manifesto commitment to create
a “7 Day NHS” still requires a great deal of clarification about
what that means, the evidence behind it, and how it is going
to be to be resourced in the real world where, in my experience,
you can only spend the same pound once.
One of the things to emerge from this dispute is that these
issues can no longer be ignored. The actions of our junior doctors
have made that impossible. These are questions that cannot now be
avoided. It is the role of the profession, united as I have
never seen before, to ensure that they are not.
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