Jeremy Hunt vs the doctors

#ImInWorkJeremy

Last weekend there was a new hashtag trending on twitter: #ImInWorkJeremy. As its originator anonymously wrote for the Guardian, it was an irreverent response to a speech by Health Secretary Jeremy Hunt (above centre) the Thursday before declaring he would impose a new contract on consultants without any opt-outs for weekend working. Ahead of the speech he was interviewed on BBC Radio 4’s Today Programme and claimed a link between higher death rates for weekend admissions and what he called “a service that cranks up on a Monday morning [and] starts to wind down after lunch on a Friday”. In the following days, health professionals across the country were tweeting selfies (a few of them above) showing them on their weekend shifts.

Saturday also saw the posting on facebook of an open letter to the Prime Minister from a junior doctor, which has now been shared more 170,000 times. Janis Burns attempted to deliver the letter in person to Downing Street following a stint of graveyard shifts at the Royal Brompton and Harefield NHS Foundation Trust, but was reportedly turned away by police officers.  She wrote of the stresses and strains of working in, as well as expenses and hardships of entering, the medical profession; highlighting the gulf between the reality and the Health Secretary’s portrait of professional life. In the days since another angry medic has gone online. “Jeremy Hunt has alienated the entire workforce of the NHS by threatening to impose a harsh contract and conditions on first consultants and soon the rest of the NHS staff.” This was the reasoning behind Dr Ash Sagidhi’s petition on the UK Parliament website calling for a parliamentary debate on a vote of no confidence in the Health Secretary. Within a day it crossed the 100,000 signatures threshold, meaning it has to be considered not only by the Government but by MPs as well.

The social media dimension might make this appear a frivolous oddity, something of a novelty news story. However, it actually fits within two bigger trends.

The first is the Conservative Party’s attitude – reminiscent of the Thatcher years – towards vested professional interests. In coalition this was the defining characteristic of some Conservative ministers (Michael Gove on teachers and Iain Duncan Smith on food banks are the most obvious examples, alongside Theresa May’s startling attack on the moral authority of the Police Federation) and this has been rolled out in the ten weeks since they won a majority. The appointment of John Whittingdale as Culture Secretary was described by the Daily Telegraph’s Christopher Hope as “an effective declaration of war on the BBC”. Meanwhile the mild-mannered Health Secretary has, since his reappointment, adopted a more hardline approach towards health professionals, and particularly the British Medical Association. In linking a figure of 6,000 avoidable deaths with a shortage of consultants on weekends, prefaced by blaming the BMA for the failure of negotiations over doctors’ contracts in 2012, he was implying they were in some way responsible for those deaths. In case there was any doubt, he made the point even more bluntly in a speech to the King’s Fund: “I will not allow the BMA to be a roadblock to reforms that will save lives.”

The second trend is a longer one. Indeed, while it may be in keeping with the strident pose adopted by ministers across Cameron II, Jeremy Hunt is not the first Health Secretary to have a run in with the medical and health professions. One of the most awkward moments of the New Labour years was when Patricia Hewitt had to abandon her speech to the Royal College of Nurses in 2006, as delegates spent 50 minutes shouting her down and slow-clapping her with complaints of being understaffed and over-stretched. The slogan they chanted over the top of the Health Secretary – “Keep nurses working, keep patients safe” – would not be ill-fitting a decade later.

It would be wrong, however, to see the protestations of doctors and nurses as a kick-back against the marketisation and restrained funding of governments since the 1980s. There was no earlier golden age. Tense relations between the government and the medical profession have been far from unusual throughout the history of the NHS. Indeed, the BMA was a more effective opposition to Nye Bevan’s introduction of the health service than Winston Churchill’s Conservative Party. Anti-socialism was perhaps the most pervasive ideology in early-mid twentieth-century Britain, and it sat behind a deep-seated concern that socialised medicine would reduce independent professionals to a salaried workforce of the state. They did not, of course, end the NHS before it had begun. But they did have significant influence on the shape of the service as it came into being, as Professor Sally Sheard has noted:

“The BMA won concessions which… undermined the structural integrity of the planned NHS. General practitioners were to be on contracts to local Executive Committees, not employees of local or central government; the proposed local government-managed health centres were to be subject to a ‘controlled trial’ and GPs would not be forced to take up residence within them; GPs would be paid on a capitation basis, not the part-salary scheme the 1944 White Paper had proposed. The BMA defeated Bevan’s plans for a Medical Practices Committee, which would have prevented more GPs setting up practice in areas which already were well supplied, and ended the sale of practices. As late as April 1948, the BMA’s members voted not to work within the imminent NHS.”

Bevan’s successful strategy was essentially one of divide and conquer. There were widespread concerns about what the coming changes would mean for their working way of life. What Bevan judged correctly, however, was that those fears were ultimately offset for poorer doctors operating in working-class areas by the security of a guaranteed income. When it came to the question of how many doctors would turn up for work on Day One, the nerve only held out amongst the elite leadership of the BMA and the rank-and-file fell into line. It was a mix of concession and contrition with the GPs. Meanwhile things were rather different with the specialists and their royal colleges. Far from attempting to take on the medical profession as a whole, when it came to the consultants Bevan famously said he “stuffed their mouths with gold”.

But what are we to make of this? Certainly Bevan’s successful strategy was very different from that of Jeremy Hunt, who has instead blurred the boundaries within the health and medical professions and invited a far more unified resistance. The notion of learning concrete lessons from history can offer false hope – for the past rarely if ever repeats itself exactly enough to provide a clear plan of action. The Health Secretary might take solace in being the latest in a long line to suffer similar treatment – it’s nothing personal. Then again, the lesson he might take is that the BMA know what they’re doing and can be a fearsome opponent. The chair of the BMA, Mark Porter, has already strongly criticised the Health Secretary’s comments, describing them as “nothing more than a wholesale attack on doctors to mask the fact that for two years the government has failed to outline any concrete proposals for introducing more seven-day hospital services.” There is not today the gulf between the viewpoint of the BMA leadership and the rank-and-file doctors that there was in the 1940s. Although Jeremy Hunt has tried to find such a division by appealing to the fact most doctors would like a more comprehensive weekend service should their friends or family need to be admitted, blaming consultants opting out of weekend working, unlike Bevan he has nothing to offer the ordinary doctor but threats.

One NHS GP and Huffington Post blogger, Zoe Norris, wrote that after promises of extra doctors being watered down to Physician Assistants, she was ready to go on strike. While continuing to provide medical care, she called for “all hospital and primary care staff to stand together” and organise “the most disruptive programme of NHS civil disobedience we can”, with paperwork and box-ticking boycotted to ensure chaos behind the scenes. “I hope the BMA view this as a gauntlet thrown down”, she wrote. “Let’s see what they are made of, because I think the profession is ready for a fight.”

We’ll see if the #ImInWorkJeremy hashtag makes a return for a second weekend. And if we do see sustained popular protestations from ordinary working doctors, the BMA might understandably feel it has a spontaneous mandate to embolden its position. We might just be heading into some very interesting times indeed.

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