by Matthew vonAllmen
Let’s talk about the National Health Service (NHS.)
Established in 1946 by the National Health Service Act, the NHS is the UK’s pride and joy. Britain’s left views it as the crowning achievement of Clement Attlee’s 1945-1951 Labour government—an enduring symbol of equality and public-sector success. But as recent events have revealed, this rosy picture hardly captures the whole truth.
On September 24th, 2016, junior doctors working at the NHS called off a series of planned five-day strikes, previously scheduled to occur within the next three months. This is the latest development in a long-standing conflict between NHS management and staff. It started in 2012, when Health Ministers attempted to negotiate a new contract with NHS doctors. Central to their proposed changes was an increase in weekend staffing, intended to reduce death rates by patients who seek treatment on Saturdays and Sundays. Junior doctors, most affected by the new policy, dissented. Talks opened between both parties, but broke down near the end of 2014.
It remains controversial whether weekend patients are truly at greater risk of death. Some statisticians speculate that weekend patients are more likely to be from an at-risk population sample, while others maintain that the “weekend effect” is very real. This debate remained unresolved during the negotiations between NHS doctors and management.
By mid-2015, Health Secretary Jeremy Hunt announced that he’d had enough; in order to keep promises made in the government’s election manifesto, he had to enact seven-day services within strict deadlines. The Health Secretary claimed he had no choice but to cut negotiations and impose the contract.
In reaction, the British Medical Association (BMA)— a powerful trade union encompassing NHS doctors and employees—balloted its members. Ninety-eight percent of them voted to take strike action.
A gritty and painful slugging match ensued. Between January and April of 2016, junior doctors engaged in six strikes, two of which consisted of the entire junior doctor workforce. The NHS had advance knowledge of each strike, and responded by freeing up consultants—higher ranking doctors—to treat patients in the meantime. For the few citizens able to access consultants, their service improved dramatically. But the drastically reduced workforce meant that most visitors simply went without access to healthcare.
In May, leadership from both sides of the dispute drafted a new contract with significant revisions, but the BMA decided to hold a referendum among its junior doctors before signing. They rejected the contract by fifty-eight percent to forty-two percent. With diplomacy failing, NHS management decided to change tactics. They made a series of public statements depicting the junior doctors as self-interested and willing to neglect the British public in pursuit of their preferred work agreement. They also began the legal process of imposing the contract despite the continued threat of strikes.
That brings us to today. Calling off these last few strikes has removed the BMA’s last line of defense against the new contract. Junior doctors claim they will continue to resist the contract through other means, but these promises have no teeth; without coordinated action by the caving BMA, the junior doctors are mostly powerless. The BMA cites its concern for patients as its reason for suspending the strikes. While this may be partly genuine, it is more likely that the BMA is trying to disprove the negative statements made by the NHS.
To an American, this entire debacle might seem superfluous—a slight increase in weekend staffing doesn’t appear worth an entire half-year of strikes. But if one looks a little deeper, it becomes clear that the junior doctors in this dispute deserve our strongest support.
Working conditions in the NHS are horrid, with junior doctors receiving most of the abuse. While European law technically caps the number of hours that a junior doctor can work at 48 hours per week, NHS management routinely ignores this restriction. They utilize a clever legal loophole; first, they have their junior doctors work over 100 hours per week, then give them a few weeks off and claim that the total averages to 48 hours per week. The NHS only needs to compute these averages over the course of six months, giving them plenty of leeway to assign doctors shifts as long as 36 hours. As a result, many junior doctors struggle to find enough time to eat and sleep.
Not all junior doctors suffer these abuses, but they are a disturbingly common occurrence. And the results are stunning: after one year, fifty-five percent of NHS junior doctors describe themselves as burned out, thirty percent have moderate depression, and a full twelve percent report considering suicide.
Many junior doctors attempt to escape this system, but theirs is a long hard road. In order to apply their credentials to foreign medical systems, British doctors need to apply for certificates of good standing—the medical equivalent of a giant gold star on their resumes. Two percent of doctors apply each year, bleeding away British medical talent at an alarming rate. The result? Nearly a third of emergency room doctors have left the country in the past five years, where many of the worst working conditions are concentrated.
The NHS has ignored these systemic problems, preferring to import foreign doctors from poorer countries who are used to the inhumane treatment. At present, forty percent of British doctors were trained in a foreign country. Opportunities for advancement by these new recruits are scarce, and many end up underemployed compared to their credentials.
Junior doctors in America face many of these same evils, but under a much shorter time span. The average American junior doctor spends around three to four years before moving on to a higher position. British doctors, on the other hand, can face these conditions from 10 to 20 years until they become consultants, the only position in the NHS with pay and freedom comparable to that of American doctors.
Imagine being a British junior doctor who has settled in for the long haul. You don’t intend to leave for another country, and are willing to endure the next 15 years until you can become a consultant. You know the experience will be tough, but you’re committed to the NHS’s mission of public service. And then Health Secretary Jeremy Hunt declares that what little dignity you have left should be sacrificed because of a statistical phenomenon that may or may not be real.
It’s easy to see how this is the straw that broke the camel’s back.
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