Jeremy Hunt’s offer of an 11% rise in NHS junior doctors’ basic pay raises two immediate key questions: will that leave trainee medics earning at least the same in the future as they do now, and will his eleventh-hour intervention prevent a strike that could have a serious impact on the NHS?
On future pay, it is impossible to know for sure whether the health secretary’s latest tweaking of the new contract he has threatened to impose on England’s 45,000 juniors will fulfil his pledge in the Commons last week that “no junior doctor will see their pay cut compared to their contract”. Given the reaction from junior doctors since Tuesday night, when news of Hunt’s move broke, that seems unlikely. At the very least he has a mountain to climb by way of explaining how his proposed shift to a very different new system of paying junior doctors will achieve that aim.
Take Dr Milo Hollingsworth. He’s a junior doctor working in the neurosurgery unit of North Bristol NHS Trust. As he explains: “I am paid £27k base salary for working 8-5pm Monday to Friday. I am paid a further 50% for working nights, weekends and bank holidays. I have worked every bank holiday of 2015. These changes would see my base pay increased to £29k but my out-of-hours pay cut [and] would leave me with a yearly income of £32k from next August; £8k less than this year.”
He adds: “We’ll be getting paid less for doing the same job working for a busier, less well-resourced health service, which is under the strain of inadequate care in the community and an expanding population, many of whom have increasingly complex health needs such as those surviving cancer and the elderly.”
Another junior doctor emailed to say: “Many junior doctors are angered and appalled at the way his offer is portrayed by him and also your article as an 11% increase in our salary. It is not. It is more like a 22% reduction in salary. This is because our salary includes a banding supplement, typically 50% of our basic pay, to pay for our compulsory unsocial hours (weekends, evenings and nights). These are not optional hours nor optional pay supplements; they are essential to normal NHS staffing.”
Like Hollingsworth, he sees a pay cut looming. “Mr Hunt’s proposal is to remove our banding (ie, reduce our total salary by 33%) and increase our basic pay by 11% – ie, a net reduction of 22%. Why should we take a pay cut and be asked to work more unsocial hours than we already do? We would like to see our families and friends as much as the next person. Is it too much to be remunerated properly to give up such time?”
Hunt’s plan appears to be that junior doctors will earn the same as now but in a different way. That is, they will still receive the same extra 40%-50% on top of the basic pay they currently get through the banding system but, from next year, that same sum will come from a combination of on-call supplements, “flexible pay premia” (monetary inducements to attract trainee medics into areas of medicine bedevilled by doctor shortages), out-of-hours payments, additional rostered hours and the 11% rise in basic pay. If these sums really do stack up, that could help assuage junior doctors’ fears. .
And will the concessions, fine print and conciliatory words avert a walkout? That looks highly unlikely. The febrile, newly politicised atmosphere among junior doctors, and the widespread loathing of Hunt in their ranks, means that many may automatically reject the health secretary’s package simply because it’s coming from him. The anger among juniors is deep, wide, spontaneous and genuine and is not orchestrated by the British Medical Association (BMA), despite Hunt’s regular but unhelpful claim that it is. They say they feel devalued, belittled, steamrollered and taken for granted.
Dr Johann Malawana, the chair of the BMA’s junior doctors’ committee, was last week castigated on social media and accused by some fellow trainees of being a coward simply for daring to explain the BMA’s proposed course of action: covering only emergency work during the first strike, then moving to an all-out strike if that doesn’t work. That underlines that even a medic loudly applauded by the 20,000-strong crowd at the protest rally in London 18 days ago as their indefatigable champion is not in control of what the 40,000 or so juniors who belong to the BMA will do when voting starts on Thursday.
As one senior doctor said about Hunt’s package: “It looks all right to me. In fact, I think it looks quite good. But my concern is that junior doctors are so agitated that they could be offered dream contracts and still reject them because they don’t trust Hunt at all. ”
Before Hunt’s offer many in the medical profession were predicting that the ballot would show 90% in favour of both action short of a strike and also a strike itself.
In the seven weeks of the dispute so far, Hunt’s tactics have throughout been aggressive, self-defeatingly crude and sometimes plain stupid. He tried – and failed – to divide juniors from their union. He pledged one key thing to MPs last week (that no junior doctor would be worse off) only to then contradict himself the next morning. His refusal to drop his threat to impose a new contract was a stance that has hindered the resumption of negotiations with the BMA.
It was guaranteed to reduce the chances of the genuine reconciliation and deal-doing spirit that this situation needs before NHS services are disrupted and many thousands of patients find their surgery or outpatient appointment cancelled. Hunt also chose to announce his latest offer through the media rather than direct to Malawana and his colleagues. They could be forgiven for seeing that as rude or even calculated to antagonise them.
Hunt’s package of measures is highly calculated and archly political. It may sway enough junior doctors to make the vote in favour of industrial action more like 60/40. If so, that may give the BMA pause for thought about the wisdom of pressing ahead with a walkout.
It may bring out into the open the divisions between some of the BMA top brass and junior doctors’ committee, and indeed between many senior doctors, such as presidents of medical royal colleges – eager to avoid a strike – and juniors, who feel they have little choice but to walk out to show the depth of their anger.
Depending on how junior doctors respond it could also put Hunt back on the front foot and even give him the moral high ground, especially if there is a walkout. This dispute – messy, fractious complicated – has a long way to go yet. Hunt’s latest move will be far from the last chapter.
