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The Guardian - UK
The Guardian - UK
Politics
Mark Tran

Junior doctors' strike day two - as it happened

Why are junior doctors striking?

Closing summary

  • As the second day of the all-out strike draws to a close, NHS England says 78% of junior doctors (21,608) who were expected to be working did not report for duty today. The figures were the same yesterday. Last week trusts said they expected there would be 12, 711 postponed elective operations over the period of 18 April to 2 May.
  • Dr Anne Rainsberry, national incident director for NHS England, said: “We’re not going to pretend the last two days have been easy but the NHS has remained open to business for patients. The health service has coped admirably to date thanks to extensive planning and the exhaustive efforts of other staff. However the strike has undoubtedly increased pressure on a service already facing increasing demand and has led to the highly regrettable cancellation of needed care for well over 100,000 patients.”
  • Several junior doctors rejected suggestions that the government and the British Medical Association (BMA) are quite close on the new contract. One doctor said: “We need to talk to them about exactly what their plan is for the seven-day NHS, how they are funding it, how they are going to staff it. Just changing Saturday pay is not going to solve the issue. It’s so complex, it can’t be just about one thing.” Around 80% of all junior doctors (45,000 out of 54,000) across England) are members of the BMA.

Helen Nightingale, 31, a junior doctor at St Mary’s hospital, tells Alessio Perrone the imposition of a contract by the government is as crucial as to its contents. There hasn’t had a BMA representative for a few months since the last one stepped aside yet the junior doctors have taken part in the strike.

“Regardless of what Hunt said, they haven’t been willing to sit down and discuss at any point. Not just with the BMA, with any junior doctor. The process has been misleading and we feel it’s all been predetermined and imposed on us. It’s disrespectful to us as professionals. A lot of people are disillusioned regardless of the contract because it’s been imposed, they are frustrated and powerless. Also, we are frustrated because the strikes haven’t brought back the expected results, they haven’t made any negotiations happen. Enthusiasm is picking up a bit in this strike, but we haven’t seen the response we wanted.”

Damien Gayle has moved on to Lewisham hospital where a packed picket line has massed around a table heaving with cake, which strikers were selling to raise money for a campaign to save the hospital.

“The NHS runs on cake and goodwill,” said Shruti Patel, a trainee paediatric doctor. “This is a good way for the community, for NHS staff and junior doctors to do something positive with the strike, to raise money for a community campaign that has been instrumental in saving this hospital and getting our message out to the public.”

Patel branded as “ridiculous” claims that the government and BMA positions were close: “If the positions were close do you think we would go to all this dramatic effort? Do you think we would manage to get this many junior doctors out if really all that was left was Saturday pay? We feel that the contract is completely unsustainable.

“I don’t think there’s a question of the BMA leading anyone anywhere. The BMA is made up of junior doctors. This is absolutely a grass roots course of action. As to whether it’s a dead end or not, that completely lies in the hands of the government. The power to end this dispute is in the government’s hands.”

Peter Latham, an NHS-trained doctor in Australia, says he is unsure of returning to the UK.

“I’m saddened and upset for my former colleagues who are having to go against their deepest morals and walk away from patient care to ensure the long-term safety of an open access and safe NHS.”

When asked whether he would return to the NHS, he admitted that, at first, his intention was to leave to experience life in another country and then come back. Now, he’s not so sure.

“I have always pictured my career in the NHS,” he said. “I believe in what it traditionally stood for and I believe it is the best model of healthcare. Now I have no idea what I’m going back to. I fear doctors will flee from such a poorly led system and leave those in it stranded. Then it will be left open for private takeover. I don’t want to work in a dangerously understaffed NHS or a privately-run one. That leaves my options limited. I can’t see a resolution under Jeremy Hunt.”

Updated

Junior doctors have been telling Damien Gayle that suggestions that the BMA and government are actually quite close are off the mark.

Claims that the BMA and government positions were actually quite close were government spin, said Benjamin Robinson, a psychiatry registrar at Maudsley, just over the road from Kings College Hospital.

“The reason they are saying that is they want to say that this is based on reasons that are selfish,” he said. “What the government really doesn’t understand is that the contracts are going to disrupt our relationships with patients, because the new contracts have rotas - times when we work - which mean that you won’t as a patient get to see the same doctor on anything like a regular basis. We won’t be able to form the relationships that especially in mental health you have got to have with a doctor.

Cate Manning, also a psychiatry registrar, said this was already a problem that patients cared about, and the government’s plans would only make it worse.

“It’s just not actually workable. There are not enough of us to staff a seven-day NHS as if it was five days,” she said.

Robinson added up: “Do [you] understand the distinction between Jeremy Hunt’s spin on the seven-day NHS? The reality is that if Jeremy Hunt has a heart attack on Christmas day we will be there to help him. For him to claim he’s creating a seven-day NHS is just ridiculous. If he’s saying that people can get their toenails removed at 8pm on a Saturday night, the way to do that is not mess around with junior doctors contracts.”

Many will be wondering at how the impasse over the new contract for junior doctors will be broken. Damien Gayle has been asking the “what next” question of strikers at King’s College hospital in south London.

Striking junior doctors were collecting ideas for a debate on how they can take their fight forward, with little sign that the government is prepared to back down.

Maryann Noronha, who works in emergency medicine at Kings, said she and her colleagues had until now been focused on these two days of all out strike action.

“The government doesn’t look like it’s going to soften, so we really need to plan how we can rack up the pressure, but at the same time still not put patients at risk. It’s a tough line to follow,” she said. “I was just speaking to a lady here and she was saying ‘you are not going to win, you should just give up, they are going to privatise the NHS.’ We were saying we (doctors) will be better off in a private system; we are here because we are fighting for the morality of it - we believe in the system.”

Noronha denied suggestions that the government’s and BMA’s positions were actually by now quite close - a criticism levelled at the junior doctors by some.

“The media has made it very close in the sense that they are focusing in on the Saturday pay. That’s pretty much what they are saying: that if the Saturday pay issue is resolved we would be fine. But I think if today the government said ‘We are still going to impose but we will align with the Saturday pay issue’, we wouldn’t agree with that.

“We need to talk to them about exactly what their plan is for the seven-day NHS, how they are funding it, how they are going to staff it. Just changing Saturday pay is not going to solve the issue. It’s so complex, it can’t be just about one thing.”

Despite accusations from some commentators that the BMA had led junior doctors into a dead end, Noronha was staunchly behind her union.

“The BMA are trying their best to negotiate with this government. It’s a difficult job, it’s not easy to sit between everything, to represent every single junior doctor in the country. I don’t think they they have taken us down a dead end, I think they are trying their best to bring then government plans back down to reality and get some concrete answers.”

Updated

A junior doctor currently on a break from medicine in the US has contacted the Guardian’s Sarah Johnson about the strike. Namrata Turaga who worked only three as a junior doctor is studying for an MBA degree at Harvard Business school and has been keeping track of events as they unfold. She has been following developments with increasing frustration.

She said: “I needed a break from a system that I felt was not adequately providing the vital clinical training I need to be the best doctor I can be and from a world where I had no choice but to agree to a work schedule that included only 12 day shifts in six months – the rest were evening or night shifts.”

She has been watching colleagues and friends in the UK become “increasingly frustrated with their concerns being ignored or belittled” and was inspired to take classes on negotiations and complex deal making. She wrote a simulation based on the current junior doctors’ contract dispute, the result of which was students with a non-medical background reaching a deal by trading and compromising on issues.

“It has left me wondering, if the Department of Health in the UK is simply choosing not to compromise with the junior doctors,” she said. “I hope that the strike is called off early because the government sees sense and listens to all the Royal Medical Colleges and patient safety organisations that are asking them to get back to the negotiating table. I hope people choose to work with one another, for the sake of fairness and for patients.”

Updated

Damien Gayle has more on the money striking doctors have collected for a food bank.

Striking junior doctors at Kings College hospital have collected £300 and a pile on non-perishable food to donate to a local food bank.

Lucy Carter, an acute medicine doctor, said: “In the run up to the strike we had a food bank drive on the wards and among the junior doctors to bring in foods or cash donations, and yesterday during the industrial action we had another collection. We are taking it to Southwark food bank because we are all quite aware that this hospital serves some of the most underprivileged boroughs in London - Southwark and Lambeth - and it’s time we did something positive with industrial action. Lots of people on the street have come by to bring us tea or coffee and we are not the people who need it the most.”

Hannah Orrell, a trainee surgeon at Kings who had just come off a night shift, tells Damien Gayle that Jeremy Hunt’s new contract would spell the death knell for the health service.

The implications of the contract for me are quite far reaching. I’m hoping that I will be in the NHS for 30 to 40 years and, from what we can see on the NHS frontline, services are already overstretched as it is. When the new contract is imposed it means that five days worth of services will be stretched to seven days, with the same number of staff. We think that not only will this be unfair for us but it will be unsafe for patients.

Orrell said that when she arrived at work at 5pm last night, she found that her department had been well covered.

“We had a consultant for each surgical specialism ... I was in work from 5pm to 8am and heard from the consultants that everything ran smoothly. There were not any concerns over safety. All that was left for me to do was paperwork. I will be in again today from 5pm to 8am. I’m safe in the knowledge that the consultants know where we are, they know our numbers. If anything was to go wrong we are willing to go in. But we are confident that it will be safe and we encourage people to use services if they need to.”

Will it take a change of health secretary to break the deadlock and finally settle the junior doctors’ dispute?

Bill Morgan - who was a special adviser to Andrew Lansley, Jeremy Hunt’s predecessor - thinks it might.

“The situation is at a complete stalemate. Jeremy Hunt has the support of Number 10 and the juniors have the support of their consultants. The public have been pretty steadfast in their support of juniors, but that’s been the same since the start – public opinion is neither rallying to their cause nor draining away. In short, neither the BMA nor the government is weak enough to lose.

“Unless and until something happens to decisively shift the balance the strikes are going to continue. It’s impossible to predict how this might play out. On the one hand, juniors might lose the support of their consultants if a local hospital declares an emergency during strike action and the juniors don’t come in off the picket line.

“On the other hand, NHS performance might deteriorate so far as a result of strike action that Number 10 pulls the plug. But at the moment neither is on the cards and both side are holding firm. The only other possible route to resolution is a change in the personalities.

“There’s an element of the ‘Jeremy and Johann’ show about this, and if either or both move on their replacements might be more dovish and more willing to compromise”, says Morgan, who is now a partner in Incisive Health, a specialist health public affairs firm.

Steven Morris has interviewed a couple of the older junior doctors - doctors below consultant level - on the picket line at the RUH in Bath.

James Leggett, 38, re-trained after a career as an academic, dong research in neuroscience and is now an F1 doctor (between medical school and specialist training) currently doing general surgery at the RUH in Bath.

“I’ve always voted, I’ve always read party manifestos but I’ve never felt at the sharp end of a government campaign like this. I think the government has backed itself into a corner. They’ve made promises they can’t fulfil but rather than backing down are intent on pushing through. They need to have a bit less ego and a bit more honesty as well as more compassion for patients and doctors. I think they’d get a lot of credit if they backed down and apologised. I don’t regret re-training. I love medicine. But it’s hard to deal with the day-to-day pummelling were getting. We’re being berated and belittled.”

Rebecca Fallaize, 36, has spent longer than most as a junior doctor because she has had two children over the last five years. She believes the “weird structure” of the shift system the government wants to impose will harm patient safety. Fallaize is a specialist bowel cancer surgeon.

“It’s continuity of care that improves patient safety. The fragmented nature of the proposed contract means that the continuity will be lost. It’s important to see your patient regularly. If you don’t see the patient every day, it’s hard to get that continuity, to build that rapport and have that understanding of how the patient is doing.”

Updated

The strikers at King’s College have been raising money for a food bank in the London borough of Southwark.

Alex Gates, 29, organiser of the picket line at the RUH in Bath, says the striking doctors are as motivated on day two as they were on day one. He thinks the next move should be for more pressure to be placed on hospital bosses to challenge the government.

“If 20 chief executives signed a letter calling for the government to think again, I think that would sort it,” he said.

Lucy Rose Jefferson, 26, who works in the geriatrics department at the RUH in Bath, is in what she calls the “Doomsday camp.” “If the government wins this, they’ll go after the nurses, the physiotherapists, everyone else. It will be the beginning of the end for the NHS.”

Aisha Gani has been talking to Dolin Bhagawati, a registrar at the national hospital for neurology at Queen Square (central London) who has been a doctor for nine years.

He says the specialist hospital he is at has probably 40 junior doctors and about 20 consultants, and at any one time 30 junior doctors.

“The majority were on strike yesterday - we had four junior doctors working and all consultants were working.”

He said he’s on strike as “this contact is unsafe and discriminatory and if imposed will worsen staff conditions. It’s not trialled and not evidence based.”

He added: “Nine years as a junior doctor I have worked in three continents - US, India and here. I found here it’s very rare to have worked in a full rota and doctors have gone above and beyond to cover and fill gaps. People have worked illegal shifts. I myself am considering my future here. My wife is Indian and her first thought when she saw my working pattern was that I am being paid less and working harder than I would in India.

As a consultant neurosurgeon, the average pay here would be £70,000 in U.S it Would be $700,000 (£479,994). In Seattle, my boss was on $4m - so it’s not about money. These are qualified intelligent people who have chosen a vocation. So rather than seeing the effect of this contract we want to negotiate and work with the government and get back to what we want to do and treat patients. Prevention is better than cure.”

It’s not all support for junior doctors, reports Alessio Perrone at St Mary’s in west London. Some passers-by shout their disapproval.

“Get back to work now. People could die!” one person said. Then a runner: “Shame on you!” And again: “Shame on you!”

Junior doctor Ali Yazdi, who works in the geriatrics department, shouted back that their bosses supported them and are covering for them. He says it’s frustrating when this happens.

“I understand some people don’t agree with us, but I wish they stopped to talk to us,” he said. “Instead many just shout and run away. We can’t explain our position.”

The numbers of pickets at Royal University hospital in Bath are picking up considerably.

Juniors on the picket line at King’s College say official figures on the number of their colleagues who went to work yesterday are misleading, writes Damien Gayle.

According to the hospital press office, six junior doctors turned up to work in emergency departments across the trust - which also includes Princess Royal University hospital. However, despite being asked to do so by the Guardian, the trust did not indicate how many of these were juniors on staff grade contracts. These doctors are not covered by the strike as they are not on training contracts.

Chris James, a trainee anaesthetist, said he had spoken to consultants in A&E who told him no trainee doctors had gone to work.

“Yesterday at Kings A&E there were zero junior doctors. At the Pru (Princess Royal) there were five staff grade doctors. They are specialists who are not on these contracts, they are not involved in this dispute. So overall, across both sites, there were zero junior doctors,” he said.

“Today we have got three non-training doctors - not on training contracts - at King’s, and I think it’s the same at the Pru again. That’s come from the consultant body. They were happy that they staffed it safely [yesterday], they had full cover and they had no problems at all.”

Maddy Wells has just finished night shift in intensive care last night at University College hospital and has joined the picket line. She tells Aisha Gani there are eight junior doctors per shift on an average day and two consultants. No junior doctors worked yesterday from 8-5pm and there were six consultants covering.

“My main reason for striking is despite multiple attempts at negotiation from people in prominent positions with Jeremy Hunt he has failed to listen,” said Wells.

An assortment of signs from St Mary’s in Paddington, were numbers are picking up, writes Alessio Perrone. About 20-25 doctors have joined the picket, but they expect it to get much busier after 9.30am, when most surgeries start.

Updated

Aisha Gani is at University College hospital in central London, where about two dozen junior doctors are on the picket line on a chilly April morning.

Lina Carmona was on call as urology registrar last night, while she is also doing her PhD in prostrate cancer at UCL. She trained as a doctor in Colombia and came to the UK to work as a registrar. She has been a doctor for eight years and has a small child.

“We’re supposed to be encouraging people, and women to be doing research. My wages doing a PhD is much lower than being registrar. I used to earn £3,000 a month and now I earn £1,600 and paying for my PhD. So who’s going to want to go into research when your salary is frozen.

“My mentor is a consultant urologist and publishes research and has four children. She is my role model but I was talking to her and she said if I was in your position I wouldn’t know what I’d do.

“So if I continue to do this job I’ll just be treated as a junior junior doctor again. I came here as I love research. I come from a country where we have to work dangerous hours and wouldn’t have any rest.”

Striking junior doctors are just setting up their pickets at the entrance to the King’s College hospital compound in Camberwell, south London, writes Damien Gayle.

Progress is slower than yesterday, some of those helping put of banners admitted to being hoarse from last night’s demo march through central London. Yesterday had seen hundreds of striking doctors join the picket at its height in the afternoon.

As many are expected today, but the atmosphere is muted for now. Chris James, a trainee anaesthetist, said that yesterday’s strike had really impressed on them the power of the media, and how much most outlets were happy to back the government’s line.

James said: ”Yesterday was about where are we, where’s everyone’s support base, are we doing the right thing, are we not. This whole thing is very emotionally charged. Today is a lot more about taking stock.”

Despite warnings from the government, James and his colleagues said they believed there had been adequate cover in critical departments of the hospital.

“I had a chat with our clinical director here saying we are staffing one to one in A&E. That’s where they were talking about the big risk, whereas yesterday was the safest day to go to A&E.”

King’s strikers had hired an open top bus yesterday, which they used to tour south west London neighbourhoods before travelling to St Thomas for last night’s march. People they met had been mostly supportive, he said.

“We had the odd person who would argue with us but if you actually engage with them and tell them [they say] they didn’t realise about the inequality issues, about stretching a five-day service over seven.”

King’s - and the wider NHS - have problems, James admitted, but management and the government were attempting to solve them without consulting those at the sharp end.

“The people who are doing it day in day out, who have got the most experience, they are not engaging with them. It just feels like that’s systematic of the whole problem. If you had an open discussion about what’s happening in the NHS then you can change.”

Updated

As well as reading your reaction to today’s strikes in the comments, we’d like to hear from those of you who are involved and see your pictures of where you are.

Are you a junior doctor on the picket lines today? Maybe you are there in solidarity, or perhaps you have gone to work as a covering senior medic? If you are not a medical worker but are at one of the hospitals up and down the country that is affected, we’d also like to hear from you.

You can share any photos you have by clicking on the blue GuardianWitness buttons on this article and we’ll use some of them as part of our ongoing coverage.

Updated

My colleague Steven Morris is at the Royal United hospital, a major acute-care hospital in the Weston suburb of Bath.

Updated

It seems the Department of Health has been reaching out to lobby correspondents, including Sam Coates of the Times, to be its new director of communications. The Spectator has this nugget on its so far fruitless search.

With the junior doctors’ strike now in full swing, it’s fair to say that these aren’t the most harmonious days staff at the Department of Health have ever seen. Perhaps that’s why they are looking for a new director of communications to take charge of the department’s ‘external and internal communication activities across a complex and high profile agenda’.

Alas, so far they don’t appear to have had much luck enticing candidates to the public relations role. Despite enlisting the help of ‘executive search firm’ Veredus, the search is still on and recruiters appear to be spending their time sending unsolicited messages to members of the lobby. Sam Coates, the Times‘s deputy political editor, has shared a message online that he received asking if he would be interested in the role — which carries a starting salary of £120,000. Alas, Coates was left unimpressed after two of his friends were approached about the same role just last week.

Updated

Junior doctors on the picket line at St Mary’s hospital in Paddington, west London.

The Labour party leader, Jeremy Corbyn, was out yesterday showing his support for striking junior doctors. David Cameron took the opposite tack saying it was “not right” for junior doctors to withdraw emergency care.

Updated

Denis Campbell, the Guardian’s health policy editor, writes:

Yesterday the highly-respected NHS blogger and health policy analyst, Roy Lilley, wrote, in effect, “a plague on both your houses” about the BMA and Jeremy Hunt for their tactics during the dispute.

Today Lilley renews his criticism of the doctors’ union - both its leadership and its junior doctors committee headed by Dr Johann Malawana.

“I’m thinking about the great NHS strike of 2016 when the junior doctors took on the mighty machinery of government and... and... and what? Lost, I suspect. What is there to win? The union have led their members into a cul-de-sac. More strikes, more disruption? More risk to reputation, careers, public patience?

Let’s be honest, the contract is not the draconian settlement it is billed as. The gap between the BMA and the DH is easily bridgeable. The BMA walked away from David Dalton and the DH threw their toys out of the pram.

The JDs have let themselves become a lightning rod for every complaint and disaffection there is in the NHS work place. Their strategic communications woeful.”

But Lilley is also worried about the lingering impact of the whole sorry saga on morale at the NHS frontline. NHS hospital trusts will have to make big efforts to try and engage with their junior doctors to keep them motivated -- not an easy task, he believes.

“There are plenty of studies about behaviour in post-strike work places. Smouldering resentment. Strikes are industrial warfare. Employees lose money, somebody will have lost face. Emotions run hot.”

Tim Farron, leader of the Liberal Democrats, last night called on Jeremy Hunt to name an “honest broker” to help bring people back to the table and has put forward its health spokesman, Norman Lamb.

Negotiations are at a standstill, with no end in sight. Something must be done before there is serious risk to the public... Our health spokesperson and former care minister, Norman Lamb would be an ideal honest broker, with experience in the department, credibility among health professionals and a record of delivering improvements in services. If the government and the BMA are willing to bring a third, independent, party to the table, Norman is prepared to work with both sides to find a way out of this dispute.

It’s day two of the first all-out strike in NHS history. Junior doctors – all those below the level of consultant - will again stay away from hospitals from 8am and 5pm. On the first day, four out of five junior doctors walked out as David Cameron criticised their withdrawal of emergency care.

At some hospitals, almost 90% of junior doctors refused to work in an escalation of their campaign against the new contract that the health secretary Jeremy Hunt intends to impose on them.

However, most hospitals coped well and did not experience any problems. Senior medics took on duties usually undertaken by their junior colleagues. A&E units were quieter than usual as patients with minor ailments heeded NHS warnings to stay away.

Figures released by NHS England showed that 21,608 junior doctors – 78% of those due to work – participated in the industrial action. It claimed that this was down from the 88% who did so on each day during the previous strike on 6-8 April. However, the 88% figure raised questions as NHS England had previously said that almost half of doctors had worked on those days.

Turnout was highest at Barts Health, the largest trust in the NHS. The London trust said that 88.4% of its 1,000 junior doctors had joined the walkout. Unlike four previous strikes, this stoppage is the first one to affect areas of life-or-death treatment, such as A&E, maternity and intensive care. More than 125,000 appointments and operations have been cancelled and will need to be rearranged as a result of the latest strike.

Updated

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