Junior doctors row: has Jeremy Hunt been politically savvy?

His stubbornness could pay off—or it could backfire catastrophically

by Peter Kellner / February 12, 2016 / Leave a comment

Protesters outside the Department of Health in London, as junior doctors have pledged to fight on after Health Secretary Jeremy Hunt announced he will impose a new contract on thousands of medics in England.

Those protesting Health Minister Jeremy Hunt’s plans to impose new contracts on junior doctors group outside the Department of Health in Westminster, London, on 11th February 2016 ©Anthony Devlin/PA Wire/Press Association Images

Read more: Junior doctors’ strike—will Corbyn miss an open goal?

Were Harold Macmillan alive today, he would surely update his famous injunction: “There are three bodies no sensible man directly challenges: the Roman Catholic Church, the Brigade of Guards and the National Union of Mineworkers.” These days it would make far more sense to substitute the British Medical Association for the virtually defunct NUM.

The Government’s dispute with junior hospital doctors looks like an exercise in political madness. Polls show that voters sympathise with the strikes. Jeremy Hunt, the health secretary, no doubt hoped that cancelled operations would turn the public against the doctors. If anything, it is Hunt who is losing ground. He, not the BMA, is being blamed for the disruptions and delays in our hospitals.

However Hunt should not be surprised. Every time YouGov asks people how much they trust different groups to tell the truth, doctors come near the top and politicians near the bottom. I doubt whether many people really understand the details of the proposed new contract, and whether the typical junior doctor doing a typical amount of weekend work will end up better or worse off, and by how much (I certainly don’t: be honest, do you?) But when it comes to winning over public opinion, that is beside the point. When a news bulletin shows Hunt saying one thing and a calmly-spoken striking doctor saying the opposite, it is plain who viewers are more likely to believe.

That’s the bad news for the health secretary. Here’s the potential good news. His decision to impose the new contracts may work. It’s possible that the strikes will peter out in due course and that when doctors receive their new pay packets they may decide the terms aren’t that bad after all. In that case, the threats of mass resignations may not materialise. If that happens, the current dispute will fade in the public mind; and, if patients end up receiving a better weekend service, the Government may start reaping electoral rewards for its stance.

On the other hand, things may not work out so well for Hunt. If strikes and resignations start to cripple the NHS, and the Government gets blamed, ministers may be forced into an ignominious retreat. It could even affect the coming EU referendum. If even a relatively small proportion of voters, say one or two million, decide that they want to weaken David Cameron, they might switch from “remain” to “leave” as a means of protesting against the Government.

All of which makes me wonder why on earth Hunt is taking such a huge risk with his imposed-contract strategy. I’m with him on the problem of weekend mortality rates, and I suspect the BMA has been unduly intransigent. The mystery is why this is being dealt with as a national negotiation. Would it not be better to instruct every hospital to provide a top-class seven-day service, and leave local managers to decide how best to make this happen, including the way doctors are paid?

A still-relevant lesson from the 1990s debate about “reinventing government” is that national politicians should steer, not row. That is, they should set overall objectives, but then give the managers of each service the freedom and responsibility to deliver them. Hunt should stop rowing and stick to steering.

Now read: The great social care dilemma

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Comments

Jeffrey L
February 13, 2016 at 11:03
I believe it will back-fire on Hunt for the very simple reason that he has lost the trust of the medical profession, not just the junior doctors. Sadly, he has succeeded only in totally alienating a highly valued and needed professional community.
DAVID_CUTTS
February 13, 2016 at 13:34
I don't think that you can blame the mortality figures on the working practices of Junior doctors. This is probably a misreading of the data and Hunt's use of it comes under the category of damn lies. Hunt gets the reaction from his staff that he deserves. They are smart and dedicated people otherwise they would have not made it this far in medicine. The NHS operates 24x7x365. It operates at different levels during that time. What he is doing is trying to get the 'normal working week' to extend through Saturday without hiring new doctors, of which he has not enough anyway. This is a cheap and ineffective way of managing the situation. It is obvious that the NHS capital treatement resoures are not used at full capacity, but to do that you need more doctors, more nurses and more beds to support the core treatment and diagnostic activity. If there is no budget for this it is because the government somehow thinks that the UK can run its health services on a fraction of the proportion of GDP devoted to it in other countries. It can, because the NHS concept is a remarkable shared element of our society which we all support. He and his tightwad friend Osborne will strangle it if they go on at this rate. And if they are trying to put the blame on the doctors they overestimate their political skill and underestimate the nous of the population.
Ian Lang
February 13, 2016 at 13:38
You say you're with Hunt on the problem of weekend mortality rates. As a statistician, have you examined the claim and the causal relationship? Saturday and Sunday admissions are more likely to be emergencies, 50% and 65% respectively, than on weekdays (29%) and length of stay is also higher for patients admitted on a Saturday and Sunday. A higher proportion of patients admitted on a Saturday and Sunday have diagnoses that place them in the highest risk of death category, 24.6% and 29.2% respectively, compared with less than 20% of weekday admissions. https://www.ucl.ac.uk/news/news-articles/0915/070915-risk-death-patients-NHS-hospitals-weekend It is no wonder that weekend admissions have a higher death rate. It is not because of the poorer quality of their treatment but because non-emergencies are less likely to be admitted then. Are you really with Hunt on this? Have you critically examined it? I have nothing to do with the NHS but I'm interested in evidenced based decision making.
Peter M
February 14, 2016 at 13:46
There are a lot dubious observations in the above reply but the most arguable is the old well worn chestnut that the " NHS concept ---we all support". Well no thinking person should. It is a 70 year old concept/design which is well out of date and deserves fundamental if not total change to meet the needs of the 21st century. Something the blinkered and overly politically motivated BMA will never understand.
Tianavaig
February 16, 2016 at 14:39
At last someone has said it - the doctors will maybe get back to sanity once they see the new wage packet. All the talk of better, safer care cannot be justified with what they are doing. Shame doctors have now become just ordinary - maybe just technicians who know about the working of the body (and only bits of it). Not like say an architect who needs to know everything (not just stress related issues to walls!! To threaten to leave and take the education we gave them to another country - my goodness how will that make the NHS safer for patients!
Mike Stephenson
February 16, 2016 at 21:11
Mr Hunt's row with the Junior Doctors is part of the Tory strategy to advance the already begun privatisation of the NHS. I am an 80 year old who has witnessed the NHS as the greatest humanitarian service in the world. Changes are required all the time but why cannot these be managed by the NHS. The private companies are interested primarily in profit without risk, or very limited risk, offered by the world's greatest taxpayer funded organisation. The end game to please rich shareholders is " how much money can we make out of this? " The present government, committed to the shrinking of the state, can hardly allow a massive NHS national body to flourish as a state enterprise. But an enlightened government would take the NHS back to its founding principles, get rid of the market forces and bring everything under the control of the NHS and start to manage it with courage and purpose for the benefit of the health of the nation. If such government comes forward to do this the support of the electorate of UK will be guaranteed. People are voluntarily supporting the NHS, raising money for research, helping friends to get to appointments, running cafes in hospitals, raffles, sponsored walks - only last year I came across thirty young adults on a sponsored climb of Ben Nevis to support a local hospital, in the name of a friend who'd died of cancer. Everyone reading this knows of spontaneous NHS related fund raising somewhere. Where does this sit along side private, profitable contracts and internal competition.