The government can't talk its way out of the junior doctors standoff

The rapid descent of discussions over the contract for junior doctors into a standoff will make politicians very nervous indeed.

‘A challenge for the government is that the public believes seven day working already occurs in hospitals’

The usual playbook for industrial disputes with the medical profession doesn’t work. You can’t brief out stories about “fat cats”, nor does the “we are all in it together” message work.

Juniors are not a group on six-figure salaries (yet), nor do they have gold plated pensions. Their lives are not too far removed from those of the many swing voters who ministers need to keep onside.

There has been lots of chatter about how the normally sure footed Jeremy Hunt could get himself into this difficult communications position.

‘No gimmick’

There is anger among doctors about claims of excess mortality at weekends. I make no judgement about their validity here, other than to observe that the quality and safety benefits of seven day working are sincerely held by Sir Bruce Keogh – the policy’s great champion – as much as the health secretary. Seven day working is not simply a policy gimmick made up in Conservative Campaign Headquarters.

I also make no judgement about claims of the potential financial loss facing some juniors. Whether or not the figures are correct, they are believed. And this is the government’s problem.

‘The simple truth is that the government is asking juniors to do more for the same total level of resources’

A further challenge for the government is that the public believes seven day working already occurs in hospitals. After all, accident and emergency departments are open every day of the year. Hospitals do not empty out their beds on a Friday afternoon only to re-admit the same people for the same issue on a Monday morning. In this sense, the row is about solving a problem that the public didn’t know existed.

There is no way to communicate your way out of this. The simple truth is that the government is asking juniors to do more – or at least do it very differently – for the same total level of resources. Try and change the working practices of any group in this way and you won’t get a very good reaction.

This is a big political headache for those in Downing Street. The juniors have received a much more sympathetic media reaction than doctors often do on pay issues, for the reasons I have outlined. Some Tory MPs are nervous. Many junior doctors (or at least their parents) will live in marginal constituencies and know their local MPs; for them, this is not some abstract dispute.

Yet it would be foolish for doctors to think that this political headache will turn into support elsewhere in government. In the midst of a bruising spending review, there will be little tolerance in the Treasury or elsewhere in Whitehall for the idea that health should receive more money to smooth over the row. Other cabinet ministers will point to the difficult reforms to working practices already undertaken in - for example, the police - and question why health should be any different.

Setting a precedent?

Hunt may well seek to secure extra funding to smooth the path to seven day services, but he should not expect a sympathetic hearing. If the Department of Health needs to buy off junior doctors, it is likely it will need to take money from within its own tight funding envelope.

There is also the issue of the precedent that this standoff will set. The junior contract is not the only employment issue facing the NHS. A new GP contract also has to be agreed and discussions with consultants are ongoing.

Officials with relatively long memories will recall the rows over new contracts in the early 2000s – a time when there was plenty of money to encourage the profession to change its working practices. The rejection of the consultant contract set the tone for the GP contract – a contract that ministers blame for many of the problems in primary care today. No one will want history to repeat itself.

‘The BMA shouldn’t feel too comfortable – public sympathy is very different from public support in the event of a strike’

This is a tough situation for health ministers. They don’t have a great deal of public support or sympathy from colleagues elsewhere in government, yet they will be well aware that the current situation is causing anxiety and there is an expectation from Number 10 that they will resolve it.

The British Medical Association should not feel too comfortable either. Public sympathy at this stage is a very different thing from public support in the event of a strike, where significant disruption to services could be expected.

The strike over NHS pensions – which was unpopular and failed to make much of an impact – provides a salutary reminder of how difficult it is to organise industrial action that disrupts services, protects safety and doesn’t lose the goodwill of the public. Neither side will want the dispute to get that far.

Mike Birtwistle is a founding partner at Incisive Health, a specialist health policy and communications consultancy