Doctors’ strike: Breakdown in trust could take years to repair

For the first time in over 40 years thousands of junior doctors downed their stethoscopes today in a protest against the government’s plans to reform their contracts in a day of action that has seen thousands of operations cancelled.

The placards have been waved and the angry debates and recriminations thrown by both sides – but as the dust settles and the NHS prepares for business as usual, uncomfortable reality will set in for both the government and British Medical Association.

One option

A negotiated settlement is the only real option – and always was.

The legacy of the industrial action is likely to be the damaged relationships and loss of trust across the NHS. Throughout today there has been suspicion, leaked emails and accusations between doctors and their trusts about the state of preparedness for the strikes.

At Sandwell Hospital there were reports of doctors in tears as they were called back to work by management declaring a major incident – only for the trust to admit later that it cancelled just 2 per cent of elective procedures.

At Watford General the trust’s medical director was accused by junior doctors of bullying and harassment over what appears to have been misunderstanding about what might happen in the event of a major incident that in the end never happened.

Even before the strike began, a series of unedifying letters between Sir Bruce Keogh and Mark Porter set the tone for the day

Even before the strike began, a series of unedifying letters between NHS England medical director Sir Bruce Keogh and BMA council chair Mark Porter set the tone for the day. Neither leader was prepared to back down over what they believed was the proper way for a major incident to be handled.

Low profile

Keeping a low profile was health secretary Jeremy Hunt, whose intervention last summer, after the BMA had refused to engage with NHS Employers since October 2014, led largely to the anger and desire to strike by many doctors.

Mr Hunt turning down the volume and the arrival of Sir David Dalton to lead negotiations with the BMA may be a sign the government wants to progress meaningful talks.

Overall, NHS England estimates 3,500 operations may have been cancelled and many trusts have reported to HSJ an average impact of 10 per cent on their elective activity. This isn’t insignificant but neither is it a major crisis in light of the much wider problem of meeting existing RTT waiting times.

As a 48 hour strike on 26 January looms neither the BMA nor trusts will want to see a repeat of today’s bruising rhetoric. The long lasting damage to workforce relations could take years to repair.

The BMA must not overstretch its muscle or it risks losing public support and playing into the hands of government ministers hoping it stumbles. Meanwhile, ministers and Sir David need to be prepared to negotiate a contract that can be realistically sold to junior doctors as a compromise good for all sides.