Peter Sykes delves into the past and compares the junior doctos’ dispute with industrial action in 1975
Historically, junior hospital doctors have been a remarkably apolitical group. Only on one previous occasion, in 1975, have they taken industrial action.
Strict wages policy
Then, as now, the country was in economic difficulties and austerity measures were in place. In an attempt to balance the books, a strict wages policy, known as the “Social Contract”, was agreed between Harold Wilson’s Labour government and reluctant trade unions.
The JHDs were concerned about their poor pay and excessive hours. Their contracts were open ended; they didn’t specify either the hours to be worked or the duties to be performed.
Extra duty payments were paid at a third of base rate (not time and a third) after 80 hours on duty. Importantly, the JHDs were supported by both public opinion and the press who clearly understood this single, simple grievance.
The support for the JHDs today seems less solid and lacks clarity as to whether the dispute is about pay, patient safety, weekend duty or is a general dissatisfaction with the current system of shift working.
In 1975 many JHDs were represented by the British Medical Association but a significant number had joined the more recently formed Junior Hospital Doctors Association which was much more militant. The Junior Staffs committee of the BMA misread the mood of their members and a vote of no confidence led to the resignation of its chairman.
The vote in favour of (undefined) industrial action was 7,355 to 5,336, a significantly smaller majority than in the recent ballot
The position of the Department of Health was that only £1.6m was available to resolve the dispute. Meetings of angry juniors took place, protest marches were held and representations made to Barbara Castle, the secretary of state responsible for health but, constrained by the Social Contract, she could do little more than invite them to be patient until the financial situation improved.
The mood in hospitals was one of frustration and anger that genuine concerns were not being heard. A national ballot of JHDs was organised.
The vote in favour of (undefined) industrial action was 7,355 to 5,336, a significantly smaller majority than in the recent ballot.
Unlike the present dispute in which specific industrial action has been prescribed, it was left to individual doctors to decide how to respond. Some declined to get involved but many reduced their hours to 40 per week, effectively only caring for emergencies.
London, the Midlands and the North West were the areas worst affected. Since the average number of hours worked per week in many specialties was 80 or more, this had a profound effect on patient services.
Many outpatient clinics and elective surgical lists were cancelled.
In an attempt to resolve the impasse, Barbara Castle argued forcibly in Cabinet that the junior doctors were a special case but with militant unions trying to break free of pay restraint, she was not allowed to make more money available. As in the current dispute, a redistribution of money within the existing budget was considered but to give more to those who worked long hours meant a reduction in pay for others, which was unthinkable.
Castle knew that the hours worked by many JHDs were intolerable, indeed unsafe but she was trapped; there was simply no room for manoeuvre, no possibility of a compromise.
It was the strength of public opinion and the prospect of an early general election (which, it should be noted, is not a concern for the present government), that led to a settlement. The NHS, which should have been a vote winner for a Labour administration, was in chaos.
Harold Wilson, who had a tiny parliamentary majority, desperately needed the dispute to be resolved. Perhaps as a political expedient, though possibly deliberately misled by Mrs Castle, he allowed his Cabinet to believe that by allowing the level of overtime pay to be determined by an independent body, the cost of the settlement could be contained within the limits of the Social Contract.
The JHDs returned to work with an agreement that their new contract would be based on a 40 hour week and that extra payment for additional hours would be independently priced. It was also agreed that a joint BMA/Department of Health group would work to reduce the hours worked.
The cost of the dispute in terms of patient care was significant
Although parliament was persuaded that the pay rise would not breach the government’s pay policy, in fact it drove a coach and horses through it. Initially, the government had suggested that only £1.6 million pounds was available to introduce the new contract. Subsequently, it was found to cost £30 million.
The cost of the dispute in terms of patient care was significant. When compared to the previous year, out-patient attendances went down by 7 per cent and the number of patients waiting for admission rose by 12 per cent to the highest level since the NHS began.
It is hoped that the present dispute between the junior doctors and the government can be settled without the harm to patients that occurred in 1975.
Peter Sykes is a retired medical director. His novel First do no harm (sold in aid of his local hospice) is set against the industrial action that beset the NHS in the 1970s. For further details see www.petersykes.org.