On the eve of the first junior doctors’ ‘strike’ in the November of 1975 my consultant invited the whole firm to dinner at his home, later dropping us off at the A&E department where he had agreed to work overnight. He and his colleagues sorted out a much-reduced patient footfall whilst we caught up on sleep – one in two rotas were commonplace. The wisdom of crowds operated, and a savvy public stayed away from hospitals where it could. The ‘strikes’ were sporadic but newsworthy, and spread thanks to TV news bulletins and word-of mouth. If derogation took place it was kept under wraps. The ethics of withdrawing labour were discussed in every Mess as were the demands of the strike movement. Opinions were divided about the safety of withdrawing labour but its’ advocates pointed out the consultant safety net and the short duration of walk-outs. The main aim of a 40 hour week with overtime was endlessly debated. Not all consultants supported their juniors, so industrial action (where it occurred) was in effect sanctioned by sympathetic specialists.
The BMA was hostile to the strikes but was diverted by a dispute with the Labour Government over private practice. As pickets and demonstrations continued into 1976 the BMA’s attitude changed and it began supporting the juniors whilst also coupling their dispute with its private practice campaign. The strike campaign then fizzled out. The outcome was not a substantial reduction in hours of work but instead enhanced pay for overtime working. Some – me included - thought the 1975/6 dispute was the beginning of the industrialisation of the medical workforce (1). If it was, it was a slow process; it took 25 years to reduce working time significantly.
The industrial and political climate could not be more different now. The junior doctor workforce has experienced a fall in income over a decade. Current thinking about the ethics of strikes seems to have hardened around the moral responsibility of junior doctors to resist declining standards of care and public acceptance that it would be unlikely for patients to come to harm because of strike action.
The current strikes have been promoted robustly by the BMA from the beginning, and the juniors do not look like pawns in a more complex game, as they did in 1975/6. If anything the junior doctors’ campaign seems to spur other public sector unions. The actions of juniors may also be shaping the roles of senior staff. The deployment of experienced clinicians to the frontline demonstrates the advantages and potential efficiencies of a health service that is provided by specialists rather than led by them. One long term consequence for junior doctors could be a relative increase in their income and a relative decline in their importance within the NHS. We shall see; 25 years should sort it.
Steve Iliffe, Emeritus Professor of Primary Care for Older People, University College London.
07956 547 554 s.iliffe@ucl.ac.uk
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Gordon H & Iliffe S Pickets in White Medical Practitioners Union, London 1977