What if the government were negotiating with the NZRDA rather than the BMA?

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by Nima Ghadiri

The government is currently locked in a dispute with junior doctors over a proposed new contract.  The organisation representing junior doctors is the British Medical Association (BMA), a trade union which was founded in 1832 and represents all United Kingdom doctors, not just Junior Doctors.  The chair of the BMA’s junior doctor’s committee  is  Johann Malawana.

Chief areas of contention in the contract are: removals of national safeguards (fixed financial penalties) for organisations when Junior Doctors work long hours, cutting out minimum break requirements,  re-designation of the normal working week leading to an added day when hospital resources are lacking, and disadvantages to doctors who work less-than-full-time and have families.

Jeremy Hunt, the Secretary of State for Health, has stated that the British Medical Association (BMA) have misrepresented Junior Doctors and has targeted the union aggressively in a bid to win public opinion.  This has been echoed in much of the tabloid press, who have used social media photos of the BMA Junior Doctors’ committee in order to portray them as wealthy manipulators of the Junior Doctors that they represent.

Indeed, The BMA has had a tumultuous relationship with Junior Doctors lately. Many felt that the union did not fight hard enough following various events which have taken place over the last decade: Loss of House Officer Accommodation, shortages of training posts, the ill-received Medical Training Application System (MTAS), pay increases below inflation and consistently increasing GMC and examination fees.

Nevertheless, in this battle, Junior Doctor consensus (based on a Facebook group which is 63,000 strong) is that the BMA is working hard and representing the position appropriately, but is simply underpowered. Junior Doctors who have worked abroad, in particular New Zealand, will know just how underpowered the BMA is.

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The  New Zealand’s Resident Doctor’s Association “NZRDA” was founded in 1985. It represents only Junior Doctors, rather than all doctors.  British doctors who move to New Zealand tend to be surprised about the power of this organization, which is very proactive and consistently anticipates future problems.

Over time, the NZRDA have (chiefly through their firebrand negotiator Deborah Powell) negotiated a number of improvements on an annual basis by means of their Multi Employer Collective Agreement “MECA”. These have included: consistent increments in pay, final year medical students being given a salary, free canteen food during working hours, training and membership costs being covered, presence of cross-cover and relief doctors to cover short-term absences, ease in going out-of-programme for family or travel.  There is even a motivation for hospitals and clinics to ensure that their junior doctors claim all of their annual and study leave, as the amount not used becomes “cashed out” as a payment.

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The NZRDA have been aggressive in the few instances when conditions have deteriorated.  In April 2008, the NZRDA gave notice of a nationwide 48-hour strike over pay, conditions and ongoing issues of retention, as 40% of Kiwi doctors were moving to Australia.  At the time, a first year house-surgeon in NZ earned 88,000 NZD (£40,000) on average.  Junior doctors sought a 10% pay rise over three consecutive years ( twice that of other health service workers) rather than two rises of 4% over two years.

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The strikes were widely seen as a success which brought the desired outcome for the doctors, caused no harm to patients (indeed, emergency department waiting times were markedly reduced), has improved retention of doctors and made New Zealand a very attractive destination for British and other doctors.  They have also empowered the NZRDA to fight annually for better conditions.

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In a hypothetical situation, what would happen If the NZRDA were transplanted to the negotiating table in the United Kingdom?  Based on their track record, they would be keeping the government on their back feet.  In particular, they would not hesitate to legally challenge the government, for example Jeremy Hunt’s assertion that we do not already have a seven-day emergency NHS has led to well-documented patient harm.

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Unfortunately, the BMA may simply not have the strength to attack on all fronts in order to secure a fair and safe contract this time round. However, a Union is only as strong as the will of its members, and for the Junior Doctors this is currently very strong indeed. One outcome of the current dispute will be a galvanised and stronger British Medical Association. Which is precisely what the government don’t want.

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Who is Jeremy Hunt?

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by Nima Ghadiri

Jeremy Hunt is the United Kingdom’s Secretary of State for Health.  He is currently engaged in a colossal dispute with junior doctors over a new contract proposal which he states is better for junior doctors and will make the hospital a safer place at weekends.  His detractors believe that the new contract is in practice less safe, spreads doctors too thinly over the week and is already resulting in an exodus of doctors from the health service.  Many have observed that he has wilfully misinterpreted cause-and-effect in quoting data about weekend mortality rates, and that a routine 7-day health service is a noble goal, but needs to be matched with an increase in spending – when in practice the opposite is happening in the United Kingdom.

In anger over this proposed contract, Junior Doctors went on strike for the first time in forty years on Tuesday 12th January, providing emergency care only.  This is to be followed by a further 48-hour strike on Tuesday 26th January and a strike of all services (including emergency) on Wednesday 10th February.  Jeremy Hunt believes that junior doctors are being misinformed by their union, and has threatened a “nuclear option” of introducing a contract regardless of whether doctors agree to it.

But who is Jeremy Hunt, and what is his pedigree? He was born from aristocratic lineage in London and raised in Surrey. His education took place at the prestigious Charterhouse boarding school, where he became head boy, and he went on to get a first-class honours degree in Politics, Philosophy and Economics at Oxford University (a degree infamous for its association with the establishment).

Subsequently, he worked as a management consultant for two years, before moving to Japan to work as an English language teacher.  On his return to the United Kingdom, he embarked on a number of business ventures, chief amongst these a failed effort to export marmalade to Japan.

In 2000, Jeremy Hunt established an educational publishing business called Hotcourses with his friend Mike Elms, funded for seven years by the taxpayer-funded British Council via an intermediate company called Sheffield Data Services (based in West London).   Hotcourses was a monopoly supplier for the British Council, which by happy coincidence was vice-chaired by Jeremy Hunt’s cousin and confidante Baroness Virginia Bottomley (former secretary of state for health).  In 2014, Jeremy Hunt missed out on a potential £17 million windfall after private equity firm Inflexion pulled out on a deal to buy Hotcourses. Nevertheless, he remains well-remunerated (earning £960,000 in 2015 from the company) and the fact remains that for a decade the British taxpayer helped set up and sustain a
monopolistic arrangement which proved to be highly profitable.

Indeed, Jeremy Hunt has shown that that he is adept at personal financial management. In April 2010, he managed to avoid a tax bill of £100,000 for Hotcourses by paying himself a dividend for his company in the form of half its office building, days before the government accounted a 10% rise in its tax on dividends.

Whether his pecuniary abilities have extended to the National Health Service, has proven to be a different issue.  He has overseen a peculiar cycle since taking over from Andrew Lanslet as Secretary of State for Health: In 2013 the government spent £1.4 billion on NHS redundancies, then £3.9 billion filling the gaps with temporary agency staff run by recruitment agencies. Headhunter firms have had a significant role in vetting key staff within this restructured Health Service. Key amongst these is Odgers Berndston, whose chair and CEO is, again, Jeremy Hunt’s cousin Baroness Virginia Bottomley.

With his mentor Baroness Bottomley acting as a powerful lobbyist in the private health sector, it is no surprise that Jeremy Hunt has made overtures in favour of privatisation.
In his co-authored book Direct Democracy (p78 Jeremy Hunt et al), he stated:

In 2015, Jeremy Hunt signed the largest privatisation deal in history, worth £780 million, to eleven private firms in order to perform diagnostic tests and procedures on NHS patients.

Jeremy Hunt has thus-far managed successfully to avoid media scrutiny for these huge contracts, and this has chiefly been a result of his very close relationship with Rupert Murdoch’s News Corp.  During his time in his previous role as Culture Secretary, his Office provided near-daily updates to Rupert and his son James regarding a proposed takeover of BskyB by News Corp. This relationship has remained strong and has ensured that media coverage of the impending NHS privatisation (which would be immensely unpopular for the British public) has been stifled.

Many who work in the National Health Service have no doubt that the end-goal is to privatise the service, which has been deemed unwieldy by the previous Labour government and the current Conservative government.  As the first group to be targeted, Junior Doctors have rallied to defend the Health Service, voting for industrial action with an overwhelming mandate (99.4% supporting industrial action with 98% supporting a full strike).  Jeremy Hunt
has raised the stakes by proposing a “nuclear option” and remains extraordinarily unpopular with NHS staff, such that he has refused to be interviewed alongside a member of the organisation he oversees. The next steps will be crucial, as the government decide whether it is worth persisting with Jeremy Hunt and alienating the consultants of the future (whether there remains a National Health Service or not) or replace Jeremy Hunt and continue covert privatisation goals by other means.

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Letter to the Chair of the Health Committee in the House of Commons

Dear Dr Wollaston (Conservative MP for Totnes and Chair of the Health Committee in the House of Commons),

It is with dismay that I am writing this open letter to you (a former GP with first-hand experience of the situation with junior doctors as your daughter has recently left the NHS to work in Australia), after seeing your media appearances targeting junior doctors who are being forced to enter industrial action due to a contract proposal which is unsafe for both patients and doctors and is already leading to a significant reduction in medical
student numbers and retained UK doctors.

(Newsnight 11/01/06 – http://www.bbc.co.uk/programmes/b06wcl4y

Telegraph – Junior doctor strike appalling and highly unsafe – http://tiny.cc/zmk27x

Polticshome – Junior doctor strike plans ‘extreme’ – Sarah Wollaston http://tiny.cc/b8j27x

Western Morning News – Appeal to halt strike – http://tiny.cc/j8j27x  )

As you are uniquely endowed with the experience of three service vocations (doctor, teacher and currently member of parliament), I find it mind-boggling that you choose to toe the party line rather than do the right thing.  This contract:

i) removes the robust national safeguards which prevent doctors working excessive hours

ii) cuts out the minimum break requirements

iii) fundamentally changes the normal working week to add a day when hospital resources are lacking

iv) disadvantages doctors who work less-than-full-time and have families.

It is truly unacceptable and the facts are there for all doctors and the public to see. There
is no union pressure which led to 99.4% of junior doctors supporting industrial action (98% full strike) and 66% of the public supporting it (http://www.bbc.co.uk/news/uk-35288042)

Your daughter and 8 of her friends have recently left the National Health Service to work in Australia:  Huffington Post   –   http://tiny.cc/otk27x

Like your daughter, I also went to the Antipodes for a few years and can vouch for the overwhelming disparity in working conditions between the UK and abroad and the ease of finding a training job as a UK-trained doctor.  I came back for two reasons: my family
and because I feel a debt to the NHS from a personal perspective. However, there are many doctors who have decided that enough is enough and the numbers leaving are surging as evidenced by the phenomenal increase in applications for the GMC certificate of good standing (needed to work abroad) since these contract proposals started.

Guardian 22/09/15 – Registrations to work abroad soar – http://tiny.cc/9pl27x

“The General Medical Council received 1,644 requests for certificates of current professional status (CCPS)  – required to work abroad – in just three days last week. Usually, the
regulator receives 20-25 a day.”

In addition to doctors leaving, the next generation of doctors is already dwindling!  The number of medical school applications this year has dropped by 11%. I teach medical
students and my current batch are all looking to apply to work abroad.

My two questions are – 1) Do you not find this immenselyworrying 2) Why are you doing this?

You must be aware that if this contract goes through, so many more doctors will join your daughter in Australia or leave medicine. When you were training, however bad working conditions might have been, there was a net influx of doctors from Australia and New Zealand to the United Kingdom. This no longer exists, and the incongruence of working and living standards now threatens the future of the national health service as we will be left with huge gaps.  This will add to the irony of this entire catastrophe starting because the Secretary of State for Health wanted to parcel it within the implausible ambition of the world’s first and only 7-day “routine” healthcare system (in a country which has reduced GDP per capita spend on healthcare consistently since 2010 in comparison with our peers).

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I beg you not to use your hugely influential position to bring about a change which will bring the National Health Service to its knees and will cause immense harm to the British public over the 21st century.

Yours sincerely,

Dr Nima Ghadiri

Junior Doctor

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