In the next few days, Junior Hospital Doctors (JHDs) will be asked to vote either for or against industrial action. It is a situation that they will not have encountered previously, indeed one that some will wish they didn’t have to face. They have many factors to consider when casting their vote and will no doubt weigh the pros and cons carefully. They may be helped in coming to a decision by considering the lessons learned during the last major dispute with the government when, as now, a ballot of junior doctors was held.
In the 1970s, a situation arose that was remarkably similar to that at present. Then, as is the case today, juniors were negotiating with an intransigent government whose main priority was to reduce public spending because of a burgeoning national debt. Harold Wilson and Denis Healey, prime minister and chancellor respectively, were in the embarrassing situation of having to go “cap in hand” to the International Monetary Fund for a loan to keep the country afloat. A strict wages policy was in place. In the weeks before the ballot, as now, there was relatively little coverage of the dispute in the press though the general public were thought to be broadly sympathetic to the junior’s plight. Protest marches had been held and representations made to the minister of health Barbara Castle but the government remained unyielding and a “stand-off” resulted. The mood in hospitals was one of frustration and anger that genuine concerns were not being heard. There were strident calls in some quarters for a complete withdrawal of labour to force the government to capitulate. A ballot of JHDs was arranged.
The ballot paper asked a number of different questions amongst them “Are you personally prepared to engage in industrial action and sustain this until the government provides extra money?”
Meetings of juniors were held in hospitals up and down the country and there was a lively debate in the correspondence pages of The BMJ. Some doctors were represented by the moderate Hospital Junior Staff Group Council of the BMA (HJSGC), others by the Medical Practitioners Union, but a significant number had joined the more recently formed Junior Hospital Doctors Association which was significantly more militant. It rapidly became apparent that many doctors held extremely strong (though widely differing) views on the way forward and the advice they received from the three representative bodies varied enormously.
In deciding how to vote, juniors had many uncertainties to consider.
Would it bring doctor into conflict with doctor; some in favour of action, others against? In fact it did, indeed before the result of the ballot was known, a vote of no confidence was passed in the chair and executive of the HJSGC who were forced to resign from office.
What form should the industrial action take; would some doctors be willing, others unwilling to break the Hippocratic Oath? Who should decide on the form of action? Some were set on a complete withdrawal of labour; others argued that there should be no disruption of the service at all. As it transpired, it was left to individuals to decide. In practice, action was patchy; some declining to take action, others reducing their hours to 40 per week. Since the average number of hours worked per week was approximately 80, this had a profound effect and where this policy was implemented, all elective work ceased.
Then there was the question of patient safety; what safeguards would be put in place and who would monitor the situation? In the days before clinical governance, this was left to the conscience of the juniors. In the event, there were no reports of disruption to the care of accident and emergency patients.
A major concern was that doctors would damage their career prospects by taking action against the wishes of consultants who were often keen to remind their staff of the hours they had worked when they were juniors. At this time, many consultants were refusing to sign the “overtime claims forms” to sanction payment for work undertaken even though the juniors had a contractual right to such payments. Other doctors, aware of their consultant’s view, hadn’t even submitted their forms to the bosses. This became a major issue between the juniors and the government who believed that the number of hours of overtime claimed, represented the amount of overtime worked.
A further complication was the major disagreement amongst the juniors as to whether the dispute was about pay or about the principles embodied in the proposed new contract. Is the present dispute principally about pay or is it about safe medical practice?
The vote in favour of industrial action, published in November 1975, was 7355 to 5336 (the nature of the action was undefined).
When industrial action began, many failed to anticipate the close examination the press then gave to the junior’s pay and working conditions at a time of national financial crisis, (support was not universal; some considering that everyone should make sacrifices to help the country through its economic difficulties). Similarly, they were unprepared for the criticism that resulted when patients suffered—as they inevitably did. Many thousands of operations were cancelled, waiting list grew and the reputation of the junior doctors was tarnished.
In that previous dispute, there had been no prior agreement of exactly what the government would be required to concede for the industrial action to be withdrawn. In fact, action was discontinued when a contract based on standard pay for a 40 hour week was agreed and an understanding reached that the rate of overtime pay should be determined by an independent body; the juniors therefore returning to normal working before they knew what the financial settlement would be. It was also agreed that the department of health and the BMA would work jointly to reduce JHDs excessive hours.
There are lessons to be learned from the JHDs previous dispute with the government and it would be wise to heed them. Some of the tensions that the industrial action induced could have been avoided and many factors needed to be considered when deciding whether to vote for industrial action. Today’s junior doctors may find looking back at history may help them in the decision that they are about to make.
Now retired, Peter Sykes worked as a general surgeon in Manchester for 25 years and became Medical Director of Trafford Hospitals NHS Trust.
Competing interests: None declared.