Sarah Walpole: To strike or not to strike? What do the public think?

The government have accepted the offer to further negotiations on the junior doctors’ contract, and many doctors in training have breathed a sigh of relief that this dispute may be settled without the need for a strike. We are ready to take industrial action if that is what is required for the government to listen to the electorate and to protect health services, but we are aware of the short term disruption that a strike can cause and the potential to damage trust in the profession. We only want to strike if it will benefit our patients and the public overall, and if we have public support to do so.

When thousands of junior doctors took to the streets to oppose changes to the contract that we believe are #notsafenotfair, many of us realised that we are part of a professional group that has not only a mandate, but also some power, to influence politics and protect health services. Why didn’t we take to the streets when the threat of the Health and Social Care Bill arose? Why didn’t we march when the “outsourcing” (privatisation) of NHS services began? I can’t answer these questions, but I can say that most of the doctors I have spoken to realise that what is happening now is a fight for the NHS, not a fight for doctors’ pay. It seems that a threat to our own contracts was required to rouse us to action, but now we have been roused. If Jeremy Hunt has achieved one thing, he has united doctors.

In a climate where the government are decreasingly listening to and representing the people that they are meant to serve, we are in a position to protect public services and represent the voice and needs of the public. Debate and action over the junior doctors’ contract must aim not only to bring safer and fairer working conditions for doctors, but to address the fragmentation of health services and the assault on working conditions across the board. More and more people are living with unemployment or unstable working conditions, for example on zero hours contracts, with all of the anxiety and insecurity that this brings. More and more people have problems accessing public services or face cost barriers to essential public services. Our action must be a call to protect the NHS, and to protect fair and equitable pay and contracts across the NHS and across society.

At the time of the ballot, it was hard to know whether the public were behind the strike action. I searched the media and couldn’t find the information that I needed about public opinion. So I did what I always do in times of indecision: I asked my friends. I set up a survey to identify the views of “the public” close to me. Admittedly, it represents almost exclusively the friends and family of junior doctors—those who I emailed the survey to and those who they sent it on to. Nonetheless, its results have something to offer.

Of 149 responses to the survey, 135 were from people who don’t work in the NHS. Of these, only one was opposed to the strike, with 89% saying that junior doctors should strike and 10% unsure. Prior to obtaining the results of my poll, I could only identify findings from a Guardian poll which found that 95% of 28,562 people said that junior doctors should strike over the contract negotiations and only 3% said that junior doctors should not strike. Since then, a poll by YouGov for The Times [behind a paywall] has found quite different results, finding that 51% support the one day strike and 45% support proposed subsequent 24 hour stoppages on 8 and 16 December. The stark variation in poll findings may illustrate the limitations of single question polls which collect the views of a particular cohort or section of society. What is remarkable is that all polls find a majority support strike action as long as emergency services are covered.

A strength of the survey over the polls is that respondents engaged with the question in more depth and offered reflections on the issue. 129 of 135 respondents gave the reason for their belief about whether junior doctors should strike, and 65 respondents added further comments. It’s worth sharing and exploring some of the comments made.

Many supporters of strike action commented that they felt the doctors had no choice but to strike, and that striking is the most effective tool they have. This doesn’t mean that a strike is convenient. One commented “I support everyone’s right to take industrial action and even though it may mean that I am not able to get routine treatment on the days of industrial action I absolutely support those as they walk out.” Nonetheless, well planned strikes should be safe. In 2012, Estonian health workers won concessions to their pay and hours after 25 days of striking, and one respondent quoted this strike, commenting that “there were no excess deaths attributed, nor any public outrage.”

Members of the public noted that the junior doctors’ negotiations have wider impacts both on health service users and on society’s perception of acceptable working conditions. They were concerned about the safety of the hours that junior doctors work, and recognise that tired doctors make for unsafe services. “Junior doctors already often work longer hours than are good for them, increasing these would be bad for patients and doctors. The new deal means a pay cut and there have been too many of these in the public sector in the past few years. This is a dangerous trend for us all, whether we work in the private or public sectors.” They noted that the struggle for safe and fair working conditions is relevant across the NHS: “I think it’s important that junior doctors continue to acknowledge how hard other NHS staff work as well, including antisocial hours, in many cases with low pay, and lacking the status and appreciation that (even junior) doctors tend to get.”

Finally, and perhaps most importantly, members of the public also realise that at the heart of this debate is the need to protect our health service, publically provided and free at the point of access. Many suggested that it is necessary to stress the wider threats of privatization. To quote one respondent: “The doctors must take the trouble to inform the public that their actions are in the interests of protecting the NHS from a government whose plans are to decimate the NHS then seek private solutions for all.”

I would like to thank Gloria Dawson for help with analysing and identifying themes in the qualitative survey results.

Sarah Walpole is a medical registrar, currently working at the Sustainable Healthcare Education network and Freedom from Torture.

Competing interests: Sarah was the Green Party parliamentary candidate for Hull East in the 2015 elections.