David Oliver: A dispute played out via soundbites and spin cannot end well for services

david_oliver_2015I write this a few hours after the BMA agreed that it would take up the offer of renewed contract talks with the government, brokered by the Academy of Medical Royal Colleges. The government have in turn agreed a temporary suspension of imposition.

PR has coloured the whole saga of the contract stand-off. What had been a low key bureaucratic process was bizarrely hijacked by Jeremy Hunt last summer when he attacked doctors’ vocation and work ethic, insinuating that they didn’t already work evenings and weekends.

Hunt and the Department of Health press office have repeatedly pumped out propaganda soundbites that you could use for a game of comms-buzzword-Bingo: “manifesto commitment to a seven day NHS,” the “eight studies showing a weekend effect (despite researchers telling Hunt his conclusions from the work are unwarranted),” “more people dying,” the “13.5% increase in basic pay,” “reducing hours,” “6th biggest funding increase in NHS history.” Then, with talks breaking down and strikes ongoing there was talk of “a small number of remaining issues,” “it’s only about the issue of Saturday pay,” “the BMA refused to negotiate,” “this is about a seven day NHS,” “more senior decision makers (i.e. consultants not juniors). House!

Now to the comms spin, let’s throw in an “independent review of junior doctors’ morale” in which they were banned from discussing terms and conditions (how would that be meaningful?). Add into that last week’s study by Meacock et al which casts doubt on the weekend effect. Peter Rothwell, commenting on the BBC said that the government’s use of weekend mortality data was “an example of how poor quality data, badly interpreted, can lead to the wrong answer.” Consider the serial opinion polls which show that public support for the junior doctors is far higher than that for the government—with blame largely aimed at the politicians.

As the dispute has gone on, the massive workforce crisis in the NHS has become apparent. There are nursing and medical vacancies galore (which have been under-reported by ministers till now), unfilled medical training posts in key specialties, and doctors are leaving after foundation training. NHS performance is dropping off in existing levels of service, even before trying to expand services.

The communications on the doctors’ side have also been imperfect. Whilst a team of government PR professionals has pumped out a small number of simple, repetitive mantras, the BMA has failed to explain in equally clear and simple terms a few key issues. For example: why the contract is “unsafe for patients” and “unsafe for doctors,” or why doctors would be striking to stop a contract that the DH says will increase their pay and reduce their hours, or why the contract discriminates against women, or that doctors and the urgent NHS already work at evening and weekends. The public respect and support for doctors is in spite, not because of the messaging.

Even as I write, the Department of Health has shown, yet again its childish tendency to re-escalate the scrap like a child forced to apologise, but doing so grudgingly, saying “the small number of remaining issues”, in response to the BMA’s statement agreeing to re-enter talks with a broader range of issues than merely Saturday pay.

I understand that the government wants resolution, with the Brexit Referendum to come and support for doctors holding up, despite the strikes. I can’t see any way that five days of talks can resolve the bigger issues the BMA want to discuss around gender equality, the catastrophic medical workforce crisis, or NHS funding gap. I can imagine some resolution over the plain time, Saturday pay, and unsocial hours issues. Even here, the BMA will put it to a members’ ballot which in the current febrile mood may reject any agreement they broker.

If an agreement is made on pay, then the spin will start all over again: “we told you it was about pay all along and we have stuffed their mouths with gold.”

This would prove a pyrrhic victory for the government and its friends in the press. Once the chaos hits the service from unfilled posts, rota gaps, and plummeting morale, once other NHS workforce groups start to mobilise over similar issues, once it becomes apparent that a service already facing huge workforce and funding gaps can’t possibly be stretched further to deliver a vague manifesto promise unaccompanied by any costed, risk assessed implementation programme, the government will be at least as big a loser as the BMA.

Although this battle has been played out in soundbites, corporate communications and political spin, it is about real services affecting real patients and requires a real workforce with real working lives.
You can’t run a health service on soundbites.

David Oliver is a consultant physician in geriatrics and general medicine, a former Department of Health National Clinical Director, visiting professor at City University, a Kings Fund Fellow and President of the British Geriatrics Society. He writes the weekly “Acute Perspective” Column in The BMJ.

Competing interests: None declared.