Junior doctors’ anger can no longer be ignored

Supporting the right to strike is not a radical position—and health professionals aren’t easily radicalised. Yet 98% of junior doctors in England, people of all political hues, feel strongly enough to have voted in favour of strike action (doi:10.1136/bmj.p416).1 The turnout, a statement in itself, was over 77%. These numbers leave no doubt about the anger of junior doctors at their pay and working conditions. They are also likely to reflect a hardening of attitudes in response to the government’s unwillingness to negotiate and to media attacks on doctors for contemplating strike action.

Health professionals don’t agree lightly to strike; the recent nurses’ strike is an example. They don’t wilfully place patients at risk. On the contrary, what option remains if your work is persistently undervalued, working conditions place patients at risk because you can’t deliver the level of care the population deserves—and your training and conscience demand—but the government refuses to negotiate with you on a central issue of low pay?

Although the government has vowed not to negotiate, it must do so now. The grievances are genuine, and, when other UK nations are making more constructive noises (doi:10.1136/bmj.p339) (https://www.heraldscotland.com/news/23328424.nurses-consider-record-breaking-new-scot-govt-pay-deal),23 the stance of England’s politicians towards health professionals’ grievances and the population’s health is arrogant and misjudged. This must change. Avoiding the negotiating table, playing for time, and refusing to talk to one profession while talking to others is not political leadership in a health crisis. Political ideology is once more being prioritised ahead of the nation’s health and wellbeing.

The energy being applied to legislating to ban strikes would be better applied to ending the dispute with all health professionals. Instead, politicians are “going from clapping to sacking,” says Paul Nowak (doi:10.1136/bmj.p389).4 The right to strike is a freedom protected under the European Human Rights Act and international treaties, and any challenge to this right will inevitably be contested up to the highest courts.

At the same time, the list of sloganeering solutions to problems in the health services continues to grow. User fees, debunked by evidence across decades and geographies, are back in vogue (doi:10.1136/bmj.p303),5 as is a proposed crackdown on “fit notes” (doi:10.1136/bmj.p406).6 What these initiatives have in common is that they discriminate against people who are disadvantaged and make life harder for staff. In some parts of England, who would you pay a fee to, for what service, given that shortages have left 17% of GP posts unfilled? One community has produced a fetching YouTube video to persuade a GP to join their highly rated medical practice in a seemingly idyllic location (doi:10.1136/bmj.p397).7

In these days of absent political leadership, the role of medical leaders becomes essential. Clare Marx, the first woman to be president of the Royal College of Surgeons, was known for a leadership style that challenged “without being challenging” (doi:10.1136/bmj.o2972).8 That attribute will be of interest to Shubulade (Lade) Smith, a psychiatrist who becomes the first black woman to head a UK medical royal college (doi:10.1136/bmj.p381).9

Strike action does pose challenges for medical leaders in terms of how to offer support and to what extent. How might patient care and public trust be balanced against the rightful indignation of colleagues? For now, however, a simple leadership decision for all medical leaders is to offer their support to junior doctors, just as the public is doing (https://news.sky.com/story/junior-doctors-likely-to-go-on-strike-next-month-union-spokesperson-says-12802734).10