The decision by junior doctors to back strike action is brave and the offer to talk through the mediation service Acas is wise. The strike weapon needs to be used as late as possible in any fight.
We find ourselves truly in a dramatic situation.
The NHS is under attack as never before. Rolling back the state is already hitting the poor and ill and vulnerable and will continue to do so. Now it is the turn of the middle class. We shall not see the 1% attacked in the same way.
This is part of a larger picture which is being played out quite openly, but wrapped up in spin. Just months before announcing huge cuts in income for working people through tax credits, prime minister David Cameron's party conference speech spoke of 'working people backed because of us…the NHS safe because of us…', and talked of tackling the 'scourge of poverty'.
Health secretary Jeremy Hunt's claims that seven-day working could save lives have also been called into question. And, more recently, his claim that in only 10% of hospitals are patients seen by a senior doctor within 14 hours of being admitted at a weekend - according to analysis by The Guardian the true figure is more like 80%.
We in Lewisham are familiar with these uses of semantics and statistics. The trust special administrator (TSA) that tried to shut down Lewisham Hospital used great phrases to paint a positive picture, while at the same time creating a data smokescreen. Sections of the population were not mentioned at all, even though services for them were going to be cut. Population figures were inaccurate. Key people were excluded from discussions if their views clashed with those of the TSA.
These Humpty Dumpty uses of meanings belie a stark process.
In 2012 the coalition government introduced a reform of NHS pensions, ending the final salary pensions that previously made NHS employment such an attractive option for doctors.
Since 2010, health workers’ pay has declined by over 12% in real terms (while MPs' salaries have soared). As the Royal College of Midwives (RCM) wrote recently: 'Protecting working conditions is important because midwives’ and maternity support workers’ working conditions are women’s birthing conditions.'
The RCM was giving evidence to parliament on the Trade Union Bill, another part of the assault. If the Bill becomes law, industrial action by health workers would require a 50% turnout with at least 40% of all those eligible to vote, voting 'yes'. Abstentions would be effectively counted as ‘no’ votes.
Although the doctors in training vote well passed these thresholds, the Bill would significantly curtail the right to strike for health workers. The Bill also threatens facility time - paid release for trade union duties - which include health and safety. This point is discussed in detail in a piece on the Open Democracy website.
And now, NHS England is suggesting that GPs may not need a pay rise, rejecting arguments by the BMA that GPs have been 'unfairly punished' by low funding awards in recent years. This is when the total health budget spent on primary care reduced for the third successive year in 2014/15.
The spending review will show us to what extent the Tories really are the friends of the NHS they claim to be. We will find out more about how the £3.8bn uplift to NHS funding in 2016/17 will be distributed.
So, here we are. General practice and the rest of the workforce in the NHS under attack. Social care in imminent crisis. Rights and pay under threat. Safety challenged. The denigration of the NHS workforce being a key part of the mood for a strike.
Austerity is a political choice, not an economic necessity. And the political choice demonstrated by the policies listed here seems clear. It is to downgrade the NHS until it is seen as impossible to fund through our collective taxes. Too degraded, too unsafe, too demoralised. Until it needs to be privatised like the USA or insurance-based like Europe.
Then general practice will be heading the way of dentistry. We are next - should we get ready to strike, too?
- Dr Brian Fisher is a semi-retired GP in south-east London and honorary vice-president of the Socialist Health Association. This column is a left-wing primary care perspective on health, social care, public health and healthcare – issues that matter to us and our patients. Some contributions will be from other authors. We hope to offer solutions as well as highlight problems.
Photo: Dan Wootton