These are difficult times for the NHS.
As bit by bit it is sold off or rented out to record companies or overly stylised investment groups, and clinical need is transformed into a series of exciting business opportunities, one thing has become clear: winning arguments about patient safety, care quality or the ethics of service provision doesn’t matter much. Nobody in government is even pretending to listen, which apart from being rude betrays a confidence that is as frightening as it is obnoxious.
The junior doctors are probably one of the most articulate groups of professionals a government can pick a fight with. So to get around this mismatch in reasoning, the health secretary has opted for the unusual and unedifying tactic of putting his hands over his ears and shouting “La la la la, I can’t hear you” loudly and then looking a bit dizzy.
Despite this the doctors have continued to behave as though they are in a grown-up conversation in which facts and old-fashioned things like clarity might resolve issues. The naïve fools! They have made it clear that they are defending patients and their capacity to do their job. All to no avail. It seems as though this cabinet sees the NHS as the centrepiece of what they revile as the nanny state. Ironic really, given they are all the types of boys who had nannies.
And so one wonders, what are we to do? Well at the risk of being called a cynic it is hard not to imagine that if the government imposes a contract on doctors, regardless of patient safety, it will almost certainly turn its attention on a more compliant and larger nursing workforce next. And one imagines that attention will amount to two things: first, a further assault on pay; despite a five-year pay freeze and a 14% pay cut in real terms over that period, a government that is riding roughshod over medicine will see an accountancy opportunity far too good to ignore.
Second, it will pile more pressure onto nursing teams, services and nurses who are already at breaking point. This remains for me the hidden crisis of the current assault. Not hidden to those nurses of course, or their families, friends or even their patients. But hidden to the accountants, to policy makers and the media.
I don’t know a nurse who is not supportive of the doctors, and I know that legislation or the threat of it unnerves unions and professional organisations in exactly the way it was designed to.
But what if this is the last line in the sand to be drawn? What if this move, which is obviously about restructuring the expectations of the workforce, is the last clear stance to make? Can we afford not to make it?
I don’t know what stops every health union in the country coming together and forming a coordinated, united and resolute defence of jobs, services, standards and staff. I don’t know if they try but can’t agree on language, strategy or biscuits. I don’t know if they cling to the defensive and self-defeating idea that insular and professional self interest is their defining rationale. Or perhaps the modern world, with its anti-union legislation and threats of sanctions make doing the right thing simply too hard.
But if there is a time to find a way to work together, it is surely now. It seems to me that whether it be junior doctors or student nurses making a stance against the imposition of tuition fees, they are doing it because it is their turn to be attacked. And it will be someone else’s turn soon. First they came for the doctors? Let’s face it, they are coming for everyone.
Mark Radcliffe is senior lecturer, and author of Stranger than Kindness. Follow him on twitter @markacradcliffe