4 min read

Editorial Thursday 19 May 2016: Churchill conciliation in junior docs' strike, financial chaos & STP WTF (Business As Usual mix)

Pyrrhic victories all round in the 'junior' doctors' dispute. The deal on offer, recommended by the BMA, looks like some tweaking of pay rates at the margins (it's still cost-neutral overall). It turns out that, in Churchill's dictum, "it is better to jaw-jaw than to war-war".

Oh, and the BMA have 'won' invitations to sit on some committees. As victories go ...

It remains to be voted on by the BMA's members, not a few of whom are pissed off to such depth that little conciliation seems acceptable or probable.

So what's the result of this unedifying, poorly-handled shitfight?

Both sides are split. Both sides have won. Both sides have lost.

Jeremy Hunt is, as I've previously noted, three health secretaries for the price of one. Good Jeremy is patient safety Jeremy. He's comprehensively pissed off the next generation of the medical workforce, to the point of full strike action. As The Don rightly said, "it is not a formula for success in this country to be in conflict with the people that will make up the workforce of the future". Epic fail.

Waffly Jeremy was at his worst in the dispute with his partial representation of the statistical evidence, to which Meacock, Sutton and colleagues so notably added. He was not lying when he told the health select committee "I'm not an academic".

We are, unfortunately, living in a post-truth political era. The bullshitisation of evidence is a battle we might not win, yet it's one well worth fighting.

Professor Nick Black's Lancet editorial is a particularly worthwhile read, especially the line "jumping to policy conclusions without a clear diagnosis of the problem should be avoided because the wrong decision might be detrimental to patient confidence, staff morale, and outcomes".

Political Jeremy told HSJ his current role "is likely to be my last big job in politics". Ahem.

He failed to sway opinion polls towards the Government's case, and had to U-turn on his fixed decision that "the matter is closed" over new negotiations.

Oh no it wasn't.

So what did Jeremy Hunt win? A cost-neutral settlement. Peace - or at least the end of strikes - in our time (that time being the Conservative Party's self-inflicted referendum on our economically beneficial and NHS workforce-critical EU membership).

He lost more than he won.

Hey, that's politics.

As for the BMA, what can we say?

Dear oh Lord.

(I'd kick the BMA's tyres, except you learn nothing at all by kicking tyres, and simply show anyone experienced in the motor trade that you're completely ignorant about cars.)

Just as there are multiple Jeremy Hunts, so there are multiple BMAs: the secretariat, the professional committees, council ... all at each other's throats and groins, to lesser or greater extents.

However, the real split in the BMA is between its functions as a membership organisation and as a political trades union. That's quite a tension. Smart BMA leaderships of yore were able to hold the sides of that fundamental fissure together. Those were, if not the days, then at least days.

As a membership organisation, the BMA has unambiguously lost. The recommended deal is at best a marginal improvement on the set-to-be-imposed contract. For some, it's inevitably worse. The inevitable political myth of betrayal must be doing the rounds on secret Facebook pages and Snapchat by now, surely?

As a political trades union, the BMA has won a conditional and Pyrrhic victory. Its members can still vote down this deal. If they do, the BMA is political history.

Yes, they have given the Government a bloody nose and forced a U-turn on negotiations. They haven't got a substantially better deal. And they have a mountain of rhetorical shit that they poured all over the Government, through which they now have to wade to regain some influence.

Another such victory would surely undo them.

Political football's the winner.

Meanwhile, HSJ thinks the NHS is in the financial shit to the tune of £2.7 billion for 2015-16, and the new Kings Fund QMR data shows that nearly two-thirds of NHS trust finance directors and more than half of CCG finance leads say the quality of patient care in their area has deteriorated over the past year.

As ever, the iridescent John Appleby, Richard Murray and Anita Charlsworth put this into succinct and scary context.

'The money is fucked' is not exactly 'man bites dog', is it? We have seen this coming from a long way off. Those who allowed this financial crisis to hit will be held to account in due course.

What else is new?

Ah yes: Kingsley Manning used his exit from the HSCIC to let the NHS know that its former resident chilled-out entertainer David Brent-alike Tim Kelsey was a bit of an impediment in terms of "delivery, detail, breadth of understanding of the practical reality of delivery".

So that's everything about his job, then.

TK Max, an impediment! You don't say, Kingsley? But to be fair, at least you did say, right at the very end. Loads of others knew this (and more), and did nothing. Those who allowed this to persist will be held to account in due course.

In a wide-ranging interview with HSJ, NHS England's Sun King Simon Stevens mulled the introduction of combine harvesters. Oh no, sorry, it was "combined authorities", or as it's properly known, 'a top-down redisorganisation without primary legislation'.

Le Roi Soleil Stevens also discussed "safe harbours", which sound wonderfully reassuring until you read his actual words. "When we have these agreed shared plans for how different parts of the country will need to evolve, I think NHS Improvement and ourselves would like to find a way of creating a safe harbour for the leaders who are going to drive that process”.

'Would like to find a way of creating' isn't anything I would call a guarantee. It's very much not, in the headline's word, a promise.

Still, let's cheer ourselves up by looking at all the oodles of transformation money. Whooppee! Don't spend it all at once!