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Editorial Wednesday 13 January 2016: On negotiating

Fingers crossed, yesterday's non-emergency junior doctors' strike has apparently passed without significant incident. There has clearly been minor silliness at Sandwell, but generally speaking, the planned consultant cover has gone safely and well.

The fact that this dispute about pay, terms and conditions has even got to the point of a strike should shame both sides.

Pay, terms and conditions
I am not going to launch into the charged dispute about seven-day working and avoidable harm. There is peer-reviewed evidence on both sides of the debate, from Rachel Meacock and colleagues' paper in Health Economics to Bruce Keogh and colleagues' work in the BMJ.

Obviously, I'm not going to mention the reproofs from BMJ editor Fiona Godlee and the U.K. Statistics Authority to Jeremy Hunt for his selective use and presentation of data to make the case for seven-day services.

The point here is whether or not junior doctors' contracts are changed, they are critical but not by themselves sufficient parts of the hospital system and infrastructure if we want seven-day service in hospitals.

We need seven-day pathology, portering, haematology, reception, IT support, facilities maintenance, sterile services, patient transport.

To say nothing of seven day discharges to intermediate and social care that don't exist.

Rostering and fostering good relationships
The case for changing junior doctors' contracts is an intriguing one. Experienced chief executives have suggested that the fact certain trusts do not appear to have issues with junior doctors' staffing at weekends is not due to their having different contracts, or indeed different junior doctors.

These people suggest that there are technical skills around successful rostering, which are less widespread than they should be.

There is unquestionably an issue about providers who have good and mutually flexible relationships with their clinicians, and providers who do not.

Experienced CEs are also telling HSJ they believe the new contract is unaffordable, but that's a different matter.

A farewell to goodwill
Perhaps the more pertinent point in the comments made anonymously to HSJ is that the new contract may be not only unaffordable in financial terms, but also in terms of the hard-to-measure, impossible-to-replace goodwill and staff morale.

The NHS has always run on goodwill. The next NHS staff survey will make interesting reading.

As I say, at the core, this issue is about pay, terms and conditions.

On negotiation
It would be nice to be able to say that the two sides of this dispute have shown adult, altruistic, mature, reflective, shrewd and smart judgments during the course of this dispute so far.

It would also be a blatant, monumental fucking lie. So, as is my wont, I won't say that.

Both sides should be (but don't seem to be) really pretty ashamed that this dispute has got to this point. It didn't need to. The two sides just needed to be any good at all at negotiating.

But they're not. Not even slightly.

The data from the Ipsos MORI polling for HSJ and Newsnight showed that the arguments from the Government's side (that this is about seven-day working) and from the junior doctors and BMA's side (that this is about patient safety) have both failed to cut throough to a majestic degree.

To quote this Ipsos MORI analysis, "When asked why junior doctors are planning to strike, pay and working conditions feature highly. The most commonly mentioned reason is long working hours (46%), followed by pay generally (27%) and because junior doctors specifically are poorly paid (24%).

"Very few mention issues regarding the safety of patients (2%) or healthcare staff (1%), showing that public understanding of the reasons for the strikes are limited to the issues affecting doctors’ pay and conditions, rather than the potential ramifications on standards of healthcare".

How to negotiate: a learner's guide for doctots and politygmies
1. Can you burn your negotiating partner?
If your negotiations don't go as you want them to, do you have an alternative option (be they purchaser or provider of skills) available at a price you can afford?

If the answer is 'yes', then your negotiating hand is strong. It might not be, of course. In which case ...

2. Do you have an option never to deal with your negotiating partner in future?
This is partly about the first question above, and also partly about tone. Which leads to ...

3. Can you communicate your case simply, clearly and effectively, such that non-NHS geeks can understand it?
It's mildly tragic that this even needs to be said, but so remedial has been both sides' peformance that it does. Here you go.

4. Do your stakeholders understand that you will get some of what you want, but not all of it?
As above. Hard to believe I even need to type this, but I do.

5. Can you win your victories without gloating, and lose your defeats without whinging?
See my comments of point four.

6. Have you behaved graciously, and in such a way that your negotiating position can alter without loss of face as circumstances require?