UK National Health Service Doctors: To Quit, or Not to Quit?

This month, British junior doctors are staging the first full walkout strike in protest against a new work contract that is unsafe and unfair; a contract which will have predictable detrimental effects for both patients and doctors. In February this year, the UK government made its position concerning the ongoing junior doctor contract dispute quite clear: Jeremy Hunt, the secretary of state for health, announced that the Department of Health will “impose” the unfair and unsafe new contract, despite nationwide uproar from frontline doctors like me.

It is becoming increasingly obvious to UK doctors that National Health Service (NHS) managers are speaking in the interests of neither its patients nor its staff, but rather the private sector and all those who support it. In the words of Ian Syme, from North Staffordshire Healthwatch: “The evidence is stacking up that NHS England have a privatisation agenda and NHS England are at the moment privatising the NHS by stealth.”

What Choices Do We Have?

Any conscientious doctor will be unable to happily work for a health system that is being systematically underfunded and undermined as it is sold, piecemeal, to the private sector. So what choices does a doctor of conscience have?

We have two choices. The first option is to quit. This is no small move for professionals who have dedicated years tothe NHS, but it is the easier option. Surveys suggest that more than 70 percent of doctors are considering this option right now, leading shadow Health Secretary Heidi Alexander to call Jeremy Hunt”the recruiting sergeant” for the Australian health service. Quitting will be the option chosen by doctors acting solely with their individual interests in mind, since it will free them from the morass of the current contract fiasco, without helping to address the root problem.

The second option is to resist. This is the braver and more difficult option of the two. What would resistance look like? It would require collective action — a unified movement leading to the only one possible outcome that we could fairly describe as a victory. Namely, we must demand that the government openly commit to the one and only principle that can save the NHS: that our health service should be publicly owned, publicly run and publicly accountable.

What Jeremy Hunt, the Department of Health and the managers at NHS England forget is that while they can talk of “imposing” a contract on us, the truth is that it is us NHS workers who actually wield the real force here. We are the NHS, and our labor is what drives it. We do not have to take the Department of Health’s announcement of “imposition” as the final word here. They can threaten us, they can misrepresent us, but what the government cannot do is run the service. Those of us brave enough to choose to resist the privatization agenda being imposed on us must stay united, stay strong and stay confident in the knowledge that we have the public on our side and the power in our hands.

Bad Strikes, Good Strikes

We should be more cognizant of the efficacy of strike action, since UK doctors have successfully threatened to strike before. In 1948, when the NHS was formed, senior doctors were concerned that they would earn less working for the NHS than working in their private clinics. Aneurin Bevan, the minister of health who spearheaded the establishment of the NHS, was facing the threat of industrial action from the British Medical Association (BMA) in response to the proposed NHS salary schemes. The result of this conflict was the infamous “Consultants’ Contract,” which allowed NHS consultants the right to do private work alongside NHS work.

Thus, it was strike action by the BMA that first opened up the NHS to private interests. Could it now be used to fight it off? Our generation of doctors now has the opportunity to make good for the BMA’s past sins. We can use strike action — a tactic employed by our forebears at the birth of the NHS for selfish reasons — for the common good, toprevent the NHS meeting its demise.

Inspiring a Movement

Could the current cohort of junior doctors pull off such a feat? I think the answer is yes. Our generation is quite different from the one that struck for selfish motives. The medical workforce is much more diverse now, in terms of class, gender and race. This means we resemble the public more than we did, and so are more likely to act in the public’s interests. But this is only possible if enough doctors of conscience remain in the country to throw their weight behind the movement.

In short, junior doctors could save the NHS, but it will require us, en masse, to choose option two: Resist. Only through ongoing strikes — perhaps triggering a series of other strikes and protests by nurses and other health workers, uniting in opposition to the destruction of the NHS — can we force the government to put a halt to privatization. In Peru, El Salvador and Portugal, what started as doctors’ strikes inspired entire nations and became broader movements involving all types of health workers, rising up to resist neoliberal reforms. Could the same happen in theUK? The choice is ours.