“Tired doctors make mistakes.” This slogan is being displayed on placards around England as junior doctors go on strike for the second time.
The 24-hour industrial action involves more than 160 pickets. Doctors voted for it after talks between the government and the doctors’ union, the BMA, broke down again last month.
Many of the strikers and their supporters are keen to get the message across that their grievances are about patient safety rather than just pay and conditions.
But will junior doctors be more tired under the new contract?
On the face of it, no. The government’s offer to junior doctors, set out in November last year, claimed that the new contract would limit unsafe hours.
Changes include a ban on scheduling shifts over 13 hours, limiting days or nights on call to seven, and preventing doctors from working more than four nights in a row or more than five consecutive long day shifts.
The absolute limit on hours would fall from 91 to 72 a week. Junior doctors would continue to work an average of 48 hours a week – as laid out by European law – or 56 hours for those who opt out of the working time directive.
#JuniorDoctorsStrike The alternative is an underpaid undertrained Dr who's been up for 20 hrs on caffeine treating my child in an emergency
— Sanjeev Bhaskar (@TVSanjeev) February 10, 2016
On paper, that sounds good for doctors, but the BMA expressed concern about breaks, and about how all these rules on hours would actually be enforced.
Specifically, the union was concerned that NHS trusts would not be hit with fines for breaching EU rules on hours, saying: “We know from our members that a penalty for employers who overwork trainees is the only effective way to make them plan safe rotas.”
This may have been a sticking point for a while, but it would appear that substantial progress was made – if statements by the government’s negotiators are to be believed.
On 4 January Daniel Mortimer, chief executive of NHS Employers, wrote that a system of financial penalties for trusts who abuse doctors’ working hours had been proposed.
He said trusts who breached working time protections would have to pay fines to a “Guardian” who would spend the money on “supporting the working conditions or education of doctors in training in the institution”. He added: “The BMA seemed unwilling or unable to discuss this major development with us.”
On 1 February the government’s chief negotiator Sir David Dalton said he had “reached agreement” with the BMA “on a majority of hours protections including rest periods”.
He added that the new “Guardian” system was “substantially agreed”.
Two days later, Sir David set out more detail in another letter: no doctor would ever be rostered to work on consecutive weekends; the maximum number of night shifts in a row would be cut from seven to four; maximum consecutive days would fall from 12 to eight.
In cases where trusts breached the rules, they would have to pay a fine based on four times the excess hours worked, some of which would go to the doctor who worked the hours.
“We have not been able to agree the level of the payment to the doctor,” Sir David said.
But crucially, he did claim that the government had “reached agreement” with the BMA on the broader package of measures to protect junior doctors from unsafe hours.
If that’s true, all those placards warning about tired doctors and patient safety must be redundant. According to the government, these are issues that have now been resolved to the satisfaction of the BMA.
We asked the BMA to clarify the situation and they told us: “We have definitely made progress in that area in the past few weeks but there are some points which are still to be agreed.”
Without being a fly on the wall in the negotiations, it’s hard to know what the real sticking points are. The BMA has made no secret today that it sees status of Saturdays as the main obstacle.
At the same time, the doctors’ union is not conceding that all the other areas of disagreement in these complicated negotiations have now been completely settled.
If it is the case – as the government claims – that earlier fears over unsafe working hours have now been allayed, this message has not trickled down to striking doctors on picket lines.
They are still telling the public, perhaps wrongly, that this industrial action is still at least partly about unsafe hours.