Jeremy Hunt has made a big deal about getting tough on junior doctors.
The Health Secretary has repeatedly said that after years of failed negotiations with the British Medical Association the time has come to impose new contracts setting out new working hours.
And junior doctors are angry. So angry that they are about to take part in the first all-out strike in NHS history and have taken the Health Secretary to court over the imposition of the contracts.
It has now emerged that Mr Hunt will not impose the contract on those with existing NHS contracts, but instead new doctors will be subject to the new contract from August.
Existing doctors will move on to it as and when they move jobs within the NHS or to a different trust, not before.
Labour’s shadow health secretary Heidi Alexander has accused Mr Hunt of giving the impression he was “going to railroad through a new contract” but was in fact just “making a suggestion” about how new contracts would be implemented.
When emotions on the issue are running very high this all hangs on language – that “impose” is very different from “implement” or “introduce”.
Ms Alexander says that Mr Hunt’s “rhetoric, underpinned by misplaced bravado and bullishness, is the real cause of the strike”.
So has the Health Secretary misled the doctors over their new contracts?
6 July, 2015
The first public, recorded reference to Jeremy Hunt saying he will “impose” doctors contracts, rather than “introduce” them, appears to come on 6 July, 2015 in a speech at the Kings Fund.
This is not in Parliament, but it is an unequivocal promise that if the BMA will not negotiate contracts will be imposed on junior doctors.
“There will now be six weeks to work with the BMA union negotiators before a December decision point but be in no doubt – if we can’t negotiate, we are ready to impose a new contract.”
16 July, 2015
In his written statement to the house on doctors’ pay 10 days later, his language is a little less strident.
However, the Health Secretary talks explicitly about changes not only to the contracts applying to new consultants but also the roll-out to exiting consultants.
He says he is talking about the “implementation of new terms for new consultants from April 2016” but also plans to move “existing consultants across by 2017”.
At this stage he avoids the word impose but says “we will take forward change, in the absence of a negotiated agreement”.
28 October, 2015
During the opposition day debate Mr Hunt explicitly links the imposition of the doctors’ contract to achieving his party’s “manifesto commitment” for a seven-day NHS
He tells the Commons he did not and does not “seek to impose a new contract” but a manifesto commitment to a seven-day NHS means he would “ask trusts to introduce new contracts if we were unable to succeed in negotiations”.
30 November, 2015
The first recorded instance FactCheck could find of Jeremy Hunt specifically refering to his “threat” of contract imposition in the Commons is on November 30, 2015.
In response to Heidi Alexander, the shadow secretary of state for health, Mr Hunt said: “The hon. Lady has repeatedly called for the Government to remove the threat of contract imposition. Let me tell her why we cannot do that.”
17 November, 2015
By November Mr Hunt appears to have changed his language again. He does not say “impose” but instead he promises to “implement a manifesto commitment” – in this case the commitment to “seven-day reform”.
On the same day, in topical questions, he repeats the same line of reserving “right to implement our manifesto commitment to seven-day reforms if we fail to make progress in the negotiations”.
9 February, 2016
On 9 Februarythis year, during health topical questions in the House of Commons, Mr Hunt appears to repeat his intention to impose doctors’ contracts.
“The Labour party is saying that if a negotiated settlement cannot be reached, we should not impose a new contract— in other words, we should give up on seven-day care for the most vulnerable patients. There was a time when the Labour party spoke up for vulnerable patients. Now it is clear that unions matter more than patients.”
11 February, 2016
The day after the second 24-hour strike it was expected he would use a surprise a Commons statement to announce he would force the new contract on doctors.
In the actual statement to the house mention of imposing, compelling or forcing doctors to take contracts was lacking. The language appears to be precise – talking about “proceeding with introduction” rather than blanket imposition.
He told the Commons he planned to “end the uncertainty for the service by proceeding with the introduction of a new contract”.
Labour constantly questions Mr Hunt on his plans to “impose” a contract. Although Mr Hunt does not say he plans an “imposition” he offers evidence to challenge Labour’s question about “whether there was support for imposition”.
Although Mr Hunt argues this is not semantics.
18 April, 2016
After questions overnight over why official government legal advice was using the term “introduction” rather than “imposition”, Mr Hunt clarified his position today.
He says it has always been government policy to use the phrase “introduction of new contracts” not imposition, however, the above examples show he has moved between the two descriptions and offered little clarity both inside and outside of the house.
However he unequivocally told the Commons: “Yes we are imposing a new contract, and we are doing it with the greatest of regret.”
Verdict:
Mr Hunt has been very guarded in his use of language around imposition versus introduction of the doctors’ contracts – despite making a high-profile, widely reported vow to impose them if the BMA would not play ball.
He cannot have been unaware about how this language was playing out in the wider junior doctor debate – and we can see he was repeatedly and aggressively challenged over his use of language by the Labour shadow health secretary and others in the Commons.
Mr Hunt says this is not semantics, but when his careful use of language is explicitly laid out as above, it is hard to see it as anything else.
The fact is there is little difference between imposition and introduction from a junior doctor’s point of view.
Most junior doctors move employer once a year and sign a new contract, so it would not take long to transfer most of them to the new contract with or without “imposition”.
It’s very much semantics but there are other misleading aspects to Mr Hunt’s comments and statements:
Despite his bluster on the floor of the House of Commons, and the attempt by the DoH to shift from “impose” to “introduce,” the fact remains that they will try to force through the new contracts in August of this year.
To suggest to the public that the new contract will only be “introduced” for junior doctors as and when they change jobs is utterly misleading, given that ALL doctors undertaking postgraduate foundation and specialty training change jobs in a frequent basis: most rotate into new posts at least once per year and some are required to move hospitals with every six-month post (or even every three months in extreme cases).
Each move to a different hospital usually requires that a junior doctor is then employed by a different NHS Trust and therefore has to have a new contract. As the majority of junior doctors change posts at the start of August each year then, if the new contract is “introduced” it is effectively being constructively imposed across across the profession (and those who don’t change jobs in August will move in October, at which time the same will happen to them too).
Throughout, Mr Hunt has relied on spin, semantics and very carefully misrepresented facts in order to push his case to the public.
He must be challenged on this and yet he carefully avoids interviews, relying instead on oblique pronouncements via Twitter. This is no way to deal with committed professionals or the British public.
The doctors concerned are not ‘committed professionals’ – they are workers striking over wages and conditions.
Committed professionals don’t strike. Its what it means to be ‘professional’.
Committed professionals also need to be treated as such, valued, and have their opinions listened to. Jeremy Hunt is presenting this as his concern about patient safety at weekends versus the doctor’s concern with their terms and conditions. The reality is that the junior doctors know, not just the impact this will have on them as individuals, but how this will actually affect staffing and the safety and sustainability of the service over 365 days of the year. They see disaster. None of them will want to disadvantage their patients, but they do also have a wider professional responsibility that goes beyond individual patients. Jeremy Hunt should recognise this too.
Wow! Well what a narrow view of professionalism that is. So there is nothing more to it Hugh: a professional simply does what the state tells them to do without question? Forget commitment to the profession (colleagues and patients), commitment to the state is all that counts! Well I’m that case, thank God we’re not doctors in Nazi Germany!
This is a lot simpler than has been portrayed. Simply put, Hunt wants a ‘7-day NHS’ and plans to achieve this with no extra funding and no extra staffing. He plans to stretch the current workforce (which already can’t cover the Monday-Friday rota) more evenly over the 7-day week. So, in essence, he’s going to cut Mon-Fri staffing (which is already inadequate) to improve weekend staffing (which will be slightly better, but still inadequate). Meanwhile, due to cutting nursing bursaries, hiking university fees, & making it harder for staff trained overseas to come to the UK; the NHS recruitment crisis is worsening by the day. It is a matter of time before the NHS cracks under the pressure, at which point Hunt would have achieved his real goal: the destruction of nationalised healthcare. If you look forward with glee to an insurance based healthcare system where poor people have to set up justgiving pages so they don’t die, then continue in your apathy. If you don’t, then get political.
It’s not complicated. The Government continues to trumpet the country’s financial stability (see latest Balance of Payments deficit from the Treasury) and international influence, however it’s beginning to run out of public assets to sell – only pensions (see Treasury attempt to raid Local Government pension pot to fund HS2), personal savings and the NHS left. Ah, ideology…..
Believe same King’s Fund speech also said that new contract would be brought in for new doctor’s and existing contracts would not be changed.
A contract without agreement has no merit . Mr Hunt seems intent on a pyrrhic victory .
I wish C4 Factcheck would lay out the proposals of both sides in this dispute. Why is Mr Hunt attempting to fulfil a manifesto commitment to a 24×7 NHS only by changing junior doctors’ T&Cs? Are no other NHS workers needed?
Exaactly what is it the JDs &BMA are objecting to? More money? Shorter hours? Shift work?
Why is the NHS in such a mess, despite all the taxpayers’ money that has been poured into it by successive governments? Is it under-resourced, under-staffed, or mismanaged?
Less than 37% of the electorate voted for the Tories at the general election. Jeremy Hunt should not be allowed to get away with claiming that the he has the the support of the ‘British people’ to impose a controversial contract on the junior doctors arising from the Conservative’s election manifesto proposal for seven day working in the NHS. A parliamentary majority is one thing, a national consensus is something different altogether.