The debate about the future of the NHS is far from over

There was always a disconnect between what most of the frontline junior doctors working in the NHS thought they were fighting for and what the union thought it could extract from the Government

Junior doctors rejected the new deal struck between the Government and the BMA (AFP/Getty)

“You see, it was all about pay.” Two months ago these were the words on the lips of many a cynically satisfied commentator on the junior doctor dispute.

A deal had been struck between the British Medical Association and Jeremy Hunt. Then days later, private messages sent between the union’s negotiators revealed that, despite arguing publicly that this was a dispute about patient safety, for some of them pay really was the “only real red line”.

What to make, then, of the fact that the pay deal these negotiators struck with the Government has been rejected by the majority of rank and file junior doctors?

The truth is there was always a disconnect between what most of the frontline junior doctors working in the NHS thought they were fighting for – a safe and sustainable NHS – and what the union thought it could extract from the Government.

From the outset, the BMA accepted that the terms of the contract should be “cost neutral” for the government. Nor was there ever any demand that in order for junior doctors to accept more weekend working in pursuit of the Conservatives’ “seven-day NHS” agenda, the Government should commit to funding a medical recruitment drive to ensure the workforce wasn’t spread too thinly.

For grassroots junior doctors this was the fundamental contradiction at the heart of the contract offer – it was asking for more work from the same sized workforce.

Already over-stretched and worried for the safety of their patients, they dug in and fought hard. Everyone in this country who values the NHS should be grateful to them for doing so.

The BMA recognised their concerns, but having already accepted the rules of the game, tinkered with the detail and drew out the dispute for maximum gain, but forgot that at the heart of their deal was gaping hole: the NHS simply didn’t have the staff to deliver this.

The 58 per cent to 42 per cent rejection of the contract deal lays bare this contradiction. If junior doctors were not so tired of fighting an intransigent government, the vote against would likely have been even higher.

The vote is also an indictment on both the Health Secretary and the leadership of the BMA.

Mr Hunt will likely be moved on from the role once the new Prime Minister is in place. The BMA, if they want to save face, and be true to their members, must turn this industrial dispute into something broader – a national NHS staff-led campaign to get the health service the funding it needs to hire the extra staff required for it to properly fulfil its duty to patients, week day or weekend.

The Government’s charade of promising expanded seven day services without a single penny extra is well and truly over. It is time for the real NHS debate to begin.