To those, like me, who lived through the miners’ strike in South Yorkshire in the 1980s, it’s clear that the then prime minister Margaret Thatcher was driven by hard ideology and harder economics rather than, as retrospectively claimed, that she championed climate action. The end of the slave trade was driven by hard economics more than the principle of ending slavery. Indeed, slavery continued for decades afterwards. The lesson here is that, apart from exceptional cases, the political world of power and privilege invariably dances to an economic tune.
A year into the UK doctors’ strikes the conclusion is the same (doi:10.1136/bmj.q591).1 No endgame is in sight, because however much the government might have agreed or disagreed with the demands for pay restoration it had no intention to settle (doi:10.1136/bmj.q600).2 A government shedding support of voters has regressed into austerity economics and ideological straitjackets. How else should we interpret a succession of health ministers refusing to negotiate meaningfully with “junior” doctors (a term that undoubtedly needs its own endgame). Whether any future government, exposed to the realpolitik of ruling, will be more receptive is yet to be seen.
The miners of the 1980s, led by Arthur Scargill, were portrayed as militants making unreasonable requests. The ones I knew endured harsh working conditions and sought to preserve family and community lives on a barely passable wage. Lives and livelihood. It suited the government to present these working class people as trade union militants and to beat them up on picket lines. The endgame was the destruction of the National Union of Mineworkers and the coal industry. A few years later, by the time I was at medical school with Scargill’s daughter, the union was little more than a rump.
The medical profession isn’t so easily destroyed. Any futurology centred on the advance of technology and artificial intelligence retains a central role for doctors, albeit an evolved one. The demand for healthcare, unlike the demand for coal, is ever increasing. Any political calculation that doctors would lose public support to the extent that strike action would cease hasn’t been fulfilled. The government’s own credibility is shot to pieces as its policies deepen inequalities and poverty (doi:10.1136/bmj.q571),3 and its moral hypocrisy over Gaza allows more deaths and destruction of health services (doi:10.1136/bmj.q519 doi:10.1136/bmj.q123).45
The health system, however, is damaged. Hospital doctors of all grades are embroiled in pay disputes. General practitioners are angered by their new contract offer (doi:10.1136/bmj.q603).6 The botched expansion of physician associates is creating divisions (doi:10.1136/bmj.q589 doi:10.1136/bmj.q618 doi:10.1136/bmj.q634 doi:10.1136/bmj.q616).78910 The latest NHS staff survey reinforces the state of staff dissatisfaction (doi:10.1136/bmj.q588),11 encompassing sexual harassment and racial discrimination (doi:10.1136/bmj.q590 doi:10.1136/bmj.q605).1213 The attractions of working less than full time were never more powerful, further depleting the workforce (doi:10.1136/bmj.q358).14 Why do economically obsessed politicians continue to ignore the evidence based maxim that a healthy workforce produces a healthy population, which in turn delivers a healthy economy?
The endgame cannot be about pay only. Huge personal debt, limited training opportunities, uncertain career progression, erosion of team working, and a loss of a sense of belonging (doi:10.1136/bmj.q392) are all major contributors to discontent.15 They must be resolved. Looking wider still, it is the professional status of doctors—taking in the science, ethics, and conduct of good medical practice—that has always made it hard for politicians to negotiate with medical professionals (doi:10.1136/bmj.h502).16 Governments can ignore the working conditions and demands of doctors as readily as they once ignored the working conditions and demands of miners, but doctors cannot be done away with so conveniently. The endgame for industrial action, when it comes, must consider all these elements. Perhaps this is why the endgame, one year on, seems no nearer.
