Let's all join Northern Ireland's doctors to defend the health service
Hundreds of junior doctors will gather in Belfast city centre on Saturday as part of a campaign to defend the health service from attacks by the Tories. They have appealed to members of the public to join them.
The immediate issue has to do with attempts by UK Health Minister Jeremy Hunt to impose new contracts on the 53,000 junior doctors in England.
The Scottish parliament and the Welsh assembly have both rejected Hunt's proposal. But the current chaos at Stormont and the absence from post of Health Minister Simon Hamilton, means that there is no clarity on whether Hunt's measures will apply here.
Spokesman for the 1,500 junior doctors in the north, Dr Michael Moran, said: "In the absence of strong leadership and of opposition to the new contract, it seems likely that Northern Ireland will shortly follow in England's footsteps."
This would be par for the course. Until now, the north has more or less automatically followed London decisions on health service policy and pay.
The term "junior doctor" is something of a misnomer. It refers to qualified doctors who have not yet become consultants - a process which, in some instances, can take 10 to 15 years: cardiac surgeons and gastroenterologists are cases in point. Junior doctors are the bedrock and mainstay of the health service.
At present, the doctors' basic hours ("plain time") are from 7am to 7pm, Monday to Friday. Hours in excess of this on a weekday, or over the weekend, are paid at a higher rate, the premium varying from 20% to 50%, according to workload. Hunt's scheme redefines plain time as running from 7am to 10pm, Monday to Saturday.
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Junior doctors are currently entitled to a half-hour break every four hours. Hunt wants to reset the entitlement to 20 minutes on an 11-hour shift in "normal" circumstances." The doctors dismiss suggestions that this won't damage patient care.
Parents who take time off to look after children will no longer receive pay rises awarded in their absence. They will return to work worse off than their colleagues.
All this against a background of junior doctors, like other public service workers, having had to take a real-terms wage cut in recent years - pay down by just over 20% since 2009.
It is an indication of the sheer unfairness of the Tory proposals that the doctors, even as they contemplate balloting for strike action for the first time in 40 years, have won remarkably wide support.
The presidents of 11 of the Royal Colleges responsible for medical training and standards of patient care have come out publicly against the contract.
Just as significant has been the scathing intervention of Tory MP and former health department minister, Dr Dan Poulter, in an article in the Guardian last week.
The Ipswich MP, who himself worked as a junior doctor for 10 years, declared: "It is impossible to reconcile these excessive working hours with safe patient care."
The key to understanding Hunt's thinking, Poulter suggested, is that, in order to meet Government spending plans, "efficiency savings" of £22bn will have to be found in the health service during the lifetime of this parliament: "Most of the low-hanging fruit was picked between 2010 and 2015. So, reforming national contracts for doctors is perhaps one crude lever available to a secretary of state."
However, money saved by paying junior doctors less may be more than offset by premiums for outside locums needed to fill gaps resulting from staff shortages - due, in part at least, to disincentives to work in the health service.
Junior doctors commonly find themselves working alongside agency doctors being paid a multiple of their own earnings. In 2012, the public accounts committee at Stormont reported that "private sector recruitment agencies can hold trusts over a barrel in hiring locums to plug gaps... the committee was astounded to hear evidence of one particular instance where a locum doctor was paid almost three times more than a permanent doctor."
It is in the interest, then, not just of junior doctors, but of all who are dependent on the health service for care for ourselves and our families, that enough pressure is exerted to prevent the new contract being imposed on the north.
The rally at Belfast City Hall at 2pm on Saturday will be in solidarity with doctors across the water - there'll be a major demonstration in Westminster at the same time - and is intended to demonstrate public support for the health service and for the doctors fighting to protect it.
In his statement this week on behalf of the junior doctors, Dr Michael Moran concluded: "We appeal to other doctors, other healthcare workers and members of the public to join with us in protest before it is too late."