Time to end junior doctor stand-off

  • Niall Hunter, Editor

Amid the claims and counter-claims, the shadow boxing and step-dancing of industrial relations, it may be difficult for the average punter to understand exactly why hospitals must now cope with a junior doctor strike that will cause serious disruption to hospital services

The IMO, which is angry at the HSE's tactics in the dispute in recent days, has decided to turn down the offer of further talks at the LRC and the first in what could be a series of strikes is going ahead.

After reasonable progress had apparently been made in trying to reach a workable settlement on the excessive hours issue, the doctors' union is taking a hardline stance by turning down the chance to iron out a final agreement on reducing hours, claiming there was currently no basis for further discussion.

If doctors decide to carry through on their current stance, their tactics may ultimately work.

Yet in this particular industrial dispute, as one side tries to 'stare out' the other, it's patients who may suffer.

There's no doubt about it - IMO NCHD (junior doctor) members were quite justified some weeks ago in serving industrial action notice on the HSE.

They had clearly reached the end of their tether after nearly a decade of little or no effort on the part of the health executive to deal seriously with the ridiculous hours that hospital doctors had been forced to work.

This was a particularly egregious omission on the part of the HSE, given that it was breaching EU law in failing to reduce these hours.

The HSE clearly needed to be called to account to rectify this serious abuse of junior doctor's goodwill, health and work-life balance, and what was potentially a threat to patient safety.

The strike notice seemed to galvanise the health executive into action.

The prospect of being hanged in the morning tends to concentrate minds wonderfully, and significant progress towards ending excessive working hours appears to have been made in recent talks between the two sides.

Judging by the proposals drawn up to date, although the HSE version produced in recent days has been rejected by the IMO, the bones of a workable agreement seemed to be there. However, nothing is ever that simple in health politics.

A disagreement remains between the two sides on how hospitals would be sanctioned for exceeding a proposed maximum shift of 24 hours, and this a key issue on which the talks have broken down.

Yes, I know what you're thinking - any health system in which limiting doctors' shifts to a 24 hour maximum is regarded as a 'concession' is clearly certifiable, but at least the 24-hour limit represents progress.

The HSE has proposed sanctions that would hold to account health managers who did not strictly operate the shift limits, and penalise hospitals by withholding part of their budgets.

The IMO felt sanctions should include paying doctors extra for work done above the 24-hour shift limit. It also claims the HSE's sanction proposals are 'heavily qualified'.

The HSE for its part, regards the extra pay action option as unworkable; it says it might unravel the Haddington Road agreement.  It also believes that attaching such payments to the hospital payroll system could simply normalise future breaches of shift limits, and therefore not act as an effective deterrent.

It is easy to understand the junior doctors' anger but a little harder to understand their tactics at this juncture.

In addition to the technicalities in implementing working time limits, much of the current impasse also seems to boil down to the fact that the IMO simply doesn't trust the HSE, and who indeed would blame it for feeling this given the past history of this row?

The HSE does not have a great track record in implementing agreements. The much heralded 'deal' a year ago under which hospital consultants were supposed to work more flexibly has never been properly implemented.

The IMO is also angry with some of the HSE's recent tactics, in which the health executive appears to have been economical with accuracy in the 'spin' it put on the negotiations to date, and in which it made public the details of what was being discussed.

The IMO's hackles have been raised by the HSE's claim that junior doctors were looking for 'treble time' payments where 24-hour shift limits were breached - this turned out to be inaccurate - specific additional payments were sought but not to that level.

The IMO says it was also untrue for the HSE to say that the union side only raised the sanctions issue late in the talks, when the IMO says it had proposed sanctions at an early stage of the process.

Each side in any industrial dispute will send out the message they that they are more reasonable than the other side, resulting in a lot of tit-for-tat stuff that ultimately frustrates the public as a dispute continues. This row is no exception to the rule.

There is, however, a good deal of accuracy in the HSE's claim that significant progress has been made in talks to date despite the complexity of the issues at stake. Both sides deserve credit for this.

The type of 'spin' tactics recently employed by the HSE, however unpalatable they may be to the IMO, are pretty much part and parcel of any industrial dispute in the media age.

Should they be allowed get in the way of a settlement that will avoid damaging disruptions to already under-pressure hospital services?

At some stage of an industrial dispute, those involved have to bury any inherent mutual dislike and take a 'leap of faith' that what has been proposed just might work. Otherwise we would be having strikes every day of the week.

And it should be said that some progress, although clearly not enough, was already being made in recent months in reducing junior doctors' working hours.

The public may be forgiven for believing that hospital services will be disrupted in a protest over what is effectively a technicality over the implementation of shift work limits. And over the hardly surprising fact that the IMO doesn't like the HSE very much.

Ultimately, does it really matter whether hospitals suffer budget cuts or have to pay doctors more if they breach working time limits?

If the new system proves to be workable, the shift limits, in the vast majority of cases, should not be breached anyway. So the current impasse in what has been discussed to date may essentially be over a theorethical issue.

At this stage, the IMO, it is understood, wants the HSE to admit it made inaccurate claims recently about the IMO's stance, in order to help restore what it feels has been a breach of trust.

The HSE may not react too enthusiastically to such requests, but surely, some formula can be devised to get the two sides back to the negotiating table.

There is great public support, and a good deal of public affection, for junior doctors.

However, the current public 'optics' may well be that the IMO is refusing further talks and raising the placards when the basic principle of putting proper structures in place to reduce hours appears to have been progressed.

The doctors' current stance could therefore severely test the public support they undoubtedly enjoy at the moment.

But that, perhaps is the type of calculated risk all public service unions must take when they engage in industrial action.

The HSE, if a strike goes ahead, essentially has nothing to lose, while patients and their families have everything to lose.

Public support isn't a key issue for the HSE - the public already doesn't think much of the health executive monolith, and the HSE will undoubtedly do its damnedest to portray junior doctors as the villains of the piece when operations and outpatient clinics are cancelled.

Also, in this type of hospital dispute, there is an almost inevitable row about the level of emergency cover being provided and whether it is safe.

Already, the HSE is predicting 'ethical' as well as patient care implications resulting from a strike, so things could turn nasty.

The two sides have made some progress in trying to limit dangerously long junior doctor hours. They really need to start talking again.

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