The Government announced after February's strike that they will impose their contract on all junior doctors in August 2016.
Despite announcing imposition, the contract has not yet been written or published.
No one knows if it is safe, if it will improve services, if it is affordable or sustainable.
The government have admitted they do not have the information needed to prove these reasonable and essential steps have been taken.
A contract imposition is undemocratic and deeply unfair.
Imposing an unplanned, uncosted, unmodelled and unfunded one is dangerous.
Doctors on strike
DO NOT DELAY OR HESITATE IN SEEKING HELP IF YOU ARE UNWELL
Independent Legal Action
Doctors have begun a legal challenge against the imposition of a contract we believe is unsafe.
We are challenging the government to prove that their plans are safe, well planned, appropriately funded and staffed. They need to prove that they have made decisions reasonably and legally.
We believe fundamentally that a contract for doctors must be agreed, not imposed, and must above all else be SAFE for patients and NHS staff. This is the only way to make sure your NHS is safe and sustainable for your future.
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Email us on: JustHealth2016@gmail.com
JustHealth - fundraising for justice
Junior doctors and NHS staff have instructed lawyers to begin investigations into Judicial Review proceedings.
"We are asking for funding to take an independent legal action started by doctors but ultimately involving all interested parties. We are challenging the imposition of an unplanned and dangerous contract which will affect patient wellbeing and safety.
We ask for your help to raise £25,000 initially to start to investigate a judicial review process and are aiming to establish a further working case fund of £100,000. This is an all or nothing target and without your support we cannot get this case off the ground."
JustHealth - this is about the future of the NHS
Why this matters to you
This is about the future of your health service and your country.
The imminent imposition of dangerous contracts affects everybody who works for or uses the NHS. Its immediate and lasting impact reaches further than doctors; it will have a knock on effect on all NHS staff, patients and their families.
The NHS is already understaffed. The government want a new contract to fulfil their manifesto pledge of a "7-Day" NHS, but they have failed to acknowledge the need for the necessary extra staffing and resources required to make their changes safe. They have not planned or prepared for the devastating consequences. As a result there will be serious gaps in the care provided to patients. Staff will find themselves under even more pressure, their mental and physical health will be impacted. This imposed contract will endanger all lives in the NHS.
JustHealth - the court decides if the imposed contract decisions are reasonable and legal
What we are doing
Judicial review is a legal process which allows the high court to investigate issues and decide whether decisions made by the Secretary of State for Health, and employers, are reasonable and have the consequences that are intended.
Talks between the BMA, NHS Employers and the Health Secretary have broken down and a new contract is due to be enforced by the government from August 2016. The Health Secretary has under pressure said an Equality Impact Assessment will be carried out and published this month but we are not confident this will result in any significant change.
We know these are only the start of widespread changes to the health service that will affect all staff working in the NHS. It is junior doctors today and other NHS staff tomorrow. We cannot stand by without a proper review of the impact on patient safety by such actions.
The only avenue left to get to the bottom of the issues surrounding the lack of planning prior to the imposition of the dangerous doctors’ contracts is to ask for the High Court to review the decision making process and decision to impose contracts.
Bindmans LLP, legendary in the area of judicial review has agreed to act for us to bring this claim. It is our hope of a just resolution. At the moment nobody is listening to genuine serious safety concerns. We refuse to be bullied into submission further.
Morale is affected and there are many doctors and other who may leave the NHS if the working conditions are not reasonable and if we cannot fulfil our commitment to our service users – patients come first.
JustHealth - we need your support
How your donation will help
This funding will enable our lawyers to study the documents about years of negotiations, research whether patient safety will be affected, and test the arguments put by the employers and Health Secretary to consider whether the process has been fair and reasonable and the result end would be justified.
At this stage we don’t know what the final costs may be. This will depend on how strongly the issues are disputed, whether other parties decide to support our challenge, how lengthy and complex the research will be, how many hearings will be needed and how long the final hearing is. The case has to be taken in stages and our lawyers will keep under review whether the case has good prospects. We may need to come back to you for further support, but if we do, we will explain why and what is needed. We will be transparent where our employers and the Health secretary has not been. Things have reached an impasse and there is no other obvious way out of this deadlock. An independent review by judges looking at the dispute calmly with all the evidence before them is best placed to judge the fairness of our respective positions.
Why this is a fight to save your NHS
This contract is UNSAFE for both patients and doctors:
The '6 Minute' Video explains our concerns.
The video also explains why the term 'Junior Doctor' is misleading, as they may have up to 15 years experience working for the NHS.
The government's manifesto soundbite to 'deliver a 7 day NHS' means they're imposing a new contract.
They claim will allow more routine services at weekends & that it will improve patient safety (weekend mortality), but we know routine services are not life and death situations.
They claim they are reducing doctors' hours and yet that more doctors will work more weekends to provide increased services, but we know there is no funding for additional doctors.
We disagree with these plans, we believe this is UNSAFE.
Here's a breakdown of the changes they've announced in November offer - the latest 'offer' that they've said is final has not actually been published so we can't analyse the details.
7 DAYS - NOW
7 DAYS - NEW CONTRACT
SAFETY - NOW
SAFETY - NEW CONTRACT
HOURS - NOW
HOURS - NEW CONTRACT
TRAINING - NOW
TRAINING - NEW CONTRACT
PAY PROGRESSION - NOW
PAY PROGRESSION - NEW CONTRACT
Frequently Asked Questions
What is a 'junior doctor'?
Anyone still in training to become a specialist
The term 'junior doctor' is incredibly misleading, it includes:
Will this give us a 7-day NHS?
To understand the '7-day' debate you need to understand that there are two different and separate parts to healthcare:
Emergency services (unplanned visits to hospital, unexpected admissions, accidents and emergencies) are already provided 24hrs a day, 7 days a week. Currently the same number of doctors are on-call for emergencies at any given moment day or night. Changing the contract won't change this.
Elective services (non-emergency, planned appointments and procedures) are staffed according to levels of workload and are spread across the week Monday-Friday. The numbers of doctors will vary to make sure each operating theatre, each clinic, each ward in covered as needed.
So for emergency care, nothing will change.
For elective care hospitals will afford to get more junior doctors doing routine work over the weekend but juniors can not do any of this alone: we need more consultants, more nurses, radiographers, physios, therapists, secretaries, ward clerks, porters, cleaners, kitchen staff etc etc.
This is an increase in services of 40%, but with no more money and no more staff to achieve it.
Conclusion: This won't work. There's no such thing as a free lunch. Nor a free hospital. If you want a service that no country on earth has ever managed to provide in human history; you've got to pay for it to make it happen.
Wouldn't it be nice to have all services 24/7?
People think it might be nice to have access to whatever we want, whenever we want it. Doctor's don't disagree.
In a time and age when people demand instant access and prioritise convenience over requirements, it would be great to be able to provide that service...
BUT the government has run pilot programs up and down the country in GP surgeries and hospital clinics offering appointments over the weekend. The results have shown that patients don't book appointments when they'd rather be with their families, and that half of the booked appointments never actually turned up on the day. This is an extremely inefficient and expensive way to run a service. The NHS doesn't have money to burn.
It turns out this sort of 'non-urgent service whenever we like' is a dream which in reality isn't required nor affordable.
Do more people die on weekends?
The published study that Mr Hunt has misquoted time and again showed an increased risk of death for patients admitted on Friday-Monday inclusive (a four day weekend!). The conclusion of this research was that this so-called 'weekend effect' is identified around the world, even in healthcare systems completely different to the NHS. This suggests the cause for this apparent increased risk of death is something to do with the type of patients and cases who come in (maybe they're sicker, maybe they've waited too long, maybe its because there are more accidents?) - We are not sure. But there's no evidence it has anything to do with staffing levels. The paper's author said that to suggest the increased deaths were avoidable would be "rash and misleading". Mr Hunt is either mistaken in his analysis, or he's misleading the public. Neither is encouraging nor appropriate for a Minister for Health.
Why should we fight against this contract?
Because this contract is dangerous.
It's a gamble with the NHS.
As outlined above, this contract will push doctors to work increasingly longer hours as hospitals come under increasing pressure to get more and more 'efficient' and get 'more out of' their staff. We could see a return to 100-hour weeks being 'normal' and we know that this isn't safe for patients and its not safe for doctors either.
Tired doctors make mistakes. Tired doctors don't work as fast. Tired doctors don't work as smart. Tired doctors can kill patients. Tired doctors have car accidents driving home, and tired doctors die.
This contract isn't fair to doctors who will be forced to work more for less, under worse conditions and with less training. We are trainees, we are learning to become experts; when we are spread more thinly covering more ground we don't get to learn or train because there's no time or supervision.
It isn't fair we won't be able to give our patients the care they need, deserve and that we desperately wish we could give.
It's important to understand the past, but it isn't simple - please bear with us and persevere!
Oct 2013: Government calls for contract review
In 2013 the junior doctor contracts were felt to be outdated and requiring review to be better able to meet future NHS demands
Feb 2014: BMA publishes views on 7-day services
In February 2014 the BMA published a Parliamentary brief on the 'Implications of introducing seven-day working in the NHS'.
This highlighted the following key points:
They made their position clear, stating:
"The BMA believes that urgent and emergency services should be the priority for investment to bring the standard up to the very best, every day. Care quality improvements should be the primary driver for seven-day service development for acutely ill patients. In the current and foreseeable economic climate, with huge financial pressure on the NHS, we do not believe resources could be freed up to deliver routine and elective services seven days a week."
And made insightful remarks on what this might mean in practise:
"Creating a seven-day service may place additional pressure on services during the rest of the week. The BMA is seeking reassurances that sufficient resources are provided so that pressure is not shifted from one part of the system to another"
See full briefing document here.
July 2015: DDRB report is published
In July 2015 the report was published at the same time Mr Jeremy Hunt made the speech setting out his vision for the future of the NHS and an ultimatum to the medical profession to re-enter negotiations
The BMA were given 6 weeks to analyze the DDRB report and make a decision to re-enter negotiations or face imposition of the new junior doctor contract.
Mr Hunt's speech angered the medical profession when he accused consultants and the BMA of being the road-block to service improvement, but note this had nothing to do with junior doctors and their contracts:
"Around 6,000 people lose their lives every year because we do not have a proper 7-day service in hospitals. You are 15% more likely to die if you are admitted on a Sunday compared to being admitted on a Wednesday. No one could possibly say that this was a system built around the needs of patients - and yet when I pointed this out to the BMA they told me to ‘get real.’ I simply say to the doctors’ union that I can give them 6,000 reasons why they, not I, need to ‘get real.’
They are not remotely in touch with what their members actually believe. I have yet to meet a consultant who would be happy for their own family to be admitted on a weekend or would not prefer to get test results back more quickly for their own patients. Hospitals like Northumbria that have instituted 7-day working have seen staff morale transformed as a result. Timely consultant review when a patient is first admitted, access to key diagnostics, consultant-directed interventions, ongoing consultant review in high dependency areas, and proper assessment of mental health needs: I will not allow the BMA to be a road block to reforms that will save lives.
There will now be 6 weeks to work with BMA union negotiators before a September decision point. But be in no doubt: if we can’t negotiate, we are ready to impose a new contract."
The BMA statement at that time:
"The BMA has been clear about our support for better seven-day services, with a focus on urgent and emergency care, but we do have concerns over how extended services will be paid for, staffed and what guarantees can be made to ensure current services do not suffer. Junior doctors already work to provide care 24 hours a day, 7 days a week. There is no ability for junior doctors to opt out of weekend services."
Read the DDRB report in full here.
Sept 2015: JDC votes not to re-enter negotiations
On 10th September the junior doctors committee took a vote after debating the issues and details in each of the 23 DDRB recommendations
Junior doctors were informed that the government was unwilling to negotiate on 22 of the 23 DDRB recommendations which would make up the new contract.
The BMA junior doctor committee (JDC) took the decision not to re-enter negotiations because "despite significant concerns raised... it was made clear that failure to accept those recommendations as the basis for talks would result in the government imposing a contract on junior doctors from August 2016."
Junior doctors have been very clear we want to achieve a safe and fair negotiated settlement.
The BMA have asked for the following assurances from the government to re-enter negotiations:
Oct 2015: The imposition & negotiation stand off
On October 8th Mr Hunt wrote to the BMA making reference to the junior doctors' concerns but refusing to give the concrete assurances the BMA requested
The subsequent communications between Mr Hunt and the BMA JDC Chair Dr Johann Malawana have primarily been played out via the media.
Junior doctors have never felt confident that Mr Hunt's verbal assurances and letters have provided the assurances required to accept the his proposals and so the BMA, no other options, began to prepare for a ballot on possible industrial action.
The BMA's response on October 12th outlined their unaddressed concerns again and set out their unchanged position here.
Nov 2015: Ballot for strike action
The BMA have begun the ballot process and the deadline is Nov 18th
Responding the letter from Jeremy Hunt, the BMA JDC's Dr Malawana said on October 28th:
“It is encouraging that the health secretary has finally made a significant shift and recognised some of the concerns raised by junior doctors. However, it has taken the threat of industrial action and the sight of thousands of junior doctors taking to the streets to reach this point.
“The BMA has been quite clear that the government must withdraw the threat of imposition of new contracts on junior doctors, the extensive preconditions to negotiations the Department of Health keep insisting on and provide junior doctors with the assurances they are demanding before re-entering negotiations. Today’s letter from the health secretary could be a step in the right direction. We look forward to seeing more of the detail that the health secretary has committed to providing in the coming few days.
“After repeated attempts to conflate junior doctors’ legitimate concerns and the government’s rhetoric on seven-day services, it is positive that the health secretary has finally acknowledged what people across the country already know: that junior doctors already work 24 hours a day, 7 days a week up and down this country.”
On the eve of the ballot opening, Nov 4th, the government finally publicised, via the media, its plans for the junior doctor contract and we were able to see the terms and conditions and pay calculations for the first time.
Unfortunately, the these plans:
A concession was made for the most senior trainees, with offers of pay protection to prevent huge losses in pay, however as a body of professionals we are not willing to accept these terms and allow 'one generation to sell out the next' in this callous way.
The ballot for industrial action went ahead.
Dec 2015: Strikes planned, then postponed...
With an overwhelming mandate for strike action, the BMA was bold to cancel them when the Government finally agreed to conciliatory talks
The ballot in November was overwhelming.
98% of doctors voted for strike action and plans were made for December strikes. On the same day as the ballot result was announced, the BMA invited the government to talk via ACAS, the mediation service.
Mr Hunt the Minister for Health refused.
7 days later on the night before the first strike the government agreed to return to talks and begin fair contract negotiations so the BMA called off the strikes at the 11th hour. The BMA hoped and believed the government was finally ready to start listening to doctors' concerns and willing to negotiate a safe and sustainable new contract.
These talks lasted throughout Christmas and on the deadline of January 4th we heard the news that the BMA was unable to secure a safe and fair deal for doctors and patients. The offer from the government was unsafe and unsustainable for the NHS in the longer term.
It was a very difficult decision for the BMA doctors to take, but strikes were once again announced for Jan 12th, 26th and Feb 10th.
The government have asked for ACAS to step in again, however no agreement was reached. The strikes are set to go ahead.
Discussions between the government and the BMA are ongoing.
Jan 2016: Strikes back on, some again postponed
Strikes were announced for 3 days in January and the BMA continued to ask for further negotiations to avoid any disruption to services
The first doctors strike in over 40 years too place on January 12th - this was the first time in a generation that doctors were forced to take industrial action.
All emergency, urgent and cancer services continued to be staffed as normal with only routine, non-urgent work cancelled. This meant that no patients were put at any risk, and there were more services running safely on strike day than on a normal Sunday or Bank Holiday!
There was not a single report of any bad outcomes or incidents on strike day, and the support from junior doctors for the BMA's ongoing industrial action plans was evident on the picket lines.
Following more talks and ongoing negotiations, the BMA announced that they would postpone to following strike on Jan 26th in order to continue negotiating.
Sadly these further talks did not achieve the necessary safeguards and terms that junior doctors required, so the next strike day was confirmed on Feb 10th.
This strike day was the same model as the previous one, it was carried out safely and again there was not a single report of any bad outcomes or incidents for our patients.
Feb 2106: Imposition is announced, but of which contract?
The government made a 'final offer' the night before the strike on Feb 10th and demanded a final answer in less than 24hours or imposition would be forced upon the junior doctors
After the BMA said the January offer was unacceptable for doctors, the government and BMA continued their talks.
The night before the Feb 10th strike, the government wrote to Dr Malawana with their final offer and demanded a response immediately.
This offer was made without any details of the contract, as it is not actually written yet.
There was also no time allowed for review and analysis of their 'offer summary document' before the deadline, and doctors were on the picket lines that day.
On Feb 11th, the morning after the second strike, Jeremy Hunt announced in Parliament that he would go ahead with imposition and there would be no further negotiations.
The BMA have continued to ask for fair negotiations and a chance to reach a safe and sustainable contract.
The BMA announced further strikes for March and April. These will continue to follow the previous format of offering ongoing emergency care - NEVER DELAY SEEKING HELP - WE ARE ALWAYS HERE FOR YOU IN YOUR NHS.
What is the DDRB?
DDRB is an advisory non-departmental public body, sponsored by the DOH
The DDRB is the organisation which every year considers the pay for doctors holding posts in the NHS on nationally agreed terms. It was set up after the Royal Commission on Doctors' and Dentists' Remuneration in 1960 in order to protect medical professionals' living standards from "arbitrary government action".
It makes its recommendations directly to the Prime Minister and the Secretary of State for Health, and their equivalents in Scotland, Wales and Northern Ireland.
The health departments, NHS Employers and the BMA send written evidence to the DDRB each September and October. The DDRB usually reports to the Prime Minister in December each year and the report is made public, with the government's decision, a few weeks later, for implementation on the following 1 April.
For many years now they have recommended that doctors in the UK should receive a pay rise, yet the government have not taken those recommendations on board and acted upon them.
This was reported by the Independent last year:
"In his letter, Dr Porter said the BMA, which represents 153,000 doctors, would submit evidence to the DDRB regardless of the Government’s attempt to by-pass the pay review process.
“This year, presumably for fear that you may not like its answer, you have elected not to ask the DDRB to make a recommendation on pay…” Dr Porter writes. “In the stroke of a pen, you have removed both the assurance against arbitrary government action [on pay] while inviting the very public dispute which the DDRB was designed to avoid.”
A BMA source said the union was not yet considering a ballot for strike action.
The source told The Independent: “The purpose of an independent review body is to ensure fairness and transparency in decisions on pay. [By ignoring the DDRB] the Government is making a total mockery of the independence of the pay review bodies and prevents them from working in a fair fashion for doctors, staff and patients.” "
This year's task of reviewing and making recommendations on the junior doctor contract is something they were never set up to do, and was a task well outside their previous remit.
The members are:
How to help your doctors
We need the public to support us.
We are fighting for the safety of our patients, the integrity of our profession and for the future of the NHS!
1) Support our independent legal action!
While the BMA is fighting for doctors' rights and safety, we are fighting for our patients' rights and safety but holding the government to account through an independent legal challenge - they must prove they are doing the right thing in front of a Judge now
3) Write to your MP!
Tell your MP why the NHS is important to you. Let them know what you think of the new junior doctor contract. Tell them what you want them to do for you and your NHS
Junior Doctor Campaigns
Since this dispute began in Sept 2105, Junior Doctors have rallied together in support and solidarity in a way we have never imagined possible. There have been many grassroots campaigns and events, some of which have become so popular and effective they're achieved incredible things. Here are the highlights!
This campaign lets doctors share personal photos and stories from the frontline of the NHS
Junior doctors began this page after being inspired by the famous photography movements called 'Humans of New York'
The Lewisham Hospital Choir
They got to 2015 Christmas No.1
"The NHS faces a cruel winter ahead. Budget cuts, low staff morale, junior doctors balloting for industrial action, and hospitals up and down the country being classed as 'inadequate'.
We are closer than ever to that cliff edge, but we WILL NOT let the NHS fall."
National Health Singers
Our national NHS choir, singing at the pickets
We started our choir to unite the British public with their NHS workers. We aim to empower EVERYONE to fight for their NHS. We’re singing for it’s survival and we need your help to raise awareness of the current threats to the NHS, whilst at the same time boosting morale, increasing positivity and ultimately protecting our National Health Service!"
Thank you for helping us!
To support our campaigns please consider making a donation to our crowdfunding account.
These funds will be used to pay for materials at campaign events, PR stunts and for getting more information to you; our patients and public!
With many many thanks, your junior doctors.
Department of Reality
Please share and help us get the message out: this contract is not safe and not good for patients!
Follow them on Twitter for updates and opinions on the latest contract and NHS developments
Doctors are fighting for their patients, their careers and the future of the NHS
There are a number of events being planned all over the country by grassroots campaigners, groups of doctors in hospitals, and regional/national committees.
One public campaign is 'Meet the Doctors' which means group of doctors in every city in the UK will be going out to your local high street or station to talk to the public, hand out leaflets and ask you to support us by signing a petition.
Further details of future events will be shared shortly.
These key videos attempt to explain the issues in quick summaries, they are made by junior doctors who feel its important to let people know what's honestly happening & cut through the government's spin & rhetoric.
Junior Doctor Contract
What's going on?
Too tired to shout: why you need to speak up
TED talk: Privatisation of the NHS
18 minute talk on how the NHS has been dismantled, by Professor Allyson Pollock
The NHS sell-off documentary
Full length documentary on what's been happening to the NHS and why it's almost too late to save it... but there's still time if we stand and fight together!
(Warning: 60 mins but incredibly important!)
The government's handling of the NHS
in 3 minutes
A guide to the structure of the NHS
6 minute video explaining the structure of the NHS following yet another top-down restructure.