If nothing else, the Health Secretary has cojones. While declaring to the House of Commons the imposition of his widely-condemned junior doctor contract, Jeremy Hunt simultaneously pledged a review into the causes of low morale among junior doctors. He had uncovered, he announced, some “deep-seated issues” relating to our “morale, wellbeing and quality of life which need to be addressed”.
Talk about fists in velvet gloves. If that man tells us one more time we’re the ‘backbone of the NHS’ while kneeing us in our collective crown jewels, he’s definitely heading for some serious ‘militancy’. As if to add insult to injury, Mr Hunt next announced that Dame Sue Bailey, the President of the Academy of Medical Royal Colleges, had been tasked with leading the review “into measures outside the contract that can be taken to improve the morale of the junior doctor workforce”.
That’s right. Measures outside the contract. The man whose contract has turned him into a persona non grata among junior doctors, has specifically excluded consideration of his contract from the causes of our low morale.
Let’s pause for a moment and define ‘morale’ – helpful in the context of a government hell-bent on pushing through a ‘truly 7 day NHS’ that they have never, ever, defined to the electorate. The Oxford English Dictionary describes ‘morale’ as ‘”the confidence, enthusiasm, and discipline of a person or group at a particular time”. In military circles, ‘morale’, or a unit’s ‘esprit de corps’, is often defined more precisely as the capacity of a group’s members to maintain their belief in an institution or goal, particularly in the face of opposition or hardship. If a unit’s morale is depleted, they are at risk of cracking and surrendering. An American General by the rather magnificent name of Knickerbocker gave a stirring definition of ‘morale’ during the Second World War. Morale was high, he said, “”when a soldier thinks his army is the best in the world, his regiment the best in the army, his company the best in the regiment, his squad the best in the company, and that he himself is the best blankety-blank soldier man in the outfit.”
How does that compare to the NHS? My army (my health service) is crumbling around me. Year on year, the government’s underfunding undermines the collective efforts of my colleagues and me to provide the public with exemplary care. Waiting lists balloon. My inpatients suffer the perils of rota gaps – arising where doctors have either fled the NHS or been signed off sick, leaving the remaining staff to carry their workloads. My regiment (my hospital) is in deficit. My squad (my fellow junior doctors) have been reduced by sick leave from three to two. And me? Since I’m doing the job of one and a half doctors, I’m too tired to be the best: it takes all my efforts to be safe and competent.
Mercifully, last Friday, the Trainee Doctors’ Group of Dame Sue Bailey’s Academy agreed unanimously to boycott Mr Hunt’s pseudo-review. Its terms of reference, they said, would render “a review unable to discuss both problems and potential solutions that have a significant impact on morale and recruitment and retention”. Junior doctors, unsurprisingly, are simply not willing to play ball.
How Hunt’s office must have seethed. The government desperately needs this review. It adds an essential veneer of legitimacy to the process of imposing a contract so loathed that 98% of juniors voted to strike against it. One wonders how much money the Department of Health is throwing at the problem of buying our cooperation. Rumours are circulating of the DoH pledging many hundreds of thousands of pounds for this review – unusual largesse for these times of unprecedented austerity.
Here, Mr Hunt, is how that money could be better spent. Forget your morale review, and conduct instead an open and transparent appraisal of the clinical and cost effectiveness of your ‘truly 7 day NHS’. Will it save lives? How much will each life saved cost? Would that money be better spent on more child mental health beds, for example? That’s how we do it for new cancer drugs – a political manifesto pledge should be no different. Simply commission NICE to appraise your 7 day baby, and watch our morale soar overnight. Until then, that junior doctor ‘backbone’ you so lovingly describe will remain stiff with resolve to oppose your punitive, patient-threatening contract.