It’s not so much a case of ‘war declared’ as the battle of wills between Jeremy Hunt and the BMA being escalated to total war.
The announcement by the BMA that the next walkout of junior doctors will be an “all-out strike,” in which emergency care won’t be covered, crosses a big line in one of the most protracted industrial disputes of recent years. Health Secretary Jeremy Hunt has already set out his stall and seems prepared to give no quarter, announcing that he will now impose contentious new contracts on junior doctors.
It’s difficult to see how the situation can be resolved without either the BMA being broken or the end of Jeremy Hunt’s career as Health Secretary. The situation has now escalated to the point where neither can afford to back down. Capitulation doesn’t just mean a loss of face, it means a fundamental undermining of that organisation’s or individual’s authority.
At this point the doctors hold the whip hand. And this is due to their remarkable ability to retain significant levels of public support despite having already staged walkouts in protest over the new contracts. To date, the BMA has been successful in explaining its position and the grievances of junior doctors, which members of the public have been prepared to lay at the feet of the Government, and specifically Jeremy Hunt. While this is in large part due to the continued respect and esteem we as a population hold doctors and other medical professionals, the most important point is that Jeremy Hunt has essentially come off as the villain of the piece.
The challenge for the BMA is to retain that public support during an ‘all-out’ strike that presents two dangers for the Association. Firstly, even though industrial action was been called off at the last minute earlier in the year, the frequency with which strikes are being put in the calendar may start to test the public’s patience. The likes of the RMT provide the example for this: while highly effective in winning concessions for their members, they struggle greatly to retain public support on account of their predilection for industrial action and the disruption it causes.
Secondly, and most importantly, public support will quickly evaporate if the withdrawal of emergency care causes severe societal dislocation – and more importantly is shown to cost lives.
If the BMA is able to come through an escalation of industrial action with public support intact, then it’s difficult to see how Jeremy Hunt can win. Junior doctors will feel empowered to take further action and resist the imposition of the new contracts. The Health Secretary will have little recourse left to him and it will likely be the end of his tenure in Richmond House.
But if the BMA’s public support falters, then it’s advantage to the Health Secretary. There will be clear limits on what the public is prepared to accept, and this will fundamentally limit the BMA’s options.