Are doctors justified in taking industrial action in defence of their pensions? YesBMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e3242 (Published 08 May 2012) Cite this as: BMJ 2012;344:e3242
The last time it happened, the Bay City Rollers were Britain’s most popular band, people were queuing round the block to see Jaws, and Barbara Castle was secretary of state for health and social services.
Don’t worry—this isn’t an “I love 1975” nostalgia trip. Like most of the young(ish) doctors who will be most deeply and unfairly affected by the changes to NHS pensions, I wasn’t even born the last time UK doctors were balloted on industrial action. The point is that it is extremely rare for us to reach this point. Doctors, or the BMA, do not take the prospect of industrial action lightly. In fact, we have gone to great lengths to avoid it, pursuing every possible avenue to press the government on a fairer way forward.
We have repeatedly articulated the many strong arguments against wholesale changes to the NHS pension scheme. Its 2008 overhaul resulted in higher contributions, a higher normal pension age for new entrants, and the introduction of a cost sharing mechanism that means employees will bear the brunt of future cost increases. The scheme now delivers £2bn (€2.5bn; $3.2bn) to the Treasury each year and was last year deemed sustainable in the long term by the public accounts committee.1 2
There was never any genuine negotiation on the further changes now being imposed. While ministers were keen to have conversations about the detail of the further contribution increases planned for 2013 and 2014, they were never willing to consider any change to their overall approach. After the conclusion of discussions at the end of last year, BMA members overwhelmingly rejected the “final offer,” with almost two thirds saying they would be prepared to take industrial action to pursue changes.3 We then urged the Department of Health and the Treasury to return to meaningful talks, but to no avail. So after pursuing all other routes to find a fair way forward, here we are—on the verge of the first ballot on industrial action by doctors in four decades.
What happens next is up to the BMA members who will shortly be receiving ballot forms. It has been argued that doctors simply have no moral right to take industrial action because to do so would inevitably put patients at risk. I fundamentally disagree with this argument—and if I did not, I would not even consider industrial action. I believe that we can take action that will have an impact but will assure patient safety.
Protection for patients
Throughout the process of developing the “urgent and emergency care” model of industrial action that we are asking doctors to take, patient safety has been our over-riding priority.
Crucially, doctors would be at their usual place of work when scheduled to be so, and patients would receive emergency care, or any other care they urgently needed on the day. The only work that would be postponed would be that which could safely be postponed—non-urgent surgery and investigations, outpatient consultations, and routine appointments in general practice. If there was any doubt, the decision would always be to provide care.
We have said from the outset that fully cooperating with managers would be essential and that decisions about which care is postponed should be determined as far as possible in advance, through planning and coordination with colleagues and employers. As well as protecting patients’ safety, this would ensure that patients received as much notice as possible of any changes that affect them. Non-urgent care is often postponed safely for a range of reasons. Furthermore, our action would take place for 24 hours initially, and we would review its effect on patients before deciding on any future action.
Of course the decision is still difficult, and doctors may feel unable to take industrial action in any circumstances. It is true that we are unlikely to achieve a great deal of public or media sympathy. There are doctors who believe that the government is within its rights to tear up the 2008 pensions deal. There are also legal complexities. That is why the ballot paper that eligible BMA members will receive will contains two questions—one asking whether they are prepared to take part in industrial action short of a strike, and one asking if they are prepared to participate in a strike. While what we are proposing is clearly far from being a strike as the term is normally understood by the public, we need to have a yes vote to both questions to ensure there is as much legal protection and flexibility as possible.
So, yes, we are in a difficult situation; doctors are being asked to do something that is unusual and that presents challenges. However, given that threats to patient safety can be addressed through thorough planning and a commitment to the continuing provision of all care urgently needed, why shouldn’t doctors have the same employment rights as other workers?
Cite this as: BMJ 2012;344:e3242
Competing interests: The author has completed the ICJME unified disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.
Provenance and peer review: Commissioned; not externally peer reviewed.