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A group of NHS doctors stand on a picket line outside a modern hospital, wearing scrubs under winter coats and holding protest signs calling for fair pay and safe staffing, under a grey overcast sky.

Worse

I hope you had a good Easter…

… the chances are you didn’t, if…

… you’ve been getting ready to stand on a picket line, or…

… figuring out how to run a hospital with people standing outside the hospital, on a picket line, instead of being on the inside, helping to run the hospital…

… which is where they way they want to be…

… if that makes any sense.

The Prime Minister’s stepped in; threatened strikers with withdrawing additional resident doctor’s training places.

In the name of the little donkey; who advised him to do a that? Total stupidity among special advisors is not unknown, but…

… this takes the wafer. 

As is manifestly obvious… it didn’t work. The only person to benefit is Streeting…

… now, slithering away from responsibility, with all eyes on the PM. It’s his strike now. What’s he gonna do?

Dunno…

… ending the resident doctors’ dispute isn’t about finding a clever wheeze. Now, it’s about shifting the incentives on both sides, so a deal becomes the least bad option for everyone involved. 

Here are five ideas that might move the dial.

1.Reframe the dispute: from ‘pay’ to ‘career value’.

At present, the argument is anchored in headline pay-restoration. HMG resists the calculation; doctors defend it. Try breaking the deadlock by widening the frame;

  • Link pay to total-career-value… pensions, exam fees, salary, training costs, might be worth just south of £6m? The NHS hasn’t made being a doctor bad value. It’s made it feel like bad value at the exact moment doctor’s life-shaping costs are high… value is back loaded… pain is up-front. How much value can be shifted forward?
  • Offer a multi-year deal with staged improvements rather than a single headline settlement.
  • Package it as ‘making a medical career sustainable again’.
  • Give both sides something to claim victory about without conceding outright… the first rule of negotiation… both sides need a win.

2. Independent-pay-rigour… aka take the politics out of it.

Trust is shot. Each side assumes the other will renege, so…

… create a mechanism;

An enhanced version of the pay review bodies, with a binding trigger formula. Start with; 

inflation + comparator professions + retention metrics, 

and …

… lock it in for, say, 3–5 years

This moves the argument from ‘what do we think is fair?’ to ‘what does the formula say?’… a depoliticisation move… that’ll suit both sides…

3. Trade pay for time… aka, the rota bargain.

Doctors don’t just feel underpaid, they feel overused.

A deal could include:

  • Hard limits on unsafe rotas
  • Enforced rest periods
  • Reduction in unpaid overtime, the ‘hidden subsidy’.
  • Less exploitation in exchange for moderated pay demands. This is tangible, immediate, and visible at the front line. 

The pathway to it might be tricky… set out milestones, leading to…

4. Productivity deal with safeguards.

Government will want something in return, so… tie any productivity commitments to system fixes, not just ‘work harder’.

For example:

  • Guaranteed theatre time, important for training.
  • Diagnostics turnaround standards
  • Reduction in admin burden, one of Streeting’s left shifts to a digitised NHS.
  • Doctors will accept productivity if the system stops wasting their time.
  • Otherwise, it’s just code for ‘do more with less,’ which will fail.

5. Find a credible broker… reset the tone.

This is now as much about mistrust as money.

A reset needs a pause in rhetoric… … tell Streeting to give it a rest. Private, not performative, negotiation. 

Allow HMG to step back without looking weak. The BMA to compromise without appearing to fold.

Who? Take yer pick…

  • Lord Darzi… leading medic, framing the future of a medical career
  • Sir Brendan Barber… former chair of ACAS
  • Baroness Ruby McGregor Smith… cross bench peer, with a strong track record on workforce and fairness.
  • Sir David Norgrove… former chair of the Low Pay Commission and chair of the ONS
  • Frances O’Grady… former chair of the TUC and credible with workforce groups. 
  • Lord Mark Price… business leader with government experience with a focus on productivity and workforce engagement

The truth is… there’s no clean solution. 

Obliging unions to put substantiative offers to their membership within ten days? Maybe?

This dispute sits at the intersection of a decade of pay erosion, no real understanding of the future of work… against the background of technologies everyone is shying away from, and …

… a service running permanently hot.

Until we address all that, there’s no deal that will solve the problem…

… just one to stop it getting worse.

News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.

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