Time to Withdraw from the Joint Statement?

Authors: Emma Runswick and Pete Campbell

On the 30th March, BMA Junior Doctors Committee and NHS Employers published a joint statement which stated that:

“the BMA agree that when not possible to implement, the working hours restrictions and rest requirements in the TCS will be suspended and that the Working Time Regulations 1998 (WTR) will be the fallback position for the duration of the pandemic.”

“Trusts should discuss proposed new patterns of work with affected trainees prior to implementation”

(emphasis ours)

Some supporters of the Broad Left, ordinary members of the BMA and the Junior Doctors Committee representatives strongly objected to this and the joint statement was rewritten reflecting some of our concerns. The up-to-date statement is available here.

We were, and continue to be, in favour of sensible flexibility during the pandemic, with the aims of providing appropriate medical cover particularly during staff sickness. However, we argued that giving employers permission to ignore our contractual rights for an undefined reason without agreement from the affected junior doctors, with no clear endpoint for that position, was dangerous.

We argued for changes, including highlighting the importance of safe working, ensuring consultation of affected trainees, and that trusts would have to prove that breaching our terms and conditions was truly a last resort.

End of “Emergency Covid-19 Measures”

On the 29th April NHS England wrote to all trusts requesting the restart of all urgent non-COVID 19 service and the gradual reintroduction of elective work. This has led to a slow withdrawal of the redeployment of junior doctors, and led us to reconsider the joint statement. The end of redeployment or restarting elective work is evidence that workload is normalising and normal TCS should be met. However, in lots of trusts, this is not happening.

“Step down” rotas are being implemented in some trusts which are designed to ‘catch up’ with delayed NHS services, some of these rotas continue to breach contractual protections with the backing of the joint NHS Employers and BMA statement. These rotas can be nothing like pre-covid rotas, with increased intensity, additional weekend working and additional hours.

Pay and Leave Arrangements

Many representatives working locally are yet to see fulfilment of the promise made by NHS Employers:

“NHS Employers is grateful for the commitment made by junior doctors and the BMA at this time and will take this into account when preparing for future negotiations once the COVID19 pandemic is resolved.”

Local trusts and Programmes are returning rapidly to old tricks, attempting to “charge” a 1.5 days of annual or bereavement leave for the new 12 hour standard day, denying leave requests and creating limits on what leave can be carried over into future rotations. Legislation aimed at allowing key workers to carry over untaken leave during the pandemic specifically excludes junior doctors.  

There is notably no national agreement on payment for untaken leave, and the new version of the contract has been withdrawn from the NHS Employers website – perhaps due to the new section on the value of a day of annual leave.

16.9       On termination of your employment, you will be entitled to pay in lieu of any outstanding entitlement accrued in the leave year in which your employment terminates or be required to repay to the Trust salary received in respect of annual leave taken in excess of entitlement. The amount of the payment or repayment shall be based on accrued salary for the leave year paid at a rate of 1/260th of your salary for each day accrued.

Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016 Version 9 (withdrawn)

There also doesn’t appear to be a pay deal for >1 in 2 weekend frequency, though some local BMA reps have won excellent deals (eg at Liverpool University Teaching Hospitals).

In nursing, the government has withdrawn the deal offering payment to “aspirant nurses” (final year nursing students) leaving many in the lurch, despite thunderously clapping for carers.

We cannot trust the government, or NHS Employers, to treat us fairly or recognise our work with mealy mouthed promises. If there is a second wave, we must not be put in this position again – we need better protections and agreements on pay and training arrangements in advance.

We are shattered

Many of us have had an extremely rough few months. Some of us have lost friends, family, and colleagues to the virus. Some of us have been sick. Some have not been able to see our families – abroad, or living away for protection, or shielded. Most of us have cancelled leave, given up training plans, worked harder rotas and stepped into unfamiliar medicine to play our part in pandemic response.

Now more than ever we need contractual protections for rest and working hours, alongside other positive trade union endeavours like the Fatigue and Facilities Charter. Many of the positive aspects of the response to the pandemic are already being stripped away. If we don’t act now to allow recuperation, there won’t be anything left to give in a second wave.

The BMA must now withdraw from the joint statement and work with local representatives to ensure safe rest and hours limits are implemented across the UK.

Nationalise Care Homes – ARM

Author: Giancarlo Bell

This is the fifth of several pieces arising from the ARM 2019, explaining our positions on the debates which occurred there.

Motion 90 ARM 2019.

Britain should nationalise its extensive network of private care homes so that the vulnerable residents of these establishments can benefit from the improved standards of care afforded by the staff and systems of the NHS. Nationalisation could also provide better regulation, improved working conditions, and higher pay for the millions of workers in the social care sector, as well as offering better integration between social care and NHS medical care processes. This was the crux of Motion 90, submitted by North East Regional Council at ARM 2019. While the Broad Left was firmly supportive of this motion, the room at ARM was divided, with many representatives questioning whether bringing social care into the NHS was the right strategy to improve falling standards. Despite the strength of the opposition presented at ARM, the Broad Left are delighted that the motion passed in all parts.

Before the recession, care homes were regarded as bulletproof investments for private equity firms. The British population was ageing, and so thousands more elderly people could be churned out into the private care system every year with a premium hanging over their heads – profit for the care home bosses. This perceived stability provoked increasingly risky financial investments and a series of reckless economic expansions, subsidised with the money of taxpayers and the savings of our elderly population. No company better embodied this story than Southern Cross, formerly the UK’s largest social care provider with a peak of 31,000 residents in 750 homes [i]. They followed the tried-and-tested pattern outlined above, with a constant cycle of buying and selling new properties and pushing into new markets. After the credit crunch, Southern Cross was hit by rising rents, decreased expenditure by councils, and falling property prices. They responded by squeezing employee pay and decreasing the quality of care provided to postpone their inevitable decline [ii].

Our elderly friends, loved ones, and colleagues should not be at the mercy of neoliberal market forces. We are a wealthy country, and we should guarantee a basic standard of living for everyone. While doctors in general, and BMA members especially, believe in a publicly funded NHS which is free at the point of delivery, these values are more contentious when it comes to social care. There has been something of a shift in the Overton window in this instance. While almost 200,000 of the half a million care home beds in the UK were operated by the NHS or local authorities in 1990, this number has dwindled to about 30,000 [i]. The public accepts the dogma that the state provides health care; while the private sector provides social care.

By bringing care homes into the public sector we can equalise the huge variation in standards of care seen across the care home industry. The private operators’ main motive is profit; the care of their residents is a secondary priority. As such, we have seen dwindling standards of care, and a growing incidence of neglect and abuse at care homes across the country [iii]. At ARM, opponents of Motion 90 argued that the care homes which scored most positively under the scrutiny of CQC review were small, privately run establishments. This may work out nicely for the people who can afford to live in such homes, but the working class are left to fend for themselves in those cheaper, often poorly run care homes with low-paid, overworked staff, because staying in a top-quality care home when nursing care is required can cost as much as £55,000/year [iv]. We would not accept such inequality in healthcare.

Employees in the care sector are at breaking point. They are working longer hours, for less pay, and with fewer benefits than their colleagues working in NHS hospitals. They also receive less training and are frequently employed on unstable zero-hour contracts with little in the way of career progression [v]. By bringing care into the NHS, we can employ care home workers on humane terms, with the pay and conditions they deserve, which will subsequently improve the standard of care they are capable of delivering.

Medical wards in NHS hospitals across the country are burdened with the complex issue of ‘acopia’ and ‘social admissions’. There has been fierce debate about the validity of these terms and about how to solve the issues underlying these admissions, but nationalising care homes could be an important step towards a solution. If care homes were provided on a universal, free basis like healthcare, and their staff were part of a wider, integrated NHS system, then elderly patients who are unable to cope at home could be admitted to somewhere to truly meet their needs, rather than taking up a costly hospital bed. This could save our NHS a significant sum of money.

Now that this motion has made it through ARM, the BMA should be unerring in its support for nationalising care homes. We must show that we believe in a humane standard of care regardless of class background, that we stand for health and social care which is comprehensive, universal, and free at the point of delivery. We must show solidarity with the workers in the care home sector. Our elderly population, and the workers looking after them, deserve better than to be treated as pawns in the games played by private equity firms.

[i] https://www.socialist.net/britains-care-homes-in-crisis-nationalise-them-now.htm

[ii] https://www.theguardian.com/business/2011/jul/16/southern-cross-incurable-sick-business-model

[iii] https://www.independent.co.uk/news/health/abuse-care-home-cqc-autism-learning-disability-whorlton-hall-police-a8969026.html

[iv] https://www.moneyadviceservice.org.uk/en/articles/care-home-or-home-care

[v] https://www.independent.co.uk/news/uk/home-news/care-home-workers-half-leave-jobs-within-year-staffing-levels-problem-report-communities-and-local-a7658281.html