Nhs

Until now, it has not been clear to most people what the junior doctors’ strikes are all about. It began about a total pay cut masquerading as a ‘basic pay rise’. Then it became about protecting doctors’ family and social lives at weekends. Most recently, there have been accusations of sexism. Somewhere in the middle, the more marketable concern about patient safety was introduced, and has risen to the forefront of the junior doctors’ campaign. Last time I wrote, I considered the plausibility of these claims. I suggested that the strikes are primarily about doctors’ quality of life. This is no cause for shame: everyone has the right to campaign and work for a better quality of life.

In the 1920s, the anthropologist Margaret Mead studied the people of New Guinea. She noticed that they hunted birds and squirrels but not flying squirrels. The tribesmen explained that they didn’t like flying squirrels: a thing should be either a bird or a squirrel. They wanted nothing to do with the dirty things. And while New Guineans of the 1920s were not leaders of scientific inquiry, Mead concluded that they were quite unstressed at work. Bear with me, because I think the flying squirrel may just be the answer to the stress epidemic that is killing us. Apparently, we’re dying of work-related stress. The media, psychologists and union leaders say that stress could soon be as deadly as cancer and heart disease.

When my unborn baby was a five-month-old fetus, twisting about in the internal dark, he was given a death sentence by a man I shall call Anton. We’d gone, my husband and I, for a 20-week scan at our local hospital. Anton was our designated sonographer; we arrived in his room bright-eyed and anxious, as even elderly first-time parents are. We looked to Anton for reassurance, but Anton looked only at his assistant, a sulky 19-year-old sexpot from Romania. The sexpot tried seven times to dig into the vein in my right arm, then began on the left. ‘Don’t worry, good practice, try again,’ said Anton to her, kindly. ‘No, don’t worry at all!’ said I, pathetically.

There’s some journalistic research you’d really never do by choice. Spending four days in an NHS hospital with a life-threatening pulmonary embolism, for example. Unfortunately it was out of my hands. I fell off a horse, one thing led to another, and suddenly there I was, lying in what I imagine is a reasonably typical NHS ward being tended by all those multi-ethnic nurses and hard-pressed doctors you read about in the newspapers but rarely encounter yourself because in order to do so you have to be quite seriously ill. So: what have I learned? First, that it’s not as bad as you’ve long feared, especially not for anyone hardened by the experience of the military, prison or — in my own case — being at an English prep school in the 1970s.

David Cameron was grilled today on plans for a ‘7-day NHS’. This is his attempt to iron out a slight kink in the NHS schedules. The trouble is that although our heroic doctors and nurses keep regular hours our deadly diseases are hopelessly unpredictable and like to smite us down whenever they feel a bit grim and reaperish. Perhaps we should write to them about it. In practice this means that NHS efficiency varies widely over the ‘7-day cycle’ or ‘week’ as it’s known. Get ill on a Tuesday and you’ll probably be at a party on Friday. Get ill on a Saturday and you’ll probably be at a funeral on Wednesday. Your own.

The BMA needs to think carefully about its next steps. In recent weeks, it has become abundantly clear that there is more to this than just the junior doctors' contract, or indeed the rate of pay for Saturday daytime work. The union can walk away with the deals brokered by Sir David Dalton - which include major concessions on pay and hours - and start to work with the NHS on the wider issue of morale. Or it can continue to do its part to make junior doctors feel worse. Only one of these options will help the NHS meet the very real challenge that it faces. Sadly, peacemakers tend not to prosper within the BMA election process. So instead they pursue macho posturing, and build up whoever is the health secretary as a hate figure.

A few months ago, paramedics were on the brink of industrial action. They had legitimate grievances. Ambulance services were being run down, their staffing levels were dangerously thin — and the mismanagement (much of it exposed by Mary Wakefield in The Spectator) was horrendous. But in the end they stepped back from the brink — for good reason. It went against their nature to endanger lives, and in addition it would have been a tactical mistake. If a single patient died as a result of the strike, paramedics would have lost public sympathy. Should a nationalised health service really use the unwell as a bargaining chip? English doctors have not shown the same strategic foresight.

This is a bleak day for the NHS. The doctors strike has gone ahead and some 3,000 operations have been cancelled. Talks broke down last night, and the British Medical Association has shown it is quite prepared to put patients in the firing line in its dispute over a deal that would mean a pay rise, not a pay cut, for 99 per cent of doctors. From 8am this morning, only emergency care will be provided. Treatment for that once-virulent condition, the British disease of strikes, has largely been successful. The number of working days lost to industrial action in the first ten months of last year was the second-lowest since records began. Pay and conditions have been relentlessly improving.

I’ve never understood the phrase ‘died peacefully’. Two weeks ago I watched my mother die, in the very same NHS hospital where I watched my father die almost ten years earlier. There was nothing peaceful about it, at least from my unwanted ringside seat. The end — acute pneumonia providing the final nail in a soon-to-be purchased coffin — was painfully slow. It dragged on and on and on. She struggled for her last breaths and appeared distressed, confused and frightened to the end. The last time I had been to St Helier hospital in south London was September 2005, as my father slowly slipped away. Naturally the memories came flooding back. And so did confusion. Ten years is a long time, especially in the NHS.