6th July 2016

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Sir Andrew Dillon
Boss of NICE, in conversation with Roy Lilley
Overnight bag
News and Comment from Roy Lilley
By a sizeable majority 58% - 42% and on a decent turnout, 68%, the Junior Docs have said stuff-yer-contract.
What now? 
The JD leader Johann Malawana, has done a Boris, thrown in the towel and left them to get on with it.
The JD BMA committee never endorsed the contract, which I thought was a dereliction of leadership.  Nevertheless, they though it good enough to leave it for the members to decide
They have.  They don't like it.
The BMA are in a tricky spot.  The JDs have got to find, vote and install a new leader and then take a view, decide on a strategy and ballot for more strikes.  That will take a month or three. 
New rotas are due to start for 6,000 newly qualified doctors arrive in August and the new pay system will kick-in later in the year.  The 55,000 JDs will be moved on to the new contract from that point onward.
The JD might organise too late.
Trusts, far more occupied with finding the Jim Reaper's 250m, and survival, are in no mood to palaver about.  They have the contract rotas worked out and Bob's yer uncle.
The JD dispute long-since stopped being about weekend working.
The dispute is about not enough doctors, austerity, political leadership and a general lightening-rod for a wider disaffection, not just in health but across the whole public sector.  The teachers are on strike yesterday, voicing identical arguments.
Issues have become confused and blurred.  When I started to take an interest in the strikes it was difficult to find a JD who had actually read peacemaker, David Dalton's letter, summarising what was on offer.  Later, finding someone who had read and understood the contract was a rarity.
As the story dragged on I thought Malawana should have stepped down and told him so.  Now he's gone; no doubt in frustration and disappointment.  He made industrial relations history, piled patients up on waiting lists and made life hell for Trust managers, for what?
Malawana is a paediatrician, a sincere and tender man but he is probably the most useless, ill-prepared trade union leader in history.  Never cut out for the role.  A prisoner of events and a pretty vicious minority, working social media.  The HSJ email leaks revealed the BMA were running a dangerous double game. 
A public face wanting reconciliation.  A sinister private face; wanting to spin-out the dispute and damage the government.
By the time Malawana realised accepting the contract was about the best he could do, the atmosphere was toxic.  Mistrust, suspicion and doubt... much of it misplaced.  Much of it, it appears, deliberately fostered.
In the end the aggression and the hostility not only damaged the NHS and patients, it also damaged the JDs themselves.  
Who follows Malawana?  A peace maker or a radical?
Unless the JDs recognise the realpolitik and this vote is a mistake, we are in for another bruising and damaging time.  A time when the NHS can least cope with it.

The contract can't fix recruitment, can't fix equality when people are not working equally, can't fix a public expectation that they shouldn't be marooned in hospital waiting for Monday.

There is more; the JDs are overdrawn on public trust, investment is at an all time low.  They are facing payback time.
There is no more money and there are no more doctors.  The 7-day-thing is a distraction.  JDs work seven days anyway and the Tinkeman has to shoulder the blame for getting the words and the mood music to his 7-day policy about as wrong as he could.
The BMA must take ownership of this mess.  Their constitutional arrangements leave the component committees with a large measure of autonomy but it is now time for wiser heads to prevail.
This news is a birthday present the NHS can do without.  We are heading for more harm to patients and more harm to the profession of doctoring, plunging headlong into uncertainty and a likely contagion across the public sector.
The future?  Trusts have been modelling the new contract and rotas.  They will know if, what is on offer, is workable or not and they must say so.
The Confed must find a voice even if it is discommodious to their ex-Tory Health Minister Chairman.
The 7-day policy objective, perhaps, once something we could all aspire to, is now poisonous.  The Tinkerman should step back.  Leave it to the Jim Reaper to draw the sting and deliver it, where it can be done, before the next election.  
Logic says there will have to be more talks.  But who do we talk to?  Who speaks for JDs?  Patently not the BMA.  An imposed contract is looking ever more likely. 

St David Dalton had better get his overnight bag packed.
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18th July - King's Fund - 5.30pm
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26th Sept Kings Fund  5.30pm.
Ed Smith 
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This is what I'm hearing;
if you know different,
tell me here
>>  I'm hearing - the result of the JD ballot came as no surprise to the DH.  I wonder what their plan B is?  Six thousand junior doctors could start on the new contract next month.  Without a leader the JDs may well find themselves eclipsed by events.  And, let's face it; the dispute ceased being about weekend working a long time ago. 
>>  I'm hearing - troubled Southern Trust boss Katrina Percy has the full support of the local GPs who want her to stay in post.
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