During the current junior contract dispute the events of 1975 have been a point of comparison for various commentators (including me in a Guardian piece), but there’s been little focus on the details of negotiations and what eventually settled it. In this blog I’ll be looking in detail at how the context around the last junior doctors’ strike, what happened and why eventually came to an end.
Although 1975 was the first time British doctors had officially gone on strike, it wasn’t the first conflict over pay in healthcare. The British Medical Association (BMA) had been active over doctors’ pay almost since its inception. From 1838 physicians fought over payments under the poor law, then from 1911 over money for free treatment administered by panel doctors. Even as the new national health service was being established in 1947, doctors debated the structure of their pay packets.
Although the 1950s and 1960s were largely conflict-free, dissatisfaction was building amongst many over the value of doctors’ pay. In 1962 the BMA’s complaints forced the government to establish the Review Body for Doctors’ and Dentists’ Remuneration (RBDD) and in 1966, 18,000 doctors threatened to resign en masse if their pay continued to decline. By 1975, both Labour and Conservative governments had spent thirty years barely avoiding direct conflict with doctors over pay, and with almost every other group of employees (including nurses) going on strike in the early 1970s the prospects for keeping industrial peace rapidly diminished.
The motivation for conflict when it finally came was a mixture of hours and pay. Prior to 1975, junior doctors had been paid extra whenever they worked above 80 hours a week, clocking 85.6 on average (43.2 on normal duty, 42.4 on call). Recognising this workload to be excessive, the RBDD proposed to reduce standard hours to 44, offering additional pay for any overtime.
Initially, some in the BMA were in favour of the new contract as it left doctors “better able to plan their lives”. However, with the Labour Government looking to restrain public sector pay, no new money was available and the scheme proposed reducing the bonus level for each additional hour by two thirds. Consequently, Junior doctors claimed the new contract would cut their pay and do little to curb excessive hours. Calling for no wage cuts and a 40-hour standard week, in October thousands of junior doctors organised bans on non-emergency work and various other kinds of collective action in different parts of the country.
Back then, junior doctors felt little need to brand their collective action as a defence of the service by proxy, instead arguing in terms of their living standards. One of their leaders, Dr Wasily Sakalo, an Australian doctor of Ukrainian descent earned particular notoriety as a militant in the 1975 strike, putting the doctors’ case in The Times:
“One of my sisters, Alla, who is 24, is a first-year house officer [in Australia] and she is earning £9,000 for 40 hours, with time and a quarter for overtime. She has been qualified for nine months. I have been qualified for seven years and I am on £4,500. It made me determined to try to obtain the same work conditions for British doctors.”
As historians David Wright, Sasha Mullally and Mary Colleen Cordukes note, by the mid-1970s NHS doctors formed part of an internationalising workforce, featuring migration in and out of Britain. Canada was a favoured destination, and during the 1960s approximately 8,000 British-trained physicians moved there, often being replaced by migrant doctors themselves. Consequently, many junior doctors were highly aware of their value on a global market-place. Then, as now, the prospects for “medical brain drain” were emphasised as the potentially disastrous consequence of their grievances being left unresolved.
However, unlike in the present dispute, the junior doctors’ actions were widely criticised by senior colleagues. One letter to The Times, by four London-based consultants read:
“The present dispute… is concerned with the relative affluence of doctors. It is not a fight to cure their poverty. Can it be right that a doctor be struck from the medical list for having sexual relations with a patient, while it appears to be legitimate to deliberately withhold treatment in the cause of doctors’ own financial gain?”
Despite their lack of external support and dependence largely on their own capacity for disruption, the junior doctors’ dispute dragged on for months of “go-slows”, partial strikes and walkouts, continuing the government found a further £2.3m to fund their overtime and concessions over hours. They finally resumed normal working in January 1976.
This partial victory for the doctors reflected in part the leverage that NHS staff wield when they stop work even in quite partial ways. The service often seems to teeter on the margins of functionality, and fairly small bouts of collective action can often send things rapidly out of kilter. In 1975, the NHS’ precariousness combined with the doctors’ own self-awareness of their value to the service to make it difficult for the government to force them back to work through moral pressure alone, even when that pressure was applied by their senior colleagues. Only when substantial extra money was found and a real improvement in working conditions offered did the BMA feel like it could finally persuade their members both to settle and, ultimately, to stay in Britain.
Securing a similar outcome with no new money and in the teeth of support from the public and other groups of NHS workers represents a huge problem for health minister Jeremy Hunt.
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