There will be considerable relief that the immediate threat of a national strike by Non-Consultant Hospital Doctors (NCHDs), scheduled for today, has been lifted. But nobody can afford to relax just yet: the final settlement of a problem that has existed for decades has not yet been agreed and there are still difficult negotiations to complete before June 6th, the target date agreed by the parties for completion. That there should still be need for negotiations on the incontrovertible problems facing NCHDs and the hospital services is, frankly, disgraceful. The need to resolve the basic problem of these doctors working excessive hours on duty was raised decades ago, when most people recognised that the old systems of medical apprenticeship were no longer appropriate to the needs either of the young doctors or their patients.
The last NCHD strike, in 1987, was called for exactly the same reasons as this one was (unbearable overtime to be worked and no, or inadequate, remuneration for doing it) and 21 years later the guff coming from the health service employers to the doctors is uncannily similar: "there is a consultancy manpower study almost completed and we can't change until we learn its findings". This was stated in 1987 by the then Minister for Health, Dr Rory O'Hanlon, and it was stated again in recent weeks by the health service employers. The 1987 strike was to demand the implementation of an agreement the doctors thought they had made in 1986 with the public service employers. The strike now deferred was called to demand a more effective implementation of the 1986 agreement. The doctors clearly can have little faith in any agreements they think they have made with their employers.
In fact, the NCHD is a very vulnerable and very insecure member of the hospital staff. He or she must complete two six-month contracts to the satisfaction of the supervising consultant before application can be made to the Medical Council for full registration of medical qualifications. The great majority will prefer to remain much longer than one year with NCHD status in order to expand their clinical skills and experience. Those hoping to go on to acquire specialist qualifications will likely remain for many years within the system of exploitation that is the NCHD's lot, providing little opportunity for necessary study and less for essential sleep. Simultaneously, the demands of hospital medical practice become greater every year: the need for quick and accurate diagnosis and therapeutic decisions in critical situations, something that a sleep-deprived doctor may not always be able to achieve. And for as long as they remain NCHDs they must find new jobs every six to 12 months, adding insecurity to their vulnerability and their stress. Small wonder that many of the best emigrate.
Hospital consultants have paid lip-service to the recognition of the need to alter NCHDs' conditions. But they have remarkably silent and apparently unsupportive of the changes required to meet their younger colleagues' needs (which almost certainly include a need for more consultants). Successive governments for four decades have demonstrated no understanding of the problem and no readiness to resolve it. For as long as it remains, patients will continue to be at risk and our hospital services will the poorer. This time, the basic needs of the NCHDs must be met without equivocation and agreements reached must be implemented forthwith.