Guest blogger, Dr Mary Edmondson, has been researching in the TUC Library, for an article on the 1975/76 junior doctors’ strike. Here she writes about the strike, her involvement as a junior doctor at the time, and relates it to the current disputes by health workers.
In August 1975 I started my first job as a qualified doctor. This was a period of economic and social crisis, and very high inflation which peaked at 25%in 1975.
By October I was involved in the first industrial action ever taken by junior doctors. There had been statutory pay restraint in the 1970-74 Heath tory government and NHS staff pay at all levels had fallen behind workers in the private sector. Ancillary staff, nurses and ambulance workers had all flexed their industrial muscle and taken industrial action in the early 70’s. Junior doctors worked to a contract negotiated with the Secretary of State for Health, but pricing and pay was determined by the annual report of the Doctors and Dentists Pay Review body (DDRB) a supposedly independent body, but from the beginning, government constraints and interference were evident.
The April 1975 report of the DDRB was the first for three years not carried out under the constraint of a statutory policy and recommended a 30% uplift for doctors. The DDRB was unable to price the award as the Hospital Junior Staffs Group Council (HJSGC) was still in negotiations with the government over the contract although a basic agreement had been reached.
The HJSGC was a hybrid committee being a subcommittee of the BMA but recognised by the DoH as negotiating on behalf of all junior doctors, BMA members or not. There were in fact two other more militant organisations to which a minority of doctors belonged; the Junior Hospital Doctors Association, which was formed by junior doctors dissatisfied with the BMA, and the Medical Practitioners Union, which merged into the ASTMS union in 1970 and was affiliated to the TUC from the start.
So, the doctor’s dispute was about both the nature of the employment contract, and the rates of pay. Until 1970 junior doctor contracts were completely open- ended. Hours of work were at the behest of the consultant and usually meant 80-100+ hours on duty. After 1970, for hours over 102 per week an extra duty allowance (EDA) could be claimed. Subsequently, in 1974 EDA could be claimed after ‘only’ 80 hours. Claims had to be signed by the consultant and not all were happy to do it. Many were late or simply not claimed.
In January 1975 an agreement was announced between the HJSGC of the BMA, and the Department of Health, on a new contract for junior doctors although due to the complexities of the pay structure there were still areas of uncertainty. The important principle of the working week being 40 hrs was agreed and payment was to be made for additional hours, thus recognising the long working hours of junior doctors.
The then Health Secretary Barbara Castle, in a clever move, asked for a deferment of the start of the contract until October. In the interim, the voluntary pay restraint agreed with the TUC became a statutory pay policy limiting pay awards to no more than £6 per week thus trapping the pricing of the contract within this cap. In addition, government sent guidance to hospitals stating the basic salary hours were 44 not 40. The review body then priced the contract with the pay cap in mind. Using the figures available for doctors’ salaries plus EDA payments historically claimed, the result was that hours over 44 (not the previously agreed 40) would be paid at 1/3 of the basic hourly rate and hours on duty from home at 10%! In addition, some doctors would experience loss of pay.
The HJSGC accepted this ‘reluctantly’ but junior doctors across the country did not. Unofficial action began in October in a few hospitals such as Leicester. Portsmouth, Rochdale, and Northern Ireland, and spread. The action was short of full on strike action. In most hospitals doctors worked only 40hrs a week in shifts which affected the routine work especially routine surgery. After six weeks and a ballot in favour of industrial action the BMA finally moved to back the action which then continued until the end of December 1975. An independent audit of the money available for the pricing of the contract was agreed and action was called off meantime. Some further money was found for the pricing of the contract.
The dispute dragged on through 1976 over issues such as pay for covering absent colleagues and no detriment to any group of doctors. There were calls for further industrial action, but support was waning. The dispute finally came to an end in October 1976. The only obvious gain was that the government had been pressurised into finding a little more money for the pay settlement which was used to revert to the originally agreed 40 hr basic working week.
Was the dispute successful? Many junior doctors thought not as the rates of supplementary pay were not increased. However, in April 1976 David Ennals, then the Health Secretary reported to Parliament that the cost of the new contract which had been estimated using figures for previous supplementary pay, was more than double this amount as claims for the hours above 40 were claimed and administered within a more robust structure and contract. The £6 per week limit had been blown apart.
The dispute was complicated by the concurrent consultants’ dispute over their right to have pay beds in NHS hospitals. Many junior doctors supported the consultants fight with the government. As the consultants of the future, they expected to benefit from the ability to practice privately. But other juniors began to see themselves as part of the wider workforce and had learnt from the industrial action of other groups such as nurses and ambulance workers. There were other fault lines too. Much of the consultant body and some juniors were opposed in principle to doctors taking any action which might impinge on patient care, and this is a conflict still experienced by health workers today. The BMA experienced the same ambivalence towards its dual role, both as professional organisation and as a negotiating organisation. The attitude of the public was mixed although I do not remember meeting any outright hostility from a public which is always inclined to be sympathetic to health workers.
In more recent disputes the BMA seems more comfortable with its Trade Union role than previously and has had the experience of several disputes since 1975. It remains however registered as an independent Trade Union, unaffiliated to the TUC.
The public has been reliably supportive of health workers in dispute as they see the action, like the health workers, as a fight for the survival of the NHS. Health workers and other public service workers have largely recognised that their fight for decent pay and working conditions is not in conflict with the fight for a better health service for everyone.
The junior doctors, at the moment, show no signs of discontinuing their action and have been joined by consultants.