Junior Doctors and the Dishwasher Dispute
When I was 15, I witnessed my mum and dad arguing about how to organise the cutlery in the dish washer. The dispute escalated.
Soon she was accusing him of being ‘sloppy’ and he labelled her ‘controlling’. The arguments moved from dishwasher to personality faults. The stakes were higher. Cutlery was thrown rather than put away. Both sides invoked past hurts and the discussion moved swiftly to divorce proceedings.
I had no chance to have a say. Perhaps I could have said: ‘if this is about the cutlery, I am sure you could sort it out without shouting, or even divorcing’. Or: ‘if this is about wider stuff and how you feel about the future of the family, let’s all talk’. At the very least perhaps ‘treat me like a grown up here’.
By the time the bitter rows erupted, I was too scared to say anything. When I did raise my head above the parapet, my brothers told me ‘don’t make it worse’. Or my mum or dad accused me of ‘sticking up for her/him’ and got angry with me.
Does this sound familiar? I am sure we all have our versions.
When the BMA and Jeremy Hunt were discussing pay and conditions, patients witnessed them arguing about how to resolve a seemingly technical dispute. The dispute escalated. It was not apparently 'just' a technical issue. Dishwasher technique was symbolic of wider, deep-seated issues.
Soon one was accusing the other of dogmatism or of potentially harming patients (now or in the future). The stakes became higher – this was about how we want to organise the NHS, whether we want better weekend care, or even according to some, about privatisation, etc etc.
Patients have had no say. There has been no discussion with patients and carers about the wider issues above that affect them (as users of the service) or a voice in policy for the future vision of the NHS (as taxpayers and owners of the NHS). Jeremy Taylor, Director of National Voices and I have written about this here.
Now, as belligerence and bellicose rhetoric rise, and as strike action escalates, lots of patients I have talked to are scared of saying anything publically, of asking questions too loudly or having a view - too frightened of the flak to put their heads above the parapet (a forthcoming BMJ article looks at this issue). Offers from patient groups to help have been ignored. See here.
Even writing this blog feels risky. A few people warned me against it. It makes me feel like that scared child again. It should not be the case that I have to defend myself. But I feel so nervous of stepping into this debate, that I want to state that I have worked 30 years trying to support patients to work with clinicians and doctors as true partners within the NHS - see here for example. I am all about improving things together.
With the future of the NHS family at stake, it’s high time for patients to be involved in the trialogue. And please can all the ‘grown ups’ get their wise heads screwed back on and hot foot it back to the table. Before it is too late. Please.
p.s. Any analogy has its limitations. For example, the government and doctors can't get divorced (I hope). They are going to have to work it out.
p.p.s. There are some articles recently which, from different viewpoints, stress the need for a wider perspective, cooler heads, space for reflection and dialogue. Here are a few which I have found interesting:
p.p.p.s You may not agree with the article, but I hope it leads to more constructive conversations about dishwashing 🙂