ABSTRACT
155(Next item: Dr Christian Barnard) 2. 2 January 1975 13.00 Item 2(Previous item: IRA extends ceasefire)DOCTORS/STUDIO INTVW jo 11,000 hospital consultants throughout Britain began their work-to-rule or work-to-contract today to protest about the new contract offered to them by the Government.It’s the first work-to-rule ever by consultants in the NHS and the British Medical Association says there’s every evidence of massive support this morning.The consultants say the contract they’ve been offered will put an end to the independence of the medical profession, and they’re meeting this afternoon to decide what to do next. One sanction they’re threatening is wholesale resignation from the NHS, which according to Mr. Clifford Astley, Chairman of the Central Committee for the Hospital Medical Services — that’s the group that represents the consultants — could come in a matter of a few weeks. The junior hospital doctors — that’s all those below consultant level — have pledged their support for the consultants, and are threatening to take action of their own unless their demands for a 40 hour week are met.They’ve written to the Secretary of State for Social Services, Mrs. Barbara Castle, asking for a meeting next week.The effect of the present work-to-rule is expected to be cumulative.Emergencies will be covered but waiting lists for non-urgent treatment will grow, and out-patients clinics will be cut back.But if the junior doctors also take action, then the NHS could be reduced to an ‘emergency only’ service.With me is the Secretary of State for Health Services, Mrs. Barbara Castle. studio intvw Kee: Mrs. Castle, on the face of it, it seems a terrible indictment of you as an employer that the very top people in the medical profession should be forced for the first time in history to take this action. Castle: Well, I think the position is, as with the nurses earlier, that I have inherited the pent up frustration of years by the consultants. This is something I inherited throughout the whole of the health service, and I’m hopeful that just as we did give the nurses a fair deal, then in the same way we shall be able to agree with the consultants a fair deal for them, because you see, the interesting thing is that in this new contract I am offering them I am giving them something they have asked my Conservative predecessors for in vain — namely a 156contract which is a closed contract. That is to say they get paid for a defined number of hours, and if they do extra sessions, or if they do emergency calls at weekends and at nights, they will get paid extra. It’s a more workload sensitive contract — it meets their major point that they have been working long hours for which they haven’t been paid. Kee: Yes, but their answer to this of course is that certainly you have given them payment for overtime, which they’ve always wanted to have, but you’ve given it to them on terms which totally undermine the independence of their profession — on terms which make it impossible for them to do what they want to do with their own spare time, because they are now penalised if they take on private medecine. Castle: I have given it to them on the terms which have obtained under the existing contract ever since Nye Bevan introduced the National Health Service in 1948. It is not I who am trying to take away the independence of the profession. I…, it is they who are trying to put back the clock, because you see at present, under their existing contract, there has always been a differential in pay between the man who does the private practice and the chap who says, ‘No, I will have no outside commitments, I will make myself totally available to my National Health Service patients.’ Now I should think that’s a commonsense principle. If a man is totally available, with no outside distractions, he should continue to be recognised. Now this is what I want to do, and it is not a new principle, and when they say I’m undermining the independence of the profession, do they think it’s been undermined all these years while the differential has obtained? No, I think this is a bogey that they are introducing as a distraction, and I think it would be quite wrong to do what they want me to do, which is penalise the man who makes himself whole time available to the Health Service. Kee: I don’t think you can fairly refer back to the principles that have obtained, because you are changing all those principles, as you rightly claim, with this new offer. Surely now by giving a differential of 18% to people who work full time in the National Health Service, and don’t have any private medecine, you are really trying to implement a political dogma. You are not remedying grievances, you are offering an inducement to comply with political dogma. Castle: No, I am trying to continue what has always been part of the compromise Aneurin Bevan entered into with the profession. Now I’m offering a compromise to them. I am not saying they must not 157do private practice, I am… Kee: But you are penalising them for doing private practice… Castle: No, I’m sorry, it is they who want to penalise the man who says, ‘I won’t do private practice’. That man at present gets a differential of 18%, and I say to the profession, ‘Look, I’m not attempting to impose a whole time service on you, not even imposing this contract, if you don’t want it. You’re free to reject it and go on as you are now, but the compromise that I’m offering you…’ Kee: But they… Castle: But I’m offering them a compromise they can continue to have, the freedom to do private practice, but where the man says, ‘No, I won’t, I won’t have outside distractions’, I think it would be wrong to take from him the differential he’s got now. Kee: But now, whether this is as reasonable as you make it out or not, they don’t think so, and the fact remains that you’ve reached a major crisis in the National Health Service. In the last 10 years we’ve seen 4,000 doctors born and educated in this country leave because they don’t like the conditions — mustn’t you do something better than you’ve done so far to stop this happening? Castle: Well, I’ll tell you what we’ve got to do. We’ve got to sit down and have a look at this contract together, because I think this mood is due to an entire misunderstanding of the contract. You see, what shocks me is this. First the profession threatened me with a strike unless the Government produced a firm statement of what it was prepared to accept, and produced it the Friday before Christmas. So I did that. Then they said, ‘Oh, you’ve brought it on a take it or leave it basis.’ I said, ‘Look, take this contract away, discuss it with your members. The details are negotiable — the principles aren’t, but the details are. Then let us meet after Christmas. Suspend your action, let us meet after Christmas, and then, you will be able to see more clearly how it affects all your members.’ Oh, no. They were all geared up for a strike. They’ve had a strike in their system, I think, for sometime because of the years of frustration when consultants’ pay has been held down under the pay policy of the Tories. Kee: But you see, you say you’ll negotiate in any new meeting over details, but not the principle. It’s the principle they’re objecting to. Castle: Yes, but I don’t think they understand, you see, just the nature of the principles. It is true that some of them, not all — we 158don’t know exactly how many do respond favourably to the contract, and how many feel outraged by it. But it is true that people like Dr. Brian Lewis want to go very much further. They want a complete items-of-service contract, which means they get paid piece work. For an operation they get so much. For a visit they get paid so much — a kind of American system which would destroy our health service. Now I had to tell them that the principle was not negotiable, because the Government is already going a long way by being prepared to put extra money into their pockets for work that at present they don’t get paid for, and in our present economic situation, the Government has really gone a very long way to try and meet what I feel, and the Government feels, is some of their legitimate grievances. Kee: But you will meet them once again? Castle: Oh, but I’m ready to meet them at any time, and I have already told the junior hospital doctors I will gladly meet them next week. Kee: Thank you very much Mrs. Castle. rt: 6’52”
