NHS bosses pressure Hunt to agree to arbitration with junior doctors

Jeremy Hunt has come under growing pressure to let independent arbitrators try to settle the junior doctors dispute before their series of strikes starts next month.

Senior NHS figures and leading members of the medical establishment want the health secretary to drop his insistence that the British Medical Association reopen talks with him before asking the Arbitration, Conciliation and Advisory Service (Acas) to mediate between the two sides.

Simon Stevens, NHS England’s chief executive, Prof Sir Bruce Keogh, its medical director, and chief nursing director, Jane Cummings, are among a host of senior figures who have privately told Hunt that he must do whatever is needed to restart negotiations with the doctors’ union in a bid to prevent the strikes by NHS junior doctors in England planned for 1, 8 and 16 December.

The walkouts, which will disrupt non-urgent NHS services, are set to go ahead after 98% of the 28,305 junior doctors who took part in a BMA ballot backed strike action to further their campaign against a punitive new contract that Hunt is threatening to impose on them. In all, 27,741 doctors backed a strike, and only 564 opposed it.

In the wake of that result, the BMA wants Acas to intervene to try and broker a settlement of the increasingly bitter dispute over trainee doctors’ pay, hours and the planned seven-day NHS.

Hunt has so far refused to agree to them getting involved at this stage. He has insisted that the BMA has to first meet him for talks – something it has refused to do for several months in anger at him reserving his right to impose the revised terms and conditions the union says are unfair and unsafe. It wants him to drop that precondition so that meaningful discussions can start.

The Academy of Medical Royal Colleges, which represents all the UK’s 250,000 doctors professionally, is also keen to see Acas getting involved as a matter of urgency. It urged “both sides in the current dispute around junior doctors’ contracts to step back from the brink and re-enter negotiations in good faith so that an agreement can be reached” using independent conciliators if necessary. Heidi Alexander, shadow health secretary, has told David Cameron in a letter that Acas represents the best hope of negotiating a deal because the junior doctors no longer trust the health secretary.

David Behan, a veteran NHS boss who now runs the Care Quality Commission, has also made clear his view that a settlement must be reached to avoid strikes that would damage the NHS. Sources say that Lord Prior, the ex-CQC chair who became a health minister in May, is of the same opinion.

The picture is complicated and Acas’s potential role unclear because, for the moment at least, Hunt’s tough stance has the full support of both the prime minister and George Osborne, the chancellor.

“Number 10 sees this as a miners moment and wants him to look tough,” said a source. “Downing Street and the Treasury are backing Jeremy on this and pressurising him to be deeply muscular, but the top people in NHS England and the medical profession are in despair. They want him to sort it out before it ends up with a strike that nobody wants.”

Dr Mark Porter, the BMA’s chair of council, said that junior doctors’ overwhelming endorsement of strike action should impel Hunt to talk to them through Acas. “The fact that today’s ballot result is near unanimous should be a wake-up call for the government. Instead of continuing to ignore the views of tens of thousands of junior doctors who, in the health secretary’s own words, are the backbone of the NHS, he should, if he really wants to avoid industrial action, accept the BMA’s offer of conciliatory talks,” said Porter.

However, allies of Hunt said that if Cameron was persuaded that the health secretary should remove the obstacle to direct talks via Acas, he would do so. “We can’t rule that out [calling in Acas without prior talks] because if it is the only way of moving it on we would have to be pragmatic about it. It’s not a big victory for the BMA if we do end up at Acas. Remember that we’ve been asking the BMA for weeks now to talk to us. We want to talk.”

If talks do get under way, Hunt is understood to be ready to offer further concessions in a bid to breach the differences between the two sides.

Hospitals are now planning what their priorities should be and what services they will need to cancel on 1 December, when junior doctors provide only emergency cover for 24 hours from 8am, and on 8 and 16 December, when they will stage total walkouts between 8am and 5pm.

“It is regrettable that junior doctors have voted for industrial action which will put patients at risk and see operations cancelled or delayed,” Hunt said. “We want to ensure patients have the same quality of care across the week, and have put forward a generous offer that increases basic pay by 11% and reduces doctors’ hours.

“We hope junior doctors will consider the impact this action – especially the withdrawal of emergency care – will have on patients and reconsider,” he added.

The many responses in the wake of the ballot result included an extraordinary public spat between Keogh and another very senior doctor, Prof Terence Stephenson, the chairman of the General Medical Council, which regulates doctors.

Keogh aroused widespread anger among junior doctors when he sought assurances that they would help if, after events in Paris last Friday, terrorists carried out a similar attack in the UK on one of the days they plan to strike. Many saw that as a slur on their professionalism.

Dr Ben Molyneux, an ex-chair of the BMA’s junior doctor committee, criticised Keogh’s remarks as “overt political spin”.

He added: “In the unlikely event of a terror attack, junior doctors would of course come in.”

Keogh’s surprising move prompted Stephenson to issue a statement which made clear that he did not doubt that all doctors would make themselves available to help with any incident.

“Of course, in the event of a major incident we know and would expect that the entire profession would respond immediately. It is important at this difficult time that all of us in the profession remember our responsibilities – to each other and to our patients,” he said, in what appeared to be a direct rebuke to Keogh.