As somebody who teaches negotiations at the London School of Economics (and whose elder daughter is a junior doctor) I have followed the junior doctors’ dispute very closely. What I have gradually discovered is that one of the key obstacles to the successful resolution of the dispute is that the Secretary of State for Health, Jeremy Hunt, has violated almost every basic principle of effective negotiation.
- Unilaterally setting a deadline for reaching agreement
Meaningful deadlines can help negotiation if both parties see costs in delay and provided both of them agree. But Hunt’s 11 September 2015 deadline, announced in early summer, was entirely arbitrary and its unilateral character signalled a complete lack of interest in the views of the British Medical Association (BMA) negotiators.
- Threatening to impose a solution if there is no agreement
Effective negotiations assume that both parties are strongly motivated to reach agreement and that neither has any credible alternative. Yet Hunt’s statement that he will simply impose the new contracts in August 2016 if negotiations fail sends the opposite message, that his commitment to meaningful negotiation is strictly limited.
- Impugning the integrity of your negotiating partner
Negotiations require a degree of mutual respect between the protagonists but there is little sign of this in many of Jeremy Hunt’s public statements. He has accused BMA leaders of ’misrepresenting’ the government’s offer and most recently of promoting ‘extreme action’ that will ‘harm vulnerable patients’.
- Issuing contradictory messages
Clarity of negotiating demands and offers is a prerequisite for successful outcomes but Jeremy Hunt’s negotiating stance is shrouded in confusion. On the one hand he has declared that his new contract is ‘not a cost cutting exercise’. On the other hand the NHS is heading for a record £2bn deficit in 2015 and Hunt has declared that hospitals must cut costs in order to begin reducing their deficits. The single biggest cost in running the NHS is the wage and salary bill so it is hard to see that record deficits can be reduced without cutbacks to staffing levels, including those of junior doctors.
- Confusing means and ends
Skilled negotiators can distinguish between means and ends: for example, more paid holidays for long serving staff is a means to improve the goal of staff retention. Hunt’s ostensible aim is to encourage more junior doctors to work at weekends in order to reduce the higher mortality rate associated with weekend hospital admissions. But at times he has described junior doctor contracts as ‘out of date’ and given the strong impression their reform is an end in itself.
- Claiming expertise you don’t possess
Hunt recently quoted an article from the British Medical Journal, claiming its figures for higher weekend vs weekday hospital mortality rates vindicated his argument that more junior doctors should work at weekends. In fact the article expressly declared that we did not yet understand the causes of the weekend mortality spike and we could not rule out the possibility that patients admitted at the weekend may have more serious and life threatening illnesses compared to weekday admissions.
- Alienating people whose support and agreement is required
The effect of all these previous errors has been to antagonise and alienate junior doctors, the professional group on whom the Secretary of State depends for the implementation of any reforms. The BMA ballot of junior doctors, conducted in November 2015, showed an astonishing 98% in favour of strike action on a very high, 76% turnout.
- Alienating third party support
Effective negotiators appreciate they often need to win broader public support for their demands, or at least avoid alienating key stakeholders. Public trust in Conservative support for the NHS has never been high but Hunt’s conduct of the dispute shows little awareness or concern about this key source of his own vulnerability. Moreover, a recent Ipsos Mori opinion poll suggests long waiting times and lack of resources top the list of people’s concerns about the NHS; poor weekend services comes way down the list in 7th place.
There clearly is a problem of higher mortality at weekends but the solution to that issue is a thorough review of the scientific evidence leading to the identification and diffusion of best practice. That approach to the issue should be led by the BMA and involve a range of stakeholders, including government, employers and research scientists. The precondition for such an initiative however is that Jeremy Hunt backs away from his obsession with doctors’ pay and hours and turns his attention where it belongs, to patient care and wellbeing.
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