The UK’s National Health Service (NHS) is in the midst of an unprecedented crisis, principally caused by austerity-driven under-funding, rising patient demand, deep cuts to social care services and chronic staff shortages. At the same time, the Health and Social Care Act (2012) has ushered in profound change through the wholesale marketization and privatisation (commissioning) of much NHS provision in England (Pollock and Price, 2011). This paper explores the degree to which early-career medics’ have an ethico-political commitment to the NHS as a universal, high quality service, free at the point of need in the context of widespread and deep-seated support for NHS values in British society (Gershlick et al., 2015). In doing so, it explores junior doctors’ responses to the deepening NHS crisis and increasing privatisation in terms of their ideas, feelings, actions and future career plans.
Evidence is presented from an ongoing study of early-career clinicians’ experience of work, employment and career in the NHS based on 30 in-depth interviews with junior doctors from across the UK conducted between June 2014 and November 2015. The interviews comprised a biographical-narrative-interpretive approach (Ross and Moore, 2014) with elements of theory-led (Smith and Elger, 2014) and active-partisan involvement by the interviewer (Brook and Darlington, 2013). The interview data is supplemented by observational data from junior doctors ‘Save Our Contract’ protest meetings and demonstrations, plus textual data from related social media campaigning.
A moral economy perspective (Bolton and Laser, 2013; Thompson, 1991) is utilised to explore the extent to which early-career medics possess a lay morality (Sayer, 2000) whereby good medical practice (GMC, 2014) is widely understood to be underpinned by a personal commitment to medicine combined with ideological support for the socialised health values of the NHS. This is explored through contrasting junior doctors’ expectations of medical practice and future careers with their experience of the medical labour process (Walsh, 2013) in a crisis-ridden NHS, together with their reactions to the public debate on care quality and the future of the NHS as a not-for-profit, socialised service.
A large majority of the interviewees, especially British medics, expressed a deeply held commitment to the NHS as a universal health service, free at the point of need. Their long-term decision to stay in, or leave, the NHS often included weighing-up whether it will remain a public service available to all, irrespective of income. Very few interviewees expressed confidence in their own collective capacity to organise and protest through their trade union, the British Medical Association (BMA). However, most interviews were undertaken prior to the 2015 general election since when there is evidence of growing grassroots protest by medics against Conservative government NHS policy. In September 2015, a large grass-roots organised ‘Save Our Contract’ campaign among English junior doctors for strike action against the government’s plan to severely worsen their pay and working hours and risk patient safety succeeded in persuading the BMA to announce a ballot for industrial action. The campaign included militant demonstrations by thousands of medics marked by pro-NHS slogans and chants. The paper argues that as junior doctors’ shared moral economy of passionate support for NHS values is challenged and tested it is being transformed from a largely atomised and placid commitment into one where growing numbers collectively organise and actively resist.
References
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