Rakesh Mistry, Final year medical student at the University of Birmingham
The fight or flight response was first proposed by Walter Bradford Cannon in his book The Wisdom of the Body in 1932. The response describes a physiological reaction to a perceived harmful event, attack or threat to survival. Changes that occur include (among other things) redirection of blood flow to muscles that will be used primarily in the response, acceleration of heart and lung action and dilation of pupils. The overall functions of such changes are to supply the body with the extra energy, speed and strength needed to survive as well as prevent excessive blood loss in the event of injury. The options available to the subject are to fight the attack or to flee.
On Saturday 17th October 2015, attending the junior doctor contract protests in London I could not help but feel the relevance of such an analogy to the state of the medical profession and the National Health Service (NHS). Twenty thousand protestors gathered in London to voice their concerns over the unsafe and unfair nature of Jeremy Hunt’s imposition of a junior doctor contract and the consequent attack on the NHS. The medical profession is looking to protect the survival of the NHS. And from the evidence of the protest it looks like the medical profession is firmly engaging in the fight response.
Noam Chomsky once described how ‘there is a standard technique of privatisation, namely defund what you want to privatise… That’s the standard technique of privatisation: defund, make sure things don’t work, people get angry, you hand it over to private capital’. Only earlier this month the NHS was deemed to be in crisis due to its deficit. The Health and Social Care Act 2012 removed the duty of the secretary of state to secure and provide healthcare for all (Health and Social Care Act 2012). And now junior doctors see the new contract imposition to be further accelerating this process. Alongside the unsafe and unfair nature of the contract, the prospect of privatisation is a large part of the reason we are fighting against it.
Amidst all this uncertainty however, my outlook remains bittersweet. Indeed, there is a fight to keep our NHS alive. Yet, through this there has been a remarkable empowerment of clinicians. As a firm believer in a clinician led NHS at all levels, what has provided me with a sense of joy throughout all of this uncertainty is the emergence of medical leadership.
Too often when mentioning medical leadership and management amongst my colleagues and seniors I am greeted with phrases such as ‘it’s not my job’, ‘it’s a necessary evil’ and ‘moving to the darkside’. What has impressed (and surprised) me throughout the junior doctor campaign is the distributed and transformational leadership emerging from the profession. Since the contract developments there have been numerous Facebook groups, Tweets and most importantly salient conversations between clinicians on how the NHS is led and operates.
The common thread uniting clinicians is a passion, resilience and belief in the NHS, which derives from experience in the day-to-day caring of patients. The vast majority have lived, breathed and slept Aneurin Bevan’s vision and finally on Saturday 17th October 2015, we as a profession were engaging and taking ownership for the future of our organisation.
Without doubt, the threat to our profession and the NHS is immediate and life threatening. However, being stunned into our fight or flight response we as a profession must direct our ‘bloodflow’ to the strongest ‘muscles’ we have in order to fight off this threat. Our biggest strength lies in our own leadership. Both collectively and individually we have already demonstrated how powerful and capable we are. We hold a unique ability to combine an evident passion with our practical experience of healthcare to lead the NHS in a direction that will continue to uphold our moral principles as well as the excellent standards.
In the short term, the immediate path to resolution seems unclear. In the longer term and for the survival of the NHS, the saga has demonstrated the true value of clinicians holding and influencing leadership and management roles. By no means are these roles easy and by no means are they for everyone - balancing clinical commitments with leadership and management tasks in an already busy schedule is no mean feat. However what I hope this situation has done is highlight our unique ability and vital contribution as clinicians over and above anyone else to provide leadership through experience. Hopefully too, it has inspired a few more clinicians to pursue this avenue in the future to fight for the moral principles and excellent care of the NHS.