Editorial Tuesday 26 April 2016: The first coup-coup of Spring sees junior doctors bursting all-out all over

Tom Stoppard's Indian Ink features an entertaining passage where Indian book reviewer Dilip offers American academic Eldon Pike a take on Indian attitudes to beggars:

"When a beggar presents himself to you, you have to ask yourself - do I need a beggar today? If you do, give him alms. If you don't, don't".

As the first strike withdrawing 'junior' doctors' emergency cover begins, both Health Secretary Jeremy Hunt and junior doctors' leaders should be asking themselves 'do I need an industrial dispute today?'

Earl of Worcester: I have not sought the day of this dislike.
King Henry IV: You have not sought it? How comes it then?
Falstaff: Rebellion lay in his way, and he found it.
(Henry IV Part 1, William Shakespeare)

Why might Jeremy Hunt need this dispute?
He would argue that this is about patient safety and the weekend effect on outcomes.

That would be an effective argument, if the weekend effect were not hotly contested (including by leaked DH documents).

The BMJ's editor Fiona Godlee has a good summary here; her letter to Mr Hunt is here; the UK Statistics Authority's letter regarding Mr Hunt's implications of a causal relationship between weekend staffing and mortality is here.

Economist Tim Hartford has a good overall review of the truthiness of the general approach taken to statistics and data here.

It would be churlish and wrong to claim that Mr Hunt has not shown a real commitment to advancing the cause of patient safety during his tenure.

Equally, it would be silly to ignore the fact that he repeatedly implies a causal relationship between the old contract for junior doctors and higher mortality at weekends, when no such relationship has been proven.

As Tim Hartford notes, the statement in response from from Mr Hunt's office when the excellent Full Fact asked him to amend the Parliamentary record was "a spectacular piece of bullshit".

Is the old junior doctors' contract the problem?

Given that high-performing provider organisations such as Salford Royal, University Hospitals Birmingham and many others already provide significant seven-day services using the old contract, we would have to conclude that it cannot be.

(As I previously observed, rostering skills may well be the problem.)

The first coup-coup of Spring
Yesterday's hysterical outburst from someone speaking for Mr Hunt (or claiming to), as well as being the first coup-coup of spring, offers an interesting insight that, for all the Government's private aim to play this dispute as a long game, temperatures are rising and nerves fraying in Richmond House - and perhaps the Cabinet or Number 10.

These nerves won't have been calmed by a new opinion poll from Ipsos MORI which shows that public support for junior doctors has remained at a fairly consistent majority, even with the all-out nature of this strike.

For all that, someone close to Mr Hunt (but not, I am assured, his very special advisors) has also briefed the BBC that he would like to remain as health secretary for several more years.

Why might junior doctors and their leaders need this dispute?
The sticking point of the contract negotiations emerged over Saturday pay rates, a topic on which the BMA changed its mind about being willing to negotiate.

Pay, terms and conditions are important, and do inform patient safety. More importantly, they affect recruitment and retention of expensively-trained staff who are in international demand.

This dispute has unleashed reservoirs of anger among junior doctors that far exceed what it would be proportionate and reasonable to expect in a contractual dispute. A big problem has been surfaced, and it won't just go away.

It is obvious that junior doctors feel seriously under-represented and disengaged. This contractual dispute has just provided the blue touch paper, which both Mr Hunt and the BMA JDC leaders have lit with the enthusiasm of an arsonist who's just found their matches.

The BMA's communication of their members' case has struggled to rise to the giddy heights of total ineptitude, given OECD data on staffing and resources.

The BMA's hugely-evident internal split over the objective, tactics and strategy has seen their mechanics and planning leak and leak again to HSJ's Shaun Lintern, whose new emergency plumbing business in Tavistock Square could increase GDP significantly.

At least the BMA is only split on pretty much every single thing about how to conduct the dispute and the industrial action.

The Government is split on the Conservatives' zombie issue of Europe and Brexit. PM David Cameron wants the country to trust him and follow his advice to vote to remain in the EU in the June's referendum.

That might not make this a smart time to be fighting teachers, with the forced academisation policy which has no evidence base (noticing a theme here?), and is unpopular with Mr Cameron's own backbenchers.

Both sides have backed themselves into a corner, like the useless negotiators that they are.

As the Grand Old Duke Of York proves, the sign of a successful leader does not stop with the ability to march your troops up to the top of the hill.

You also have to be able to march them down again.