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The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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“If you have tears prepare to shed them now”. The next set of problems for the BMA.

Filed Under (BMA) by Paul on 25-06-2012

When it examines the outcomes of its industrial action last week what lessons does the BMA learn and how does it decide what to do next?

As I commented on Friday it is difficult to understand how they might decide whether or not the industrial action was successful. They will have local reports telling them how well their membership engaged with the action. There will have been a few resignations but I suspect that, by and large, the membership will have taken action as recommended. (It is after all a bit easier to take inaction than to take action).

The BMA leadership will also have a digest of what the media said about the action – which won’t be good. However even though the BMA received a panning in the media at the moment these attacks are of little consequence. There is a short term reputational hit, but as of this weekend it will not lead to big relationship problems for the BMA. But if there are more days of industrial action this will change.

The BMA will also have to make a judgement about the whole aim of the action – which was to persuade the Government to renegotiate pensions. At the moment, it would appear that the action has not been successful in this regard.

Indeed if I were the BMA leadership one factor I would need to take into account is that – right now – they are taking on a Secretary of State who is famously inadequate as a communicator.

In terms of communication he probably had his best days of being in the job in two years last Wednesday and Thursday. The BMA had handed him the opportunity to adopt a pro-patient narrative which was simple and direct and he managed to use it in nearly every interview to get his message across.

If I were the BMA I would also need to take into account the fact that if they take more industrial action in the autumn it is just possible that there will by then be a new Secretary of State who might be a first class communicator.

Over the last few days I have been imagining what either of my old bosses, Alan Milburn or John Reid would have made of this particular communications battle. How would they have responded to the BMA’s industrial action?

I would expect that their defence of NHS patients against the BMA’s action would have begun on the Saturday before the action – and would still be going on. This would have been a news story which would have lasted the whole week and which by the day of the action would have placed the BMA on the defensive.

On the day of inaction itself, in every region of the country, ministers would have turned up at hospitals and surgeries to talk with patients as they were being turned away. Every region of the country would have had the opportunity to have an interview with both a minister and a puzzled patient about what was going on. If the Government wanted to be really tough those interviews would have been carried out in the car park next to the doctors’ cars.

So if they take industrial action again the BMA may just have to take on a Secretary of State with a good communication plan and a point to make. (If the Government wants one I could provide such a plan).

With all of this evidence to hand, how should the BMA make its decision about whether to go ahead with more industrial action? I think rationally, looking at what happened it is very difficult to see that any good can come from repeating or escalating the action. But rationality doesn’t really come into it.

There are two problems for the BMA that will call for very considerable maturity of leadership.

The first is that if they stop now they will need to explain the rationale for the industrial action they have already taken. They need to be able to say “Whilst we are taking no further action, we were right to take industrial action on June 21 because…. and it has achieved..….” It is difficult to think of words to fill in the blanks.

It is true, as I said on Friday, that the industrial action has brought the issue of doctors’ pensions to the attention of the public, but it is also true that now,  as a result of last Thursday, the public know a bit more. Now many more of them think that doctors get a very good pension – and that it is a bigger and better pension than nearly anyone else they know receives.

Nor can the BMA say, “We are taking no more industrial action because the action we took brought the NHS to its knees.” Saying that would cause the public to hate the BMA even more.

Nor can they say that, “We are taking no more industrial action because our successful action has made the government change their mind on pensions”, because they haven’t.

So the mature leadership action on next steps might be to say “We are taking no more industrial action because we now think that the action was wrong to take in the first place and we apologise. It was a mistake.”   

That would be a big step forward for the BMA and would recoup most of its lost reputation.

That would be the mature response – but another political issue makes this very difficult to give.

The problem is the BMA membership. The vote for industrial action was overwhelming and after all, for many members, there was no financial cost in taking that action. As far as the BMA membership is concerned there is still a problem with their pensions.

And this is the real problem for the BMA. They are about to go through a set of elections which will really test the relationship between leadership and membership.

So there are those who could put themselves forward in the election by saying “We were right to take industrial action, but any further action will get us nowhere, so we are are standing on a platform of calling off the action”.  

Someone else could stand on the platform that “Our action was successful; we now need to vote for more industrial action. One last push and the Government will concede”.  

Just reflect on these two leadership positions for a moment and think which would resonate most with the BMA membership.

Your answer will depend upon how far from the real world you think the membership of the BMA lives.

If the membership vote for a leadership which argues for further action they are moving further away from what is at all possible.

The BMA have discovered the first rule of trades union industrial action – don’t start industrial action if you don’t know how to stop it.

Having started this action will be difficult to stop. This summer presents the opportunity for us to gauge the calibre of both BMA leadership and membership.

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