- The government’s proposed new contract for Junior doctors in the NHS
- “Hospitals may refuse to impose Hunt’s new contract”
- Preventing Prevent: “students not suspects”
- “Met signals a shift in attitude to rape claims”
- Non compliance and democracy in 2016.
Recent events, including twice being on the picket outside The Royal Hospital in Liverpool, in support of the UK Junior Doctors’ strike (12 01 2016 & 10 02 2016), have caused me to reflect on the question of non compliance. Four examples clarify how we might understand the concept and practice of non compliance in 2016.
The government’s proposed new contract for Junior Doctors in the NHS.
Months ago, a young Junior Doctor friend described the proposed new contract to me as “medieval”. He was agitated, anxious and angry. So was I. We had met through helping organise Liverpool’s People’s Health Assembly in 2013.
Junior Doctors in the UK have been driven to strike by one of the Tory government’s attack dogs, Jeremy Hunt, a man with the permanent stare of a rabbit in the headlights, and a man who once described the NHS (treasured by 92% of the population since its inception in 1947) as “a failed experiment”. This is the man David Cameron judiciously decided to put in charge of the NHS, in place of his previous ill-judged choice, Andrew Lansley, who had himself managed to create havoc and widespread professional hostility within the NHS as he mismanaged its reorganisation. (See Mark Steel’s incisive and hilarious summary online of Hunt’s political progress, including his earlier disastrous period as Culture minister, when his political career just missed becoming toast by a mere Tory whisker.) As Steel puts it, speaking of the Junior Doctors, there they go again, another strike after the last one, only 40 years ago. . . .
Hunt‘s chosen ‘strategies’ have been bullying and coercion: old style male dominance, but dressed up as metro elegance and feigned dismay. It is about crushing those who deliver NHS services, those who train and study over long years to deliver excellence and save lives. It is about control of a professional cohort that has ‘dared’ to assert its professional expertise and commitment against government diktat. Their offence is in part that they have demonstrated their capacity for professional integrity, personal responsibility and non compliance.
Unfortunately for Hunt, the Junior Doctors are knowledgeable (and better informed than him about the jobs they do and the conditions required to do them well); they are articulate (clear and convincing on camera) and passionate (demonstrating authenticity rather than shifty duplicity and spin); and as their witty and moving placards declare: “Ain’t afraid of no Hunt“ (only his new contract), and “One profession. We stand together”.
At this point, it should be noted that Junior Doctors live and work in a world in which evidence counts; it’s part of their training as well as the ethic that underpins best practice. By contrast, Tory politicians don’t do evidence, preferring to get by on the back of a highly honed sense of entitlement and superiority, backed up by unlimited funding from friends in the City, and Tory-dominated media. The Tories may commission evidence, as a PR gesture, but generally bury it or ignore it once it’s handed in, hoping the media will forget it was ever commissioned, that questions were ever asked.
Negotiation is supposed to involve sharing information and knowledge; identifying issues together, in a spirit of cooperation; partnership in problem solving; and listening. Negotiation is best conceived as a peer process, in which all sides care about that third thing they have in common (the enterprise, project, challenge, problem, relationship) rather than a parent-child power struggle or conflict, premised on the idea of one side ‘winning’, overpowering the other. Negotiation should not resemble arm wrestling. Hunt went one better from the outset, when he publicly threatened to impose his new contract without consultation or agreement. He assumed threat would induce fear and panic in the doctors. He was opting for what constitutes an abuse of power within a social democracy: force.
Democratic accountability flounders in these deep waters. And, as the Junior Doctors have found, like many previous groups of employees, negotiation may be the name on the can, but the can gets kicked down the road till it is unrecognizable and not fit for purpose.
So the doctors strike twice (so far) in an orderly and careful manner, to best limit inconvenience and damage to normal service in hospitals. Theirs may be described as an example of non compliance as social responsibility, personal and professional integrity; simultaneously survival strategy and political clout as a result of collective action. It is also importantly a way of communicating their values and the detail of their professional complaint to the wider public, who, in their work, they serve. After 40 years without a strike, their action has genuine shock value for the public, as citizens and service users. Most of us are both at various points in our lives.
‘Hospitals may refuse to impose Hunt’s new contract’ (James Meikle, Denis Campbell & Jessica Elgot, The Guardian. 13 02 2016).
Heidi Alexander, shadow health secretary, says this “underlines the extent to which the decision to impose a contract that nobody wants would destroy morale in the NHS” (cited Meikle et al.) And morale is no mere trifle in a health service, but can make the difference between excellent, inadequate or dangerous practice; fragmentation and disengagement or effective team work. This second example of non compliance moves beyond individual non compliance, into institutional or corporate non compliance, and hospitals may act independently or in an act of country-wide institutional / professional co-ordination. This measure retains features of the Junior Doctors’ non compliance: for example, as social responsibility, survival strategy and the public exercise of power in refusing to obey what amount to orders from the government. Their act of non compliance also serves to demonstrate allegiance with their own staff: a tentative (and desperate?) act of solidarity across professional demarcations and power relations.
Preventing Prevent: “Students not suspects”.
My third example is in relation to the government’s Prevent scheme for implementation by schools, colleges and universities. The rhetoric speaks about “delivering fundamental British values”, and exhorts individuals and organisations to identify signs of potential “extremism” in their peers and colleagues (along the lines of the Stasi in postwar Eastern Germany, where a considerable percentage of the population were required to act as government spies against neighbours, friends, colleagues and intimates).
New concepts and terminology have been invented by the Tory government, such as “non violent extremism”, and “domestic extremist”, and the language of safeguarding is used to emphasise “cohesion’ and “managing risk”. At a meeting held at the University of Liverpool (10 02 2016) to advocate against this scheme, speakers on the panel and from the floor described the policy as racist and in particular anti-muslim, arguing that it implicitly identifies all Muslims as terrorists-in-the-making. Staff and students in schools, colleges and universities are organizing to oppose Prevent, claiming that it will poison and undermine peer and staff and student relations, distort the educational environment, creating fear and mistrust all round, without reducing risk or increasing safety. In fact, speakers all thought it would make race relations and social cohesion far worse.
These staff and students therefore advocate non compliance with the legislation, and this can be understood as an act of social and professional responsibility; as an humanitarian act, refusing to ‘other’, for example, Muslims; as an act in defence of the open practice of education for democracy, acknowledging the intimate and essential interconnections between education, equality and democracy.
‘Met signals a shift in attitude to rape claims’ (Vikram Dodd, The Guardian, 11 02 2016).
My fourth example comes in the wake of the Metropolitan police commissioner, Sir Bernard Hogan-Howe, announcing that he wishes to see the policy of police automatically believing victims of rape and sexual assault dropped (see Dodd).
Vera Baird, the police and crime commissioner for Northumbria, said her force would not be adopting the policy of not automatically believing an alleged abuse victim” (Sandra Laville, ‘Hogan-Howe under fire for abuse comments’. The Guardian, 13 02 2016).
Baird explained: “Thousands of victims of sexual abuse have been denied justice through the attitude the Met commissioner now advocates” (Laville, ibid.). Similarly, the College of Policing chief executive, Alex Marshall, “put distance between the rest of UK police and Hogan-Howe” (ibid.):
While careful consideration should be given to ensuring the integrity of the evidence, to begin an investigation from a position of doubt is unlikely to encourage victims to come forward (cited Laville).
Vera Baird’s speedy declaration of non compliance with Hogan-Howe’s proposal for a reversal of what has been implemented as best practice in the wake of the Jimmy Savile revelations in 2012 (followed by many others), may be variously identified as an act of personal and professional integrity; an act of conscience; an act of social responsibility; and an exercising of the political power vested in her position as a police and crime commissioner.
Baird is so far the only police and crime commissioner to declare non compliance with Hogan-Howe’s proposal. It remains to be seen whether others in her position follow suit, in which case it would become another example of collective non compliance by a professional / political cohort (cf the hospitals cited earlier). It will also be of interest to see if there is a political split on this issue across party lines. Baird is a Labour party member, but we know that on gender issues and sexual politics, consensus does not necessarily follow party political demarcations, being itself subject to those tensions and differences. For example, women are a tiny minority as police and crime commissioners. There were 192 candidates standing for election in England and Wales (not including London) for 41 posts. Of these, only 35 candidates were women, and only 6 of these were elected. And those in post (women or men) with gender-aware, feminist values will be an even smaller minority.
Non compliance and democracy in 2016.
Democracy requires people’s vigilance, our active engagement. Without that participation, it can be high-jacked by those with vested interests democracy fails to ‘serve’; those who relish their own power and who see democracy as their enemy. Dr Rachel Clark, a core medical trainee, sums up the current impasse and its destructive consequences for Junior Doctors and the NHS after Hunt’s decision to impose his new contract:
I don’t think the relationship with the government can get more poisonous. And really, all I really want to do is get on, and go to work, and care for patients. I don’t want to be speaking to the media, or protesting, or fighting the government (cited Jessica Elgot,‘Defied doctors weigh future’. The Guardian, 13 02 2016).
I sympathise, I really do. For example, as a fellow human being, as a woman, as a mother, as an anti-Tory activist and anti-fascist, and as a worn-out feminist and anti-racist campaigner, amongst my multiple identities. But I am also tempted to observe: welcome to the real world we share under a Tory government using Austerity as its cover for imposing its malign will on the people.
Another doctor, from one of the poorest constituencies in the country, describes the imposition of Hunt’s new contract as “the final nail in the coffin for some of them” (Dr Stephen Hitchin, a registrar in emergency medicine, cited Elgot, ibid.) “Medicine” he says, “is already dominated by people from wealthy backgrounds, this will make it worse” (ibid.). And it is also likely to particularly disadvantage women doctors with caring responsibilities for young or elderly relatives. So gender and poverty, for example, are relevant issues in debates about the Junior Doctors’ contract.
The despair and exhaustion Junior Doctors feel are widespread across society now, not confined to those most disparaged and victimized by government policies, such as those with disabilities, those on welfare benefits, the unemployed and the homeless. And as one young Merseyside Momentum supporter asked me after the last picket: “How many of the Junior Doctors actually voted for this government in 2015?” I had to admit to him that, on the picket on that freezing cold morning, I had forgotten to ask.
So acts of non compliance can also be identified as urgent and emergency actions: refusals to accept, for example, injustice, cruelty, corruption (material as well as of the spirit), and above all, the rule of force and coercion. The examples discussed here are all responses to imposition, to force (legal or otherwise), to politics and governance as dominance and coercion (you can make your own list), designed to create subservience, and inculcate a sense of inferiority and powerlessness (no matter what your social, economic position or circumstances). I have the following words on a postcard, cellotaped to the front of a ring-bound shiny silver notebook that I currently carry to meetings;
When INJUSTICE becomes Law,
RESISTANCE becomes Duty.
Democracy necessarily involves critique and dissent, as opposed to silent obedience, endurance and conformity in the face of violation, for example of someone’s human rights. Non compliance can therefore be understood as a civic duty, as a defence of democracy, equality and social justice. By acting together (and for safety and greatest impact, we need to act together, not in isolation or discrete constituencies), with both small gestures and collective movements, we can turn non compliance into widening ripples of creative agency for social justice, equality and human rights. And bring this Tory government to an end. Please participate.
val walsh / 14 02 2016