Junior doctors' row: Should we care?

Amid all the claim and counterclaim about anti-social-hours payments, on-call duties and long working days, it's easy to get bogged down in the detail of the junior doctors dispute.

But with a second strike by medics in England taking place on Wednesday, it's worth stopping for a moment to ask why this row matters.

Of course, how much doctors get paid for working weekends is clearly important to them - and, as taxpayers, the rest of us. And if the quality of care at weekends improves as a result of this contract, as the government argues it will, it goes without saying that matters too.

But there is another element to this dispute, which is arguably much more fundamental than either of these issues: it's about the changing nature of healthcare - and how we respond to it.

Since the health service was created in the aftermath of World War Two, it has gone from a service where patients either died or were cured of their illness to one where people are surviving but having to sometimes live with debilitating conditions.

It's a success story in many ways. We are now surviving heart attacks, strokes and cancer in a way that would have been unimaginable when the NHS was formed in 1948.

But that has brought with it challenges. There are about 15 million people living with what are classed as chronic illnesses such as dementia, heart disease and diabetes - for which there is no cure. Many of these people are elderly and need careful support and care.

It has meant that hospitals are now full of incredibly sick and frail patients who would simply not have been alive 20, perhaps even 10 years ago. One in four hospital beds is occupied by dementia patients, for example.

That means the lives of junior doctors are very different to what they were in previous generations.

More is being asked of them in terms of dealing with large numbers of ill patients. One medic told me how at weekends she could regularly be in charge of 80 really sick patients - all of whom ideally need huge amounts of care and support. The doctors feel run ragged and undervalued.

It is this that is clearly contributing to the "high level of discontent" in the workforce referred to by Sir David Dalton, the hospital chief executive brought in to negotiate with the British Medical Association, in his letter to ministers after the latest breakdown of talks.

But this isn't just unique to junior doctors. A similar theme has emerged in general practice where last week we heard that many GPs feel they can no longer provide adequate care to their patients, while demands from care homes meant there needed to be a complete re-think of how their residents are cared for.

This is because as hospitals have had to cope with more and more really sick patients, a lot of the care that was once done there has been pushed out into the community. GPs now run asthma clinics, provide diabetes care and even carry out minor operations, while dealing with patients who are living with a range of different illnesses.

Now a lot of people may say, 'So what? There are lots of different jobs where people could argue more and more is being asked of them too. What makes being a doctor so special?' The simple answer - and it is one the profession puts time and time again - is that the work they do affects people in a much more profound way than other professions. What, after all, could be more fundamental than an individual's health?

And so, even when this dispute is over, we will still be left with an even more intractable problem.

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