The Making of an Active Moral Economy: Junior Doctors, Socialised Healthcare and the National Health Service (UK)

This paper explores the dynamic content and manifestation of UK-based junior doctors’ widely shared moral economy of commitment to the British NHS as a publicly funded universal service, free at the point of use. Between 2014 and 2016 this moral economy was a largely passive and atomised phenomenon that was rapidly transformed into an unprecedented mass collective protest by medics. In a fierce campaign against the Conservative central government’s attempt to impose a new contract that removes junior doctors’ working-hours safeguards and cuts their  pay many medics quickly harnessed their social media networks to mobilise a series of large demonstrations involving tens of thousands throughout England. Under the slogans of Not Fair, Not Safe and Defend Our NHSjunior doctors went on strike in January 2016 for the first time since 1975 after 98% voted in favour.

The reasons for this historic struggle are manifold. Junior doctors have long worked dangerously long hours (Walsh, 2013) but now they have reached breaking point as the NHS is in the midst of an unprecedented crisis. This is caused by austerity-driven under-funding, rising patient demand, deep cuts to social care services and chronic clinical staff shortages, including record levels of medics emigrating. At the same time, the Health and Social Care Act (2012) has ushered in wholesale outsourcing much NHS provision in England (Pollock and Price, 2011). Evidence is presented from an ongoing study of junior doctors’ experience of work, employment and career in the NHS based on 35+ in-depth interviews conducted from mid-2014 to early-2016, plus participatory/observational, documentary and social media data from the Save Our Contractcampaign.   

A moral economy perspective (Bolton and Laser, 2013; Thompson, 1991) is utilised to explore the extent to which early-career medics possess a lay morality (Sayer, 2000) whereby good medical practice (GMC, 2014) is widely understood to be underpinned by a personal commitment to medicine combined with ideological support for the socialised health values of the NHS. Prior to September 2015 a large majority of the interviewees expressed a shared, if passive, moral economy of passionate commitment to NHS values but distress, often anger, at the crisis and privatisation. Their long-term decision to stay in or leave the NHS often included weighing-up whether it will remain a public service available to all. Very few interviewees prior to September 2015 expressed confidence in their own collective capacity to organise and protest through their trade union, the British Medical Association (BMA). However, the latter was transformed with the explosive emergence of the Save Our Contract campaign among English junior doctors. The paper argues that as junior doctors’ shared moral economy of passionate support for NHS values is challenged and tested it is being transformed from a largely atomised and passive commitment into one where the huge majority collectively organise and actively resist. However, many junior doctors, if not most, struggle to marry a growing commitment to supporting and defending the NHS with planning for a personally sustainable future medical career within it.