This Thursday, the result of a ballot by the British Medical Association of its junior doctor members will have closed, and the result will be out. There will be a strike. Unless talks restart, there will initially be three days of strike action. The BMA released the dates of these well in advance: 1, 8 and 16 December. What happens after that will depend on how united the juniors are in the face of massive negative media campaigning, and whether Mr Hunt really thinks he can produce his longed for routine care at weekend, with no extra money or staff. There have been numerous articles written about the strike - I'm not going into all the details here. Suffice to say, as a doctor, my concern is for my patients. And their concern is what happens to them in this strike.
It's 1 December. You have come to see me in my surgery with abdominal pain. We chat, I examine you, and confirm your own thoughts - this could be appendicitis. You need admitting to hospital.
"But Doctor, there's a strike - is it safe?"
Hand on heart, I can say yes. I would never admit you to an unsafe hospital. The first strike reduces the number of junior doctors to emergency cover only. There will still be a team of junior staff ready to deal with emergency admissions; ready to assess you, to prescribe your medication, to get you ready for surgery. I admit you knowing you will get the care you need.
It's 8 December. You're eight months pregnant. You come to see me in my surgery with headaches. I take your blood pressure, test your urine, and confirm your own thoughts - this could be serious. I am worried about you and your baby. You need admitting to hospital.
"But Doctor, there's a strike - is it safe?"
This time, there are no junior doctors. This strike is a full walk out. But hand on heart, I can say yes. I would never admit you and your unborn baby to an unsafe hospital. You and your baby are absolutely safe. Usually, you would see two or three junior doctors in a row when you arrive on the labour ward, as well as midwives. They would take all your details, examine you, arrange scans and tests. Then they would find the Consultant in charge and tell them all about you. What they think is wrong, what needs to happen, what the plan is to keep you and your baby safe. The Consultant would have the final say, and often the junior doctors would be the ones carrying out your care. With no junior doctors, all those early stages are skipped. When you arrive at the hospital, the midwives will greet you, but the first doctor you see will be the Consultant. He or she will do all the things the junior doctors usually do, they will make the same decision, but the Consultant will be the one to carry out your care. Consultants will be on all the wards, in A&E, seeing patients, admitting them, arranging tests, making decisions. Hospitals will be safe.
It's 16 December. You bring your baby boy to see me in my surgery with vomiting and diarrhoea. He is only three months old. We chat, I examine him, and confirm your own thoughts. He needs admitting to hospital.
"But Doctor, there's a strike - is it safe?"
This is your baby; the most precious thing in the world. You would die rather than let your son come to any harm. You are exhausted, anxious, and terrified from all the headlines in the last few weeks. You didn't come to see me when he first became ill, because you were hoping to miss the strike if you managed at home. But he kept being sick and he wouldn't feed. You had to come, and you don't want the dangerous doctors strike to do him harm.
Hand on heart, I say yes. I would never admit your baby to an unsafe hospital. He will be safe going into hospital. Usually, you would arrive on the ward, and see the junior doctors. Like on the labour ward, they and the nurses would assess your son, take all the details, examine him and decide what he needed. The Consultant would sign off the plan, and his treatment would start. There are no junior doctors; today is another full strike. So when you arrive on the ward, you see an experienced Paediatric Consultant straight away. Your baby boy is cared for, he gets immediate help from the most expert doctor there is. He is totally safe.
Up and down the country, hospitals are planning for these strikes, some albeit more reluctantly than others. The BMA gave them warnings precisely for cases like these and to keep patients safe. In a typical large hospital in the south of England, there are 920 junior doctors. There are 630 Consultants. During the strike, the hospital should cancel all Consultant work that isn't an emergency. No clinic appointments. No routine surgery. No meetings. Every single Consultant will be on hand to see and treat emergencies like these three patients. They will be in all departments, round the clock. This cover is being provided willingly and with full support for their junior colleagues in many hospitals. It is also part of Consultants contracts that they provide safe cover in exceptional circumstances like these. Any headlines and any politician that says patients will not be safe during a strike is wrong. There will be disruption and annoyances - that is the whole point of a strike. But there will be the most experienced doctors providing hands on care for the patients that need it.
You could argue, "Well, surely this system is better! We cut out the middle men, the junior doctors causing all the problems. Why aren't we just seen by Consultants straight away all the time?"
Great idea. But they aren't an endless resource. You need to train new Consultants. Guess who the Consultants of tomorrow are? That's right - the junior doctors. They are striking because they have no choice. They are striking because short term inconvenience to Jeremy Hunt, is worth long term safety for patients. Any and every patient who needs to be seen during these strikes, will be. They will have the care they need. The scary headlines will come. The rhetoric will increase. But despite all this, patients will be safe. They are the priority of every single doctor. So hand on heart, I won't be worrying about admitting my patients during these strikes. I will tell them I support the junior doctors because we need them for the NHS to survive.
But if the juniors don't follow through, and cave to the dangerous demands of Mr Hunt, I will worry. When they are working this proposed new contract, with 90 hour weeks with no rest, no limits, and are exhausted - that is when I will tell my patients not to go to hospital. Because then it really won't be safe.