Some men can’t be bought, bullied, reasoned, or negotiated with.

‘Shock horror’, you say, ‘a politician spinning the truth’. I would urge you, firstly, not to be complacent where an elected official deliberately misleads on any topic. But the implications of this campaign on this topic are literally hurting people: following (unfounded) statements by the Department of Health on the safety of hospitals at weekends, some patients, too scared to attend hospital at weekends because of the ‘weekend effect’, have become seriously ill or even died as a direct consequence of waiting until Monday before seeking medical advice. When accused of scaremongering (see Appeal To Emotion), the DoH refused to apologise:

“The public should not delay accessing services if they need them. However, there is clear independent clinical evidence that standards of care are not uniform across the week and this Government makes no apology for tackling the problem to make sure all patients receive the same high quality care seven days a week.”

Clearly a little collateral damage is OK in ruthless pursuit of the greater good.

Let’s look at some of the other spin weapons the government is using (we’ll come back to the “clear independent clinical evidence”).

Shift The Debate.

The primary concerns of the BMA are — and always have been — safety of patients, and safety of doctors. What does the government say? “there’s only the one issue of Saturday pay outstanding”.

How have they done this? The current system of ‘unsocial hour’ pay banding protects doctors from working excessive hours by making it expensive for employers. So the government is technically correct — but it’s missing the point. The BMA have proposed alternative, cost-neutral safeguards, but these have been rejected.

(There actually are significant pay implications — particularly discriminating against mothers working part-time — but these came much more recently)

The real beauty of this spin is the can of worms it opens: shifting the debate on to pay has resulted in hundreds of column inches being written comparing doctors overall salaries with other professions, contrasting other jobs that work unsocial hours without pay premiums, and ultimately creating a forum that allows the doctors to be branded greedy, lazy, overpaid, etc.

Remember: Doctors did not ask for a pay rise, and already work weekends.

Some of the stories that resulted from this line of spin truly showed off the worst that tabloid journalism has to offer: criticizing doctors for going on holiday and owning their own (modest) homes; implying they are striking so that they can have hobbies on weekends; branding doctors elitist for challenging comparisons that shop-workers also work weekends.

Assume Unproven Truths.

Let’s get back to the “clear independent clinical evidence”: since publication 6 months ago, the government’s justification for the contract changes are almost exclusively because, in the words of the Health Secretary, “according to an independent study conducted by The BMJ, there are 11,000 excess deaths because we do not staff our hospitals properly at weekends”.

This is not correct. To quote the study itself:

“It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.”

The Editor of The BMJ has registered her concern about “the way in which you have publicly misrepresented an academic article published in The BMJ”. The UK Statistics Authority has asked that “future references to this article are clear about the difference between implying a causality that the article does not demonstrate, and describing conclusions reached by authors”. The Prime Minister was confronted in Parliament that the Department of Health was misrepresenting the statistics. He responded by Avoiding The Question.

Perhaps the reason the government refuses to acknowledge this correction, and instead continue to cite the study as justification for the contract imposition, is because it is such a powerful tool for Appealing To Emotion.

As the DoH said, “any debate about precisely how many of the thousands of deaths are avoidable misses the point”. Indeed. The point is not how many deaths are avoidable — the point is the deaths are not linked to staffing levels.

Appeal To Emotion.

You see this one any time intrusive laws are introduced in the name of ‘defending us from terrorists’, or ‘protecting children from paedophiles’. This logical fallacy is characterized by the manipulation of emotions, usually to disguise an absence of factual evidence (see Assume Unproven Truths). When done well, the lack of a direct causal link can be missed, and the audience finds themselves agreeing that whatever needs to be done must be done.

We’ve already seen this with the scaremongering of weekend deaths (strangely, that news article was published the same day that the study was published, which must mean one of the UK’s most reviled trash tabloids was given early access to The BMJ’s research). The government even doubled-down on this approach, singling out a specific condition that elicits strong emotional responses from many of us: stroke victims, they said, are more likely to die on weekends, as a result of staffing levels. Despite pleas from stroke specialists that the highly publicised untrue statements were leading patients to defer seeking treatment and coming to unnecessary further harm, the Prime Minister himself repeated the claims. A month later, one of the co-authors of the cited paper commented on a blog that “we have never looked at junior doctor staffing in any of our papers, and have never claimed to”.

On the 13th November 2015, a series of coordinated terrorist attacks were carried out in Paris. Barely missing a beat, on the 19th November the Medical Director of NHS England, Sir Bruce Keogh, published an emotive letter asking for assurances that striking doctors would return to work in the event of a terror attack. Emails later surfaced proving that the letter was written in collaboration with the government, who advised Sir Bruce that “the more hard-edged you can be on this, the better”.

(Three weeks later, an off-duty junior doctor demonstrated this ‘lack of duty’ by saving a man’s life in a terror-inspired knife attack, at great personal risk.)

One last example. The strikes themselves are, naturally, an easy target for the government to claim the moral high-ground and stir up some fear in the general population, e.g. “the action taken by the BMA will inevitably put patients in harm’s way”. They offer no reassurance that junior doctors’ roles will be filled by senior consultants during the strikes, so patients are likely to be in safer hands. In fact during the New Zealand junior doctors strike of 2006, senior doctors demonstrated (predictably) that they could carry the workload of at least two junior doctors, and both waiting times and length of stay were reduced by about 50% in the Emergency Department.