In the latest issue:

Real Men Go to Tehran

Adam Shatz

What Trump doesn’t know about Iran

Patrick Cockburn

Kaiser Karl V

Thomas Penn

The Hostile Environment

Catherine Hall

Social Mobilities

Adam Swift

Short Cuts: So much for England

Tariq Ali

What the jihadis left behind

Nelly Lahoud

Ray Strachey

Francesca Wade

C.J. Sansom

Malcolm Gaskill

At the British Museum: ‘Troy: Myth and Reality’

James Davidson

Poem: ‘The Lion Tree’

Jamie McKendrick

SurrogacyTM

Jenny Turner

Boys in Motion

Nicholas Penny

Jia Tolentino

Lauren Oyler

Diary: What really happened in Yancheng?

Long Ling

Short Cuts: Harry Goes Rogue

Jonathan Parry

Close

Terms and Conditions

These terms and conditions of use refer to the London Review of Books and the London Review Bookshop website (www.lrb.co.uk — hereafter ‘LRB Website’). These terms and conditions apply to all users of the LRB Website ("you"), including individual subscribers to the print edition of the LRB who wish to take advantage of our free 'subscriber only' access to archived material ("individual users") and users who are authorised to access the LRB Website by subscribing institutions ("institutional users").

Each time you use the LRB Website you signify your acceptance of these terms and conditions. If you do not agree, or are not comfortable with any part of this document, your only remedy is not to use the LRB Website.


  1. By registering for access to the LRB Website and/or entering the LRB Website by whatever route of access, you agree to be bound by the terms and conditions currently prevailing.
  2. The London Review of Books ("LRB") reserves the right to change these terms and conditions at any time and you should check for any alterations regularly. Continued usage of the LRB Website subsequent to a change in the terms and conditions constitutes acceptance of the current terms and conditions.
  3. The terms and conditions of any subscription agreements which educational and other institutions have entered into with the LRB apply in addition to these terms and conditions.
  4. You undertake to indemnify the LRB fully for all losses damages and costs incurred as a result of your breaching these terms and conditions.
  5. The information you supply on registration to the LRB Website shall be accurate and complete. You will notify the LRB promptly of any changes of relevant details by emailing the registrar. You will not assist a non-registered person to gain access to the LRB Website by supplying them with your password. In the event that the LRB considers that you have breached the requirements governing registration, that you are in breach of these terms and conditions or that your or your institution's subscription to the LRB lapses, your registration to the LRB Website will be terminated.
  6. Each individual subscriber to the LRB (whether a person or organisation) is entitled to the registration of one person to use the 'subscriber only' content on the web site. This user is an 'individual user'.
  7. The London Review of Books operates a ‘no questions asked’ cancellation policy in accordance with UK legislation. Please contact us to cancel your subscription and receive a full refund for the cost of all unposted issues.
  8. Use of the 'subscriber only' content on the LRB Website is strictly for the personal use of each individual user who may read the content on the screen, download, store or print single copies for their own personal private non-commercial use only, and is not to be made available to or used by any other person for any purpose.
  9. Each institution which subscribes to the LRB is entitled to grant access to persons to register on and use the 'subscriber only' content on the web site under the terms and conditions of its subscription agreement with the LRB. These users are 'institutional users'.
  10. Each institutional user of the LRB may access and search the LRB database and view its entire contents, and may also reproduce insubstantial extracts from individual articles or other works in the database to which their institution's subscription provides access, including in academic assignments and theses, online and/or in print. All quotations must be credited to the author and the LRB. Institutional users are not permitted to reproduce any entire article or other work, or to make any commercial use of any LRB material (including sale, licensing or publication) without the LRB's prior written permission. Institutions may notify institutional users of any additional or different conditions of use which they have agreed with the LRB.
  11. Users may use any one computer to access the LRB web site 'subscriber only' content at any time, so long as that connection does not allow any other computer, networked or otherwise connected, to access 'subscriber only' content.
  12. The LRB Website and its contents are protected by copyright and other intellectual property rights. You acknowledge that all intellectual property rights including copyright in the LRB Website and its contents belong to or have been licensed to the LRB or are otherwise used by the LRB as permitted by applicable law.
  13. All intellectual property rights in articles, reviews and essays originally published in the print edition of the LRB and subsequently included on the LRB Website belong to or have been licensed to the LRB. This material is made available to you for use as set out in paragraph 8 (if you are an individual user) or paragraph 10 (if you are an institutional user) only. Save for such permitted use, you may not download, store, disseminate, republish, post, reproduce, translate or adapt such material in whole or in part in any form without the prior written permission of the LRB. To obtain such permission and the terms and conditions applying, contact the Rights and Permissions department.
  14. All intellectual property rights in images on the LRB Website are owned by the LRB except where another copyright holder is specifically attributed or credited. Save for such material taken for permitted use set out above, you may not download, store, disseminate, republish, post, reproduce, translate or adapt LRB’s images in whole or in part in any form without the prior written permission of the LRB. To obtain such permission and the terms and conditions applying, contact the Rights and Permissions department. Where another copyright holder is specifically attributed or credited you may not download, store, disseminate, republish, reproduce or translate such images in whole or in part in any form without the prior written permission of the copyright holder. The LRB will not undertake to supply contact details of any attributed or credited copyright holder.
  15. The LRB Website is provided on an 'as is' basis and the LRB gives no warranty that the LRB Website will be accessible by any particular browser, operating system or device.
  16. The LRB makes no express or implied representation and gives no warranty of any kind in relation to any content available on the LRB Website including as to the accuracy or reliability of any information either in its articles, essays and reviews or in the letters printed in its letter page or material supplied by third parties. The LRB excludes to the fullest extent permitted by law all liability of any kind (including liability for any losses, damages or costs) arising from the publication of any materials on the LRB Website or incurred as a consequence of using or relying on such materials.
  17. The LRB excludes to the fullest extent permitted by law all liability of any kind (including liability for any losses, damages or costs) for any legal or other consequences (including infringement of third party rights) of any links made to the LRB Website.
  18. The LRB is not responsible for the content of any material you encounter after leaving the LRB Website site via a link in it or otherwise. The LRB gives no warranty as to the accuracy or reliability of any such material and to the fullest extent permitted by law excludes all liability that may arise in respect of or as a consequence of using or relying on such material.
  19. This site may be used only for lawful purposes and in a manner which does not infringe the rights of, or restrict the use and enjoyment of the site by, any third party. In the event of a chat room, message board, forum and/or news group being set up on the LRB Website, the LRB will not undertake to monitor any material supplied and will give no warranty as to its accuracy, reliability, originality or decency. By posting any material you agree that you are solely responsible for ensuring that it is accurate and not obscene, defamatory, plagiarised or in breach of copyright, confidentiality or any other right of any person, and you undertake to indemnify the LRB against all claims, losses, damages and costs incurred in consequence of your posting of such material. The LRB will reserve the right to remove any such material posted at any time and without notice or explanation. The LRB will reserve the right to disclose the provenance of such material, republish it in any form it deems fit or edit or censor it. The LRB will reserve the right to terminate the registration of any person it considers to abuse access to any chat room, message board, forum or news group provided by the LRB.
  20. Any e-mail services supplied via the LRB Website are subject to these terms and conditions.
  21. You will not knowingly transmit any virus, malware, trojan or other harmful matter to the LRB Website. The LRB gives no warranty that the LRB Website is free from contaminating matter, viruses or other malicious software and to the fullest extent permitted by law disclaims all liability of any kind including liability for any damages, losses or costs resulting from damage to your computer or other property arising from access to the LRB Website, use of it or downloading material from it.
  22. The LRB does not warrant that the use of the LRB Website will be uninterrupted, and disclaims all liability to the fullest extent permitted by law for any damages, losses or costs incurred as a result of access to the LRB Website being interrupted, modified or discontinued.
  23. The LRB Website contains advertisements and promotional links to websites and other resources operated by third parties. While we would never knowingly link to a site which we believed to be trading in bad faith, the LRB makes no express or implied representations or warranties of any kind in respect of any third party websites or resources or their contents, and we take no responsibility for the content, privacy practices, goods or services offered by these websites and resources. The LRB excludes to the fullest extent permitted by law all liability for any damages or losses arising from access to such websites and resources. Any transaction effected with such a third party contacted via the LRB Website are subject to the terms and conditions imposed by the third party involved and the LRB accepts no responsibility or liability resulting from such transactions.
  24. The LRB disclaims liability to the fullest extent permitted by law for any damages, losses or costs incurred for unauthorised access or alterations of transmissions or data by third parties as consequence of visit to the LRB Website.
  25. While 'subscriber only' content on the LRB Website is currently provided free to subscribers to the print edition of the LRB, the LRB reserves the right to impose a charge for access to some or all areas of the LRB Website without notice.
  26. These terms and conditions are governed by and will be interpreted in accordance with English law and any disputes relating to these terms and conditions will be subject to the non-exclusive jurisdiction of the courts of England and Wales.
  27. The various provisions of these terms and conditions are severable and if any provision is held to be invalid or unenforceable by any court of competent jurisdiction then such invalidity or unenforceability shall not affect the remaining provisions.
  28. If these terms and conditions are not accepted in full, use of the LRB Website must be terminated immediately.
Close
Vol. 38 No. 3 · 4 February 2016
Diary

What a Junior Doctor Does

Lana Spawls

Antidiuretic hormone​ , also known as vasopressin, is released when levels of water in the blood become too low – when you’re dehydrated. It tells the kidneys to reabsorb water back into the bloodstream. For a while this keeps you going: it was working overtime in my system when I found myself ten hours into a Saturday shift at the hospital, without a drink or a break since my breakfast cup of tea at home. It wasn’t a shift crammed with life or death emergencies: I had a clinic in A&E reviewing patients with minor injuries, two ward rounds and a never-ending list of jobs to do. Each time I crossed one off I’d receive a bleep on my pager: another sick patient to review, scans to order, bloods to take, prescriptions and discharge letters to write. At weekends, junior doctors cover care across the whole hospital. I’d been assigned three wards. I managed to make it to the canteen, and a first mouthful of beans, before the familiar jangling started again. I went to the nearest phone to dial in: a prescription of intravenous paracetamol needed changing to oral. I added it to my list and went back to eat. A few more mouthfuls and it went off again. There was no answer when I dialled back: apparently the 15 seconds it took me to reach the phone was too long and the caller had rushed off. I added the number to my list. I’d call them back.

Four days later I’m working my ninth day in a row. On normal weekdays I’m only responsible for the forty or so patients under the care of my usual team. Usually I would split this with another first year foundation (FY1) doctor, but he’s on holiday so it’s down to me. From 4 p.m. until 9 p.m. I’m on call looking after patients from four different surgical teams. About half an hour before I should finish I’m bleeped to examine a patient who has just arrived on the ward and is due to go for surgery the next day: a teenage girl with a brain tumour. Until she has surgery we won’t know if it’s cancerous or benign. She and her mum look nervous. We talk about her older brother who’s just had a baby daughter, her favourite subjects at school (art and drama) and what she wants to do when she grows up (be a dancer). Before surgery she needs blood tests so I go to find a tourniquet, needles, bottles and gauze. It’s a ward that I don’t usually work on, and every ward keeps its equipment in a different place. On top of this, the printer for the blood bottle labels isn’t working. It takes me nearly an hour, including a trip to another ward, to get everything ready. The patient tells me how difficult – and painful – it was the last time someone took her blood. I tell her how important the tests are and how quick I will be, but now I’m getting nervous too. My first attempt is fruitless and she’s not keen to let me try again, but eventually I persuade her. This time I find a better vein, a little deeper but more bouncy, and get it straightaway. She stops crying to tell me it wasn’t actually that bad. When I leave work, nearly two hours late, the lights have been stolen from my bike, which I’d left in front of the hospital, so I cycle home in the dark. At least it’s not raining. I never find out what happened to the girl.

I’m up at 6.30 a.m. the following day. My basic hours on a surgical rotation are 8 a.m. to 4 p.m., though it’s rare for me to finish on time, and there’s a rota for out of hours work – weekends, evenings, night shifts. Depending on the size of the hospital, the team (or teams) for any specialism might comprise a group of consultants, two or three registrars and a few other more junior doctors, looking after between 15 and 50 patients. Because consultants spend a lot of their time in clinics and seeing outpatients, only one is usually responsible for inpatients each month; registrars are often in clinics too, or reviewing patients on other wards or in A&E. The term ‘junior doctor’ encompasses everyone from the newly qualified doctor fresh out of medical school to the registrar one day away from becoming a consultant. Because the training path is so long, and not everyone becomes a consultant, doctors can remain junior for a long time, or for ever. The basic path to consultancy takes around 14 years. The five or six years of a medical degree are followed by two foundation years, during which you take six rotations in different specialties (usually a mixture of medical, surgical, GP and A&E). Most doctors then start a training programme to specialise in a certain area – this can take anything from three years for GP training to more than eight for neurosurgery. Some programmes are ‘run-through’, which means you start straight away, but most require two more years of core training (another four or six placements) before you apply for jobs as a registrar. You can be well into your thirties before becoming a consultant, even later if research breaks and parental leave cause delays. The junior doctor treating you in hospital may have more than ten years’ experience, across the different hospital departments, and it’s this general medical expertise that the government is relying on to enforce its ‘seven days a week’ NHS.

Of course the NHS already operates 24 hours a day, seven days a week. But the hospital day is designed to wind down: patients need to rest and non-essential procedures often aren’t carried out the day they’re ordered. There are always doctors on duty: all hospital doctors work night and weekend shifts, junior doctors in the hospital and consultants on call at home. The night team works from 9 p.m. to 9 a.m. (or 8 p.m. to 8 a.m. in surgery). The doctors’ workload is managed by the nurse practitioner, who screens all the jobs and assigns them based on doctors’ seniority and availability. A night shift can see you dashing from one ward to another across the hospital. If anything serious comes up you can call the medical registrar, but the nurse practitioners are invaluable for a new doctor, struggling to put in a cannula in the middle of the night. Common blood tests are run by lab technicians through the night, but to get a scan or a more unusual blood test often requires a phone call to convince someone (whom you may have woken up at home) that it can’t wait until the morning.

On a normal day, week or weekend, we start with a handover from the night team. We each have a list of the patients under our care. Every patient is seen every day, but the team often splits into smaller groups and runs simultaneous ward rounds; each of these can still take three or four hours. My first patient is J, a 76-year-old man with a bad infection (cellulitis) in his foot. He came in the day before, and has a history of diabetes, ulcers, heart disease. He’s still able to look after himself, but only just: the short daily visit by his carers is no longer enough. I take his notes from the trolley by the nurses’ bay and we look them over. He’s on intravenous antibiotics and fluids as well as his regular medication. Blood forms I left out yesterday were taken by the phlebotomists early this morning but we won’t get the results for another hour or so. The tests will tell us whether the infection is responding to the antibiotics, and we check the observation chart kept by the nurses: his blood pressure is good, oxygen saturation normal, temperature has settled but his heart rate is high. Each observation has a score (zero is normal) which, added together, give an indication of how sick a patient is. J gets a not too worrying two.

But results and notes only tell a small part of the story: we treat the patient, not the results, and diagnosis doesn’t end with the first treatment plan. The antibiotics have started to work – but J is complaining of pain in his chest as well as his feet. He hasn’t seen a physio yet – I’ll have to chase that up – and a diabetes nurse needs to be scheduled to review him too. We’ll have to think about his home care and what antibiotics he’ll need when he comes off the IV. He may need stronger painkillers too. But the first concern is his chest and we need to take more blood and get an ECG to rule out a heart attack. Few patients, especially elderly ones, have only one problem. I quickly note down the jobs that need doing – physio, nurse, prescription, bloods, – and request an ECG, before we move onto the next patient. On a good day there will be three or four of us on the ward round and we can break off to do jobs along the way, but if I’m the only junior doctor I have to finish the ward round before I can do anything else.

The hospital canteen stops serving lunch at 2.30. If my ward round goes on too long I’ll miss it. But most doctors don’t eat there anyway: the sandwiches are better at the branch of Costa in the hospital, or at the Subway over the road, and we take them down to the basement mess to eat. The mess is shared between all the junior doctors (though registrars might eat in one of their communal offices). It’s here I would take a nap if I got the chance on a night shift – though that never happens – and in the daytime it’s where we have a break (that doesn’t happen much either). There are sofas, kitchen stuff, toilets, lockers, a ping-pong table. In the afternoon I work through the jobs accrued during the ward round and anything else that has come up.

Some of my patients are ready to go home but have remained on the ward for weeks, or even months, because the necessary social care isn’t in place for them: rehabilitation or more equipment, a bed in a nursing home. Meanwhile they stay in hospital, at risk of infection and taking up a bed that could be used for someone else. With the hospital always on red alert, with an acute shortage of available beds, there is constant pressure to discharge patients in order to be able to admit new ones. But over the last five years local councils, their budgets slashed by central government, have made billions of pounds of cuts to social care budgets, making it harder for hospitals to discharge people safely. It costs between £200 and £300 per night to keep a patient in a hospital bed, money that would be better spent on helping medically fit patients be cared for at home.

Rotas vary considerably between specialties, but it’s common to work one long day a week (12 to 13 hours) and one weekend in five, as well as weeks of night and twilight shifts. Some rotas give you a day off the following week if you work a weekend, but many expect you to work 12 days in a row. The European Working Time Directive limits the number of hours that junior doctors can work in a week to 48, averaged out over 26 weeks. Doctors, like all workers, are required to have minimum rest periods: 11 hours in every 24, and one period of 24 continuous hours a week (or 48 a fortnight). Under the current contract, the Health and Safety Executive can challenge hospitals with unfair rotas and fine them up to £5000 for each breach. The government initially proposed to remove this provision in the new contract for junior doctors; they have now agreed to penalties for hospitals where doctors work more than 72 hours in a week, but not when that limit is breached by doctors who’ve had to work beyond their contracted hours.

An FY1 doctor earns a basic salary of £22,636 a year (it increases each year). In addition, each rotation is ‘banded’ depending on how many hours you’re scheduled to work each week and how many of them are unsocial – outside 7 a.m. to 7 p.m., Monday to Friday. If, for one four-month rotation, you worked 48 hours a week, most of which were unsocial, you would get a 1A banding, earning you 1.5 times your basic salary. But if in your next rotation you worked only 40 hours per week, none of which was out of hours, you would earn just the basic salary. Under the new contract, it would increase by 11 per cent, but the hours that are considered normal (‘plain’ hours) would also be extended: 7 a.m. to 10 p.m. Monday to Friday and 7 a.m. to 7 p.m. on Saturday. Most doctors would have their banding decreased and their overall pay cut as a result of this change. The government has offered a transitional pay premium to ensure no doctor has a pay cut when the new contract is introduced, but this is time-limited and merely delays the inevitable. The current system of pay increases means that doctors are not financially disadvantaged if they take time out for research or to have children, or if they change their training programme. Under the new contract, pay would correlate to training level, regardless of previous experience. It would also mean a fundamental shift in working patterns, to a system closer to the unsociable and more complicated rotas of A&E. The government has announced no plans to hire more doctors or increase the student intake, so the seven-day NHS will be staffed using only the doctors currently working in hospitals, inevitably lowering the levels of care on weekdays. The proposed locum pay cap will make covering absences even more difficult.

The British Medical Association has been in talks with NHS Employers since October 2013. The talks lasted a year before the Review Body on Doctors’ and Dentists’ Remuneration was asked to investigate and make recommendations on a new contract. It published its final report in July 2015. Its general recommendations included cancelling the supplement for trainee GPs, which would lead to some being paid up to a third less than their hospital counterparts, and removing the clause which allows consultants to opt out of providing non-emergency care at weekends (only 11 out of 20,000 surveyed last year currently did so).

The government returned with a new contract. After polling its members, the BMA decided not to re-enter negotiations. The contract proposed by the government offered doctors a worse deal than the one it had rejected almost nine months earlier. The main points of contention included the extension of plain hours, the tying of pay rises to training level rather than experience, the overall reduction in pay, the removal of penalties for hospitals imposing unsafe working hours and the fact that the government was prepared to force the contract on doctors regardless of whether the BMA agreed to it. David Cameron said last month that junior doctors could not be allowed to ‘block progress in our NHS’. Whose NHS?

The government has done everything it can to make it seem as if its main concern is with reducing weekend mortality rates, but even if that were the issue it isn’t nearly as simple as Jeremy Hunt would have us believe. His claim that 11,000 lives could be saved every year is misleading. The research paper it was based on found that while support services are more limited over the weekend (this includes porters, phlebotomists, radiologists as well as doctors), this was not necessarily the cause of the relative increase in deaths among those admitted over the weekend who died within the next thirty days. For one thing, it’s important to note that patients admitted to hospital at the weekend are sicker than those admitted during the week. It was not possible, the researchers said, to determine ‘the extent to which these excess deaths may be preventable’ and it would be ‘rash and misleading’ to assume they were. One statistic given to the media – that babies delivered at the weekend have a higher mortality rate – is not surprising, given that all the predictably difficult births are scheduled for Caesarean sections during the week. Hunt’s discredited claim that patients were 20 per cent more likely to die if they suffered a stroke at the weekend overshadowed an achievement – the creation of acute stroke units that have greatly improved outcomes on all days – which should be the model for weekend services: improved and well-supported emergency provision.

In November the BMA balloted its members. Turnout was 76 per cent, with 98 per cent in favour of strike action. The three strikes, planned for early December, were delayed when the government agreed to talks mediated by Acas. The government gave some ground – no one would be forced to work two Saturdays in a row, for instance – but wouldn’t backtrack on increased plain hours and pay changes, and so on 12 January junior doctors went on strike for the first time in forty years. I joined the picket line outside my hospital. Only six people are legally allowed to be official picketers but anyone else is welcome to visit, and there were around a hundred people there – mostly doctors but also local pensioners’ groups, other unions’ reps and supporters. The strike started at 8 a.m. and we stood in the freezing cold, talking to the press and passers-by, occasionally singing and chanting, and holding banners: ‘Not safe, not fair’; ‘Tired doctors make mistakes’; ‘Honk if you support junior doctors.’ Passing drivers honked all day. The media reported that 38 per cent of junior doctors went into work, trying to suggest at the same time that the strike wasn’t well supported and that the junior doctors were wilfully negligent. In fact, almost all of the doctors who went to work were scheduled as emergency cover – the same level of cover as on Christmas Day, or the day of the royal wedding in 2011.

Although the second strike has been suspended for more talks to take place, the mood among doctors is pessimistic. The first round of negotiations gave us some hope, but the government has proved belligerent. Why is it so determined to impose this contract? The desire to remove pay progression across the public sector – it has already done so for teachers – is one motive. The UK already spends a smaller proportion of GDP on public healthcare than many countries, although it has a much bigger workforce, and it’s hard not to see this as yet another move towards a part-privatised NHS. If the next government is Tory, I expect we will see a system of insurance plans and charges before I become a consultant.

Back on the ward there isn’t much time to think about the future. A six-year-old who’s just been operated on for appendicitis won’t stop screaming, or let us near her. A boy who came in with constipation is about to go into surgery for a twisted bowel: he’s on a school trip to the UK, and his parents won’t get here before they begin. Doctors come to prep him while I hold his hand. In a few days’ time he’ll be sitting in bed ringing the nurses to bring him hot chocolate and pass the TV remote, but I don’t know that yet.

22 January

Send Letters To:

The Editor
London Review of Books,
28 Little Russell Street
London, WC1A 2HN

letters@lrb.co.uk

Please include name, address, and a telephone number.

Letters

Vol. 38 No. 5 · 3 March 2016

Lana Spawls writes that ‘only six people are legally allowed to be official picketers’ (LRB, 4 February). In fact, there is no legal limit on the number of pickets allowed on a line: the figure of six comes from the Code of Practice for Picketing, issued in 1966. It says that ‘pickets and their organisers should ensure that in general the number of pickets does not exceed six at any entrance to, or exit from, a workplace,’ but there is no limit in law on the number of people who may lawfully picket.

Michael Carley
Bath

Vol. 38 No. 4 · 18 February 2016

I congratulate Lana Spawls on finding the time so vividly to portray her daily (and nightly) life as a junior doctor (LRB, 4 February). Fifty years ago, I was a first-year doctor at St Bartholomew’s Hospital. My experience was much the same as hers. The hours were even more ridiculous: on alternate nights we wouldn’t get to the end of our list of tasks until 3 a.m., after which we would be called out of our beds at least once before getting back to the wards at eight. We then worked another 12 hours before our ‘night off’. We rarely sat down to eat until the small hours, when we feasted on cornflakes pilfered from the nurses’ kitchen.

We knew then, as Spawls does now, that we were most of the time too exhausted to be good doctors, and that as a result patients were suffering – sometimes dying – unnecessarily. We felt powerless to change things, conditioned as students to be sycophants, giving ourselves up as burnt offerings to our consultants, the gods whom we aspired to join.

For the last fifty years the NHS has been consistently underfunded. This particular government’s attempt to argue that weekend services can be improved without additional resources is farcical. Its attempt to discredit junior doctors is a cynical and devious excuse to undertake further privatisation. But now there is one big difference. The mass of junior doctors has learned and organised, and for the first time in history they are identifying themselves as workers, rather than gods.

Mike Downham
Glasgow

send letters to

The Editor
London Review of Books
28 Little Russell Street
London, WC1A 2HN

letters@lrb.co.uk

Please include name, address and a telephone number

Read anywhere with the London Review of Books app, available now from the App Store for Apple devices, Google Play for Android devices and Amazon for your Kindle Fire.

Sign up to our newsletter

For highlights from the latest issue, our archive and the blog, as well as news, events and exclusive promotions.