Public pay the price for corrosive strikes

Published by The i paper (14th August, 2023)

There has been little to celebrate in recent political discourse, but one welcome change is belated recognition that the National Health Service should not be seen as the envy of the world. This deluded British exceptionalism, a blinkered belief the rest of the planet was looking with longing at an institution lurching from one crisis to another for much of its 75-year existence, has been highly damaging. It silenced critics of poor patient safety, overshadowed the social care meltdown and masked failings such as dire treatment outcomes compared with rival systems.

Now we need to stop deifying doctors as saintly protectors of a sacred institution. This is not to detract from their dedication, skills or societal importance, but simply to accept they are human beings with the same ambitions, flaws and foibles as the rest of us. This is crucial as another corrosive strike by junior doctors hits the NHS for four days, with two more planned actions by consultants. For these disputes are led by a self-serving body ruthlessly exploitative of public affection for its members in its frequent battles against the despised denizens of Westminster.

The British Medical Assocation (BMA), the nation’s most powerful trade union, has always been fiercely protective of its members’ interests regardless of wider impact. It even opposed a plan in 1938 to loosen rules to let in 500 Jewish doctors threatened by the Nazis, forcing a reduction to 50. It fought the creation of the NHS, to the fury of health secretary Aneurin Bevan, who saw doctors’ leaders as “politically poisonous” activists but infamously had to “stuff their mouths with gold” to win them over. Then its first industrial action by doctors was to ensure consultants could retain lucrative private work.

One negotiator of the 2004 contract for general practitioners later bragged they won such a great deal that salaries soared 60 per cent over the next three years. He added that dropping out-of-hours cover for a tiny trim was “a bit of a laugh” – yet a study found this disastrous concession even led to a significant rise in avoidable emergency hospital admissions for children.

So be sceptical of the BMS’s pose as NHS saviour. The last strike by junior doctors in 2016 claimed to be about patient safety, yet leaked WhatsApp messages among their leaders suggested pay was “the only real red line” and exposed plans to draw the dispute out “for a prolonged period” to tie health chiefs “in knots for the next 16-18 months”. The chair of the junior doctors committee urged them to take part in “rubbish” mediation talks “to play the political game of always looking reasonable”.

Now hardliners have taken control of this committee. They are ideological and partisan – as shown by their social media accounts or co-chair, Robert Laurenson, admitting last week they would not accept the sort of deal being contemplated in Scotland on the basis that “the Governments are very different”. They can also be weirdly naive: this posh trainee GP swanned off on holiday during the first strike. Another key activist tweets that the UK’s pay is the “poorest in the English-speaking world”, seemingly unaware this collection of countries goes far beyond the Anglosphere to the likes of Guyana, India and Zimbabwe.

Doctors have seen real wages decline. They are not immune to cost of living and housing pressures. Yet, like other campaigners or politicians, these union leaders abuse statistics to suit their cause. The Institute for Fiscal Studies tore apart the core claim of junior doctors that their pay – allowing for inflation – declined 26 per cent since 2008, putting the real figure at about half that level.

Few baristas have the future earning potential of general practitioners on six-figure salaries – let alone of consultants, who saw pay increase more than one third in the first decade of the century to become among the highest-earning specialists in terms of purchasing power in richer nations even before any private work. You can compare consultants with Australia or Ireland to make them look poorer – or France, Spain and Italy to make them look rich. Their state-funded pensions are so huge the Government just ditched the £1.07m tax-free cap to appease them.

Ultimately, we are witnessing political games no different from those played by other unions – except instead of factories shutting down or trains cancelled, patients suffer and might die needlessly in prolonged health battles. And the central creed of doctors is supposed to be first do no harm.

These strike leaders admit “our biggest lever with the Government is waiting lists and financial loss”. The junior doctors’ actions alone have cost the NHS £1bn while waiting lists – already surging due to collapsing social care, staff shortages and Covid – have hit record levels. Both sides blame each other. Before this year, there had only been two previous outbreaks of strikes by doctors in the NHS. Suddenly they seem almost routine.

Certainly the Tories have been corrupt, divisive and economically disastrous in office – but they have pumped an additional £50bn into health since 2010 while driving up the number of doctors and nurses.

These disputes expose two consequential issues confronting our country. First, how do we afford a decent health system without crippling other public services amid sluggish growth? Health salaries already account for about one pound in every eight spent by the state while the NHS soaks up more than double its share of public spending than at the turn of the century and nearly four times more than when I was born in the 60s. Such growth is unsustainable.

Second, those striking junior doctors are victims of generational inequality that makes life such a struggle and prospects so much poorer for those entering workplaces than their predecessors. They feel rightly betrayed by my generation of baby boomers. These issues are profound, corrosive and need to be tackled – even if ministers do refuse to stuff more gold into the mouths of doctors to silence them.

Categorised in: Health, home page, Public policy