Leading article

Striking doctors need an injection of realism

Workers in Britain’s unreformed NHS are among the very few who can still hold the public to ransom

16 January 2016

9:00 AM

16 January 2016

9:00 AM

Treatment for that once-virulent condition, the British disease of strikes, has largely been successful. The number of working days lost to industrial action in the first ten months of last year was the second-lowest since records began. Pay and conditions have been relentlessly improving. Since the Winter of Discontent in 1979, the average worker’s disposable income has almost doubled. And no thanks to pressure from trade unions: the steady progress comes from the transformative effects of an open economy and a free market.

In the 1970s and early 1980, it was miners, steel workers, railwaymen, bin men, and British Leyland car workers who earned the worst reputations for trade union militancy. Striking was almost entirely associated with blue-collar workers standing around braziers in their donkey jackets.

Now things couldn’t be more different. Of the above groups, only railway workers retain a reputation for industrial action, and almost all strikes are carried out by privileged white-collar public sector staff. Almost half of the days lost to strikes in 2014 were in public-sector administration, with most of the others in education and in health and social care. With the junior doctors’ strike and a walkout by teachers in West Dumbartonshire, it is a trend which is sure to continue.

Professionals have grown more militant, but unions have not grown more professional. As with the union barons of yore, the British Medical Association first sought to spread misinformation. First, by publishing a fake ‘pay calculator’ which wrongly suggested that doctors’ pay would be cut by almost a third. Then the BMA put junior doctors in front of cameras to claim that they are going to suffer ‘longer hours and pay cuts’. It just isn’t true.

The new arrangements were always going to balance cuts to overtime pay with a healthy 11 per cent uplift in basic pay (already, the total pay for those not in the first two years of training averages £53,000). Three quarters of doctors were always going to be better off. Last November, however, the health secretary Jeremy Hunt made an improved offer, which guarantees no cuts to almost every doctor’s pay for three years. Only 1 per cent of doctors will lose out — the ones who work unhealthily long hours.

When the BMA sensed that public support for a strike was wearing thin, it did what the railway unions always do: pretended the dispute was about public safety. Yet the new deal improves safety; the maximum hours a week that any doctor will be allowed to work under the new system will fall from 91 to 72. The maximum number of consecutive night shifts which any doctor can work will fall from seven to four. Were the government proposing a longer working week, there might be a legitimate point about safety. As things stand, it’s a nonsense.

The old industries have shrunk, of course: miners and steelworkers no longer exist in large numbers. But that is far from the whole story. Some formerly militant unions have been forced into a new sense of realism because they are no longer feather-bedded in nationalised industries and can see what damage they would wreak by striking. Workers at the Grangemouth refinery pulled back from a strike in 2013 because they could see that the owner of the plant, Ineos, was serious about closing it down. After the crash, the industrial trades unions behaved sensibly and constructively — accepting pay restraint in return for fewer redundancies.

Car production in Britain is roaring: Nissan’s Sunderland factory alone makes more cars than the whole of Italy. Toyota has said it is so pleased with its plant in Derbyshire that it will stay regardless of whether or not Britain leaves the European Union. Indeed, you never hear now of car workers going on strike, because they are all employed by private companies with more professional relations between staff at all levels.

Most bin men, too, are now employed by outside contractors with whom they seem able to negotiate pay without constantly threatening to walk off the job. There aren’t many organisations that can still hold the public to ransom: the London Underground is one and the NHS is, alas, another.

But if doctors were employed by independent companies, each with its own contract with the NHS, they would have a huge disincentive to strike because they would know they were putting their firm’s contract — and their own employment — at risk.

Mr Hunt has made mistakes along the way: he placed too much weight on the idea that a seven-day NHS is needed to improve patient safety. But the biggest mistake is one made by David Cameron: to think he had kept the NHS safe by ringfencing its enormous budget and not attempting radical reform of the whole system. As he is now finding out, an unreformed NHS will always represent a risk to the government and patients alike.

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  • ohforheavensake
    • Ameliaa

      I find it interesting that it doesn’t matter if the NHS is bad for patients to the point they’re dying unnecessarily and hospitals are being placed in “special measures”, and bad for doctors to the point they’re striking and leaving the UK to work elsewhere, it’s still must be entirely the fault of the patients for expecting too much, and doctors for being selfish and greedy, and none of this stops the “beloved” NHS being the “envy of the world”.

      The comment in this article about running more of the NHS on contracts is interesting, much of the NHS is already run on contracts with private companies and we can see how well that is going with the bastardised mix of contracts and expecting patients to still act like it’s the NHS, spending months getting referrals, even longer on waiting lists, and little to no say in who they see or what treatment they get. Brits, for some reason, like comparing the NHS to the healthcare system in the US, instead of all the other western countries with their own public healthcare systems. Keeping the institution and bureaucracies of the NHS, keeping the name and worship of it, while running the services on contracts seems like the worst of both worlds. I prefer the healthcare system in Norway, where I live now since living the UK (I am not Norwegian or British).

  • Clive

    From the Telegraph, Oh that The Guardian were so balanced:

    …The BMA has published a summary of the recent negotiations, according to which four significant areas of disagreement remain. Three concern pay, in particular the definition of antisocial hours. The other is about safeguarding measures to ensure adherence to the new hours policy. Is this latter really irresolvable? Or is it just there to anticipate the charge that this is all about money?

    The Government has promised that there will be no pay cut for all but one per cent of junior doctors. Some will even see a pay rise. True, many will not get the rise they expected. But that is very different from a cut. And if that is what we are striking about, we need to be upfront about it with a public that has voted to accept austerity.

    We have also been assured that the maximum hours we can be required to work will be reduced. Some of us may work longer hours but many will work fewer. And the longest shifts will go. They may not be such congenial hours – there will certainly be more weekends. But those are the same hours that plenty of other professions accept, including nurses….

  • James Chilton

    The truth seems to be that junior doctors, backed by the doctors’ union, are either gullible or greedy. But that’s buried beneath the emotional blackmail of the claims that patients are ‘at risk’ under present pay and conditions.

    • red2black

      There’s also the emotional blackmail of being told that taking strike action is doing the same thing.

  • victor67

    No more race to the bottom or divide and rule by the billionaire class who preach austerity while they feed from the trough.

    • Johnnydub

      Imbecilic waffle.

      • victor67

        Its about what we value as a society.
        Is it the Andrew Lawnsley’s who mess up reforms costing billions and then take jobs from drug companies to enrich themselves from their botched reforms.
        Or is it about making the pay and conditions acceptable for those who choose to benefit society.
        The problem with the Tories is if they think something doesn’t make a profit it has no value.

    • David

      Well said. That’s exactly what was said in 2009 when the civil service had their dispute, which was shortly after the Lindsey oil dispute

  • Adrian Shaduwa

    Gob smacked. What utter nonsense this article is. If you want some realism, well, the ‘reality’ is, we need a good strike. We need a bloody good riot! Why do any of us even put up with this?

    I suppose PFIs are a good idea too? Anything that transfers wealth from the public purse (the taxpayer) in to private hands, further lining the pockets of the social elite, yeah? Oh aye, marvellous idea.

    The way our country is run is corrupt to the core. It’s totally normalised to the point where it’s not even questioned. There are too many examples to list, but ultimately ordinary people always end up picking up the bill.

    • Hamburger

      Every state employee transfers wealth from the public to the private purse.

  • davidshort10

    How laughable it is to read stuff like this, written by people who sit on their bottoms in comfortable offices and earn four times what doctors so because of their extra columns in newspapers but put in very much fewer hours.

  • red2black

    An open economy and a free market? It’s all been based on credit, borrowing, and State involvement and intervention.

  • grimm

    As usual a huge number of comments by The Spectator’s enthusiastic left wing leadership who (barricaded behind their computers) live in a perpetual state of righteous denial and turn up here in the hope of persuading others to join them in their delusions.

    Meanwhile we Londoners look forward to a series of highly disruptive strikes by London Underground staff who, having tried the old “public safety” shtick are now bleating about their “work/life balance”.

    • Leon Wolfeson

      Ah yes, the delusions of allowing different views.

      As you ignore the left-leaning voters of London… as you ignore little facts…

  • Jonathan

    If this was about pay and 3/4 were going to be better off why do you think 98% voted to strike? Also why isn’t there a strike in Wales or Scotland? It’s not because they’ve negotiated a new contract, they haven’t had one imposed on them allegedly to create some sort of mystical 7-day NHS. Perhaps its time to actually listen to those who work on the frontline and try to make things better.

    If you truly want a market based healthcare system you will end up paying much more for it – look at the the USA. Given the number of unfilled doctor and nursing vacancies, exposure of proper market forces on pay will increase them hugely. Someone has to do the work and despite MPs claiming increased numbers of people in training there aren’t enough actually working. We’ve largely stopped importing doctors from the Indian sub-continent thanks to immigration reforms and last time I checked immigration from the EU wasn’t very popular.

    Imposing poorly thought our contracts and reforms will lead to more staff leaving further exacerbating the problem.

    Everybody wants more for less – particularly the public when it comes to the NHS. It’s time we had a referendum about NHS funding so people can put their money where their mouth is.

    • Hamburger

      The USA health system is not a model anyone with any sense would try to copy. There are better ones.

      • Chloesbrother

        Take it from a Yank, you speak the truth! Do not be taken in by this author or others of his ilk.

      • Leon Wolfeson

        Indeed, so why are elements of it the ones creeping in, and being advocated in articles like this?

        • Hamburger

          I have no idea. Sometimes I think that there are writers who have such a hatred for the EU that they cannot contemplate that anything sensible happens there. Otherwise they would look at the various European solutions.

    • Leon Wolfeson

      “If you truly want a market based healthcare system”

      It’s not and can’t be a market, of course. He’s after a Capitalist healthcare system, like America’s.

  • Jamie Murphy

    I don’t need an online calculator. I put my rota on intensive care through the proposals, each shift over 8 weeks and scaled up. And my pay cut was around 10%. This is still a massive, massive pay cut for any worker.
    Averaging £53,000 in those not in the first 2 years of training? I think you need to be a little more honest with the facts as I was on around 50k the highest banding for maximum out of hours work as a ST3 (3 years out of the first 2 years). My basic pay would have been around 34500 for 9-5 working.

    Holding the public to ransom, no we are exercising our democratic right to oppose these unfair changes in our contract being enforced upon us. You make it sound like the BMA are often on strike which is just not true. Ultimately, we must also consider the rights of the worker as well as the service they provide. However, your article stinks of the type of neoliberal, capitalist, agenda which literally puts the fingers up at workers and their rights.

    • David

      The same old tack ticks that is thrown at those standing up against employers. The government think of a figure which they assume is the salary , often well over the top of what your salary really is.
      Those at the sharp end in the NHS in my opinion should be the highest paid workers of this country.
      All those standing up and being counted have my full support

  • David

    I can not believe the person who wrote this article, it gives the impression people go on strike for nothing, just being militant. Or thinking of holding the country to ransom. How wrong that is.
    No one wants to go on strike. After a failure to agree. And the employer says that’s what you have to accept. And then state everyone will be given a new contract. What will the employer do if everyone refuses to sign an agreement, that undermines tthe reason why these people are on strike. What will the employer do ? Sack everyone, I think not. The nurses and doctors deserve what they are in dispute for. And they should be the highest paid workers of the land. As for militant unions. Some who read this will remember the “Lindsey oil dispute” I was involved. We went on strike because of a foreign contractor refusing to employ British workers. We were all sacked, not even acas could settle the dispute. After 8 days of mass media coverage, the public support increasing. The top people of the union got more involved and made the strike official. Pressure was applied by the MP,s and talks took place in parlement. The foreign contractor was told he must employ British workers or lose the contract. We were all reinstated with continued service. Take no notice of those with negative views. Stick together and be prepared for this dispute to go on for some time. The usual retorhic will come from Mr Cameron. Who hates any organised work place. Good luck with campaign.

  • Lucy Michael

    “Were the government proposing a longer working week, there might be a legitimate point about safety”

    1. They are proposing a longer working week, to include Saturdays as a normal day. They have no intention of increasing budget for pay, i.e. there is no intention to employ more doctors, so by increasing the number of “Doctor hours” per week, but not the number of doctors, staff will have to be spread more thinly on weekdays to ensure the same cover on Saturdays. This will cause a decrease is quality and safety across weekdays.

    2. Also despite the argument from Hunt that the number of hours doctors can work will be reduced, he is planning to remove the safeguards which are in place to prevent doctors working over contracted hours. Currently if a trust over works it’s doctors they are fined. In the new contract they won’t be (or they will be fined, but essentially the fine would be paid to the trust itself). Doctors have a very strong sense of duty and vocation, if there isn’t enough staff (see point 1) doctors will stay to make up the cover, thereby working more hours than safe, and the trust will have no disincentive to prevent this happening.

    3. Clearly a thinly stretched overworked workforce is detrimental to patient safety.

    4. The proposed contracts pave the way for ongoing deconstruction of the NHS, due to an inability to retain staff (doctors and other allied healthcare professionals whose contracts will change to reflect the “7-day working week” promise) and therefore a reduction in quality of care. The strikes are not simply about pay and working conditions for doctors, they are about preventing this deconstruction, and fighting for the survival of a healthcare service which promotes equality and access for all which is free at the point of care.

  • Egerton Yorrick

    The author of this article has not made very much effort to understand the government’s proposed contract. It is not just the 1% of doctors working on illegal rotas that will lose out, as if it would be okay if those poor sods were the ones that ended up being punished for the illegal and coercive actions of their employer.

    -All doctors receiving “pay protection” will effectively have their salaries frozen for three years (they usually go up each year with increasing seniority) but then pay protection disappears altogether, leaving them earning less than the otherwise would have been under the current contract.

    -New doctors leaving medical school (who already have the highest amounts of debt of any graduating cohort for half a century) will simply be paid less for doing the same work than doctors currently in those jobs.

    -Doctors whose last rotation was unbanded (doctors rotate every four months and have no influence over whether or not their jobs included anti-social hours work/pay) will effectively receive no pay protection because their future pay will be “protected” at a much lower rate than their future jobs would usually attract.

    It is ludicrous to claim that removing banding (which makes up 40-50% of most junior doctors’ pay) in exchange for an 11% increase in basic pay will leave 75% of doctors better off. And that does not include the fact that juniors will be expected to work more anti-social hours for that reduced amount of pay. The contract proposals are complicated but they’re not so complicated this author couldn’t have understood them for the price of 60 minutes investment.

    • Leon Wolfeson

      “who already have the highest amounts of debt of any graduating cohort for half a century”

      Actually, I’m not convinced from the figures it’s not more like 100 years.

      (Good post)

  • Becki

    Please, dear author, explain to me, how with the same overall pay budget, he will be giving anyone a penny of pay rise, whilst no other doctor will lose out to balance this?

    Have you noticed if there are ‘winners’ and ‘losers’ in the game Hunt is playing with increasing basic pay and decreasing the number of ‘antisocial hours’ in the week and reducing the rate that these hours are paid; that the losers are those who work weekends and evenings – i.e ‘the backbone of our NHS’ that he claims to be trying to strengthen. The ‘winners’, those in specialties which never got much of their pay topped up by antisocial hour payments – such as dermatology, sexual health, public health etc – all important members of the team, but not going to improve stroke, cancer or emergency admission mortality rates that he claims to be desperate to improve.

    Please explain, how he will have the hospital full of junior doctors at weekends, whilst also cutting number of hours worked and without leaving it depleted in the week?

    If you take even a second to look past the spin you can see there are some serious questions to be asked, and he isn’t coming out of his hole to answer them – he just pops up to give another attention grabbing headline (based on misinterpreted or out of date studies) to a friendly news agency with a list of pre-authorised questions – then scurries away again.

    This contract (after his temporary pay protection expires – for many this would not apply, and for a significant proportion would be lost within 12mths), would disproportionately affect the pay and quality of life of our front-line doctors – A+E, acute medicine and surgery, psychiatry and general practice – these talented professionals are in demand outside the UK in their vocation, and within the UK in other industries.

    I am not a Junior Doctor, and I have never previously held any particular political affiliation, but it is clear if you take even the shallowest of explorations into the issues, that the agenda of this government is NOT about strengthening our NHS given the above saga and the attack on future nursing staff by removing bursaries.

  • Gabi

    So is your argument privatise the NHS? Seriously? The injection of realism for junior doctors should be that if the contract is forced through they will be better off to go abroad. I presume the author is brainwashed by the government’s propaganda and has plenty of money for private health insurance.

  • Sue Smith

    The first thing to understand is that doctors belong to the most powerful ‘trades union’ in the country. And they behave like it!!

    • Jaria1

      The doctors should come up with proposals of their own. They could try reading the Francis report and what happened to his re organisation of the hospital that was so successful until the BMA forced its closure .
      They might then suspect that their needs come second to the Unions left wing ideals

  • Sue Smith

    My nephew; 46 year old Australian General Practitioner in sea-side town practice:

    “Being a doctor is a licence to print money, but don’t tell anybody”.

  • Chloesbrother

    Privatize? You’re joking! Just look at the USA.

  • Leon Wolfeson

    Workers have some chance of decent pay and conditions in one sector? And being able to help the 99%?

    Quick, crush them – you’re a good little Capitalist Tory.

  • Myla

    Goodness, lots of junior doctors frothing on here. I wonder why? Don’t answer that, please!

  • I respect the view of such regular users of the NHS as The Spectator.

  • Paul Rand

    53 grand? Get back to work.

  • Steve

    This is exactly why the government needs to stop regulating doctors’ wages and let the free market set the appropriate level of pay. This will almost certainly lead to higher pay for doctors but it will send the right price signals to the healthcare provides and funded and mean that strikes like this will become a thing of the past. Strikes are a symptom of government interference in the market for medical skills.