A government source (anonymous of course) has told
the BBC that junior doctors, in their long running dispute, are
really trying to topple the government. It appears some in this
government really think that this dispute is their version of the
1984 miners’
strike. A compromise to trial the new contract, which would have
almost certainly led to the strike being called off, was rejected
by Jeremy Hunt as ‘political opportunism’.
It is natural when this kind of standoff happens to choose sides. The
government is trying to introduce a 7 day week culture into the NHS:
are they trying to do this ‘on the cheap’ by suppressing pay (and
safeguards against excessive hours), or are the doctors being
unreasonable and putting lives at risk?
I think that is the wrong question. A much better question is to ask
how this dispute came about in the first place. The mine workers had
a long history of strike action, but this strike by doctors is unprecedented. Unlike coal miners, doctors are not in a declining
industry, and they are not led by the likes of Arthur Scargill.
Instead they are a key part of a sector where demand continues to
rise, and technology (for the moment at least) tends to add rather
than reduce costs.
In this context, this government and its predecessor have tried to do
something pretty radical, which is to reduce the share of NHS
spending in GDP (for a chart from the Kings Fund, see here,
and for details of the NHS squeeze see here).
It is part of their attempts to reduce public spending, initially
under the pretext of deficit reduction but in reality to allow tax
cuts. In their typically Orwellian way, they call this ‘protecting
the NHS’. Their hope is that this squeeze on resources will reveal
and end inefficiencies which until now vested interests, lethargy and
bad management have maintained.
An alternative way of achieving the same goal is to embark on a top
down reorganisation that you believe will make the system more
efficient.
The 2010 coalition government tried to do both at the same time. You
do not need to be an expert on the health service to guess that
trying both at once would be a disaster. Any kind of successful
wholesale reorganisation of a large organisation costs resources in
the short term, even if it brings benefits in the longer term.
Predictably, according to the experts,
this reorganisation was “distracting and damaging”.
Did the new (2015) government learn the lesson? Silly question.
Introducing a 7 day week culture into the NHS may well be a good idea
in principle, although the evidence is not nearly as clear as Hunt
suggests (which is why trials are a good idea). Using dodgy
statistics to suggest to the public that going into hospital at
weekends rather than a weekday was dangerous was an extremely
irresponsible thing to do. To the extent that there is a problem it
is unclear whether doctors are critical to it. But even if the reform
itself is justified, it is another reorganisation that requires
resources in the short term.
Aneurin Bevan,
who set up the NHS, said that to persuade reluctant doctors to accept
the idea he had “stuffed their mouths with gold”. Reorganising
doctors’ contracts was bound to create winners and losers,
and in a profession with considerable solidarity that would not be
agreed to without extra money to compensate the losers. To try and do
it while starving the system of resources was just crazy, and
allows doctors to tell themselves that they are striking to save the
NHS rather than to protect their pay.
The only similarity with the miners strike is that the doctors also
cannot force the government’s hand. The more they escalate the
dispute, the more their solidarity and public support will fragment.
Jeremy Hunt has already got away with putting party interest above public probity once
in a previous job, with Cameron’s active assistance, and he may profit this time as well. If he does demoralised UK doctors will leave in increasing
numbers for more congenial working conditions overseas, and gaps will
be filled by doctors trained overseas (if the home secretary lets
them in).
The question to ask is not which side is right, or whether the strike
is justified. The critical question is how did we get to this
situation, and what that tells you about this government’s
competence. The NHS works on relatively meagre resources because of
the goodwill of those that work within it. Do we really think that
facing down UK doctors is the way to get a better NHS? If the
government does not compromise, the only losers in this dispute will
be you and me.
