The thorny issues of NHS pay and strike action

9 October 2015

It was during a recent BBC Newsnight programme that I finally cracked. An admirably self-possessed young woman – I’m now of an age where I am qualified to say that – was explaining in ostensibly reasonable terms why junior doctors in the NHS would be right to strike. Except that the arguments did not seem very reasonable at all, not for the realities of the modern working world anyway.

Listen to the interviews given by junior doctors and their champions in the British Medical Association; read their articulate and often caustic blogs; study the letters in their support from the Royal Colleges, and what comes across – to me, at least – is a hugely inflated sense of entitlement masquerading as concern for patients and the sad fate of “our NHS”.

The dispute is all about a proposed new contract of employment, but there are different angles. For some, it’s less about the contract itself, than how no one “consulted” them (well, they did try, but junior doctors’ representatives walked out) and how, in the playground language of such quarrels, the process was “unfair”. We need to be “valued”, they said.

For most, though, it is about the contract – and they know exactly what buttons to press. Savour this particularly self-righteous passage from a letter addressed to trainees from the Royal College of Paediatrics and Child Health: “The consequences, gravely damaging to the health and wellbeing of children, include increased difficulty in providing 24/7 paediatric cover, increasing need for locum and agency staff, and a reduction in innovation and medical advance.” In other words, the new contract is a false economy in every way.

But is it a false economy? It will be if the BMA has its way, because it is doing as good a job as any old-fashioned trade union in trying to frustrate any change. And it is using the same arguments in support of junior doctors as it is in its efforts to block the introduction of a seven-day NHS: compromised patient safety, longer working hours, demoralisation, and the risk that every half-competent doctor will hightail it abroad (not, note, for voluntary service in the backwoods, but for the good life in Australia or Canada). But the money? Good heavens, it’s not about the money. No, really.

All of which reminds me of the well-used quip coined by the American journalist, HL Mencken: “When somebody says it’s not about the money, it’s about the money.” So let’s just take a look at the money.

Insofar as they can bring themselves to mention it, doctors themselves estimate that, because the new structures would incorporate most evening and weekend work into basic pay, junior doctors could lose between 15 and 30 per cent of their current earnings. But 15 to 30 per cent of what? They have been notably coy about this.

Junior doctors start on a salary of £23,000, which is at the high end of a new graduate’s pay. This can rise to £47,000 – a solid increment way beyond most UK wage earners. And this, remember, is basic salary, before those “out of hours” supplements. And there is more to look forward to, much more, with £100,000 being the norm for hospital consultants and many GPs.

Those outside the medical establishment might see the other advantages of becoming a doctor, in addition to job satisfaction. Once you are accepted as a medical student, your future is secure. There are predictable career structures; generous provision for training and leave; and, so long as there remains a ceiling on the number of UK medical students, there is almost no risk of being made redundant. In retirement, a public-sector pension awaits. The Government says the loss of out-of-hours supplements would be completely offset by a rise in basic pay. But an element of choice in the present system – more hours for more pay – means that there may well be some who lose. Is that really a false economy? Or is it rather a sensible reform that belatedly updates working practices in at least one area of medicine? How many other professionals earn overtime these days?

There are jobs – those in the emergency services being a prime example, you would think – where so-called “out of hours” working is a basic requirement. Yet these services have been among the last to formalise this necessity in the pay structure. The archaic principle that junior doctors work the unsocial hours for additional pay, while consultants have somehow earned the right to work nine to five, five days a week, may finally be coming to an end. But still the special pleading goes on.

In defence of current arrangements, I hear junior doctors say they need the extra payments because their courses are longer and their loans higher than those of other graduates. Yes, but their repayment terms are the same – and their later rewards are often far higher. They complain, too, that they will have to wait longer to buy a house, as though doctors are uniquely entitled among their contemporaries to their own home in their 20s. Female doctors complain that the new system will make it harder for them to work part-time and combine a career with motherhood – as though this is not a serious problem for almost every professional woman.

When I look back, there has hardly been a year in my adult life when junior doctors were not complaining. First it was the 100-plus hour week; EU regulation stopped that. Then it was that they could not work enough hours to accumulate the experience they needed. Then it was a new system for applying for first jobs. The one complaint that has remained valid is one you almost never hear: junior doctors have to take on too much responsibility too soon, because so few consultants work evenings or weekends. This is a real danger to patient safety. That is what junior doctors ought to be striking about – but they already know their chosen profession too well.