The Spectator

It’s junior doctors – not underfunding – pushing the NHS to the brink

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Yet again we start the year with news that the NHS is facing the worst crisis since its inception. This has a real impact. People who think the health service is in crisis will be less inclined to use it. As we saw over lockdown, this leads to fewer treatable conditions being diagnosed, more ‘excess deaths’ from various causes and a greater healthcare burden for the longer term. It’s a calamity that only worsens.

The NHS is forever on the point of disintegration and collapse. Or, in the words of the British Medical Association, the system is under ‘intolerable and unsustainable’ pressure. Why, then, do so many members of the BMA seem to be determined to make matters worse?

A nation paying for world-class care is given mediocre outcomes by a system that no longer works

It is estimated that this week’s six-day strike by junior doctors will cause up to 200,000 operations and other treatments to be cancelled. Combined with last year’s strikes, nearly a million planned procedures have been delayed or cancelled – at a time when the waiting list for NHS England alone is at a record 7.7 million.

The latest round of industrial action is not only the longest in the NHS’s history, it is occurring at a time of the year when demand on the health service is at its greatest, as a result of the annual peak in viral infections. It seems timed to cause maximum harm. Moreover, this strike follows on the heels of a three-day walkout before Christmas, when one A&E department, in Cheltenham, was forced to close altogether.

This week, a former medical director of Public Health England was warning elderly people to take extra care to keep warm during the strikes, for fear that there would be no bed for them if they did fall ill. The BMA would like us to believe that doctors are striking on a point of high principle, that they are on the side of the public, embroiled in a battle against government neglect. ‘The health service has been facing years of in-adequate planning and chronic under-resourcing,’ it declared in October.

In truth, the UK spends more money on healthcare as a share of GDP than most of Europe and the developed world. This strike is just another grubby pay dispute: a battle of wills between employees and employers. There is nothing wrong with workers wanting to be better paid and pressuring their employers to increase their remuneration. That is, after all, how markets work. But the NHS is a state-run monopoly, and the BMA is invested in making sure it stays that way. When a union is willing to deny patients the only care they can access, over demands which can scarcely be described as reasonable, it cannot claim the moral high ground.

Junior doctors have already been offered a 3 per cent rise on top of the 8.8 per cent raise they were given last year. Their demand for a 35 per cent pay increase is not just excessive – it is made with blithe disregard for the current pressures on the public finances and the decline in productivity in the NHS over the past six years.

According to the Office for National Statistics’ figures, ‘productivity gains’ have been shrinking since long before the pandemic. This problem exists across the whole British economy. It is the reason pay in all sorts of occupations has not kept abreast of inflation in recent years. If an economy cannot produce more, it cannot grow and bring about real-terms pay rises. This is as true for the NHS as it is for any other sector.

The BMA claims that a pay rise of 35 per cent is needed to restore junior doctors’ pay to the real level it was in 2008. Yet it has based this figure on the discredited Retail Prices Index (RPI), long abandoned as the official measure of inflation owing to faulty methodology. Nor should the BMA’s claim that a junior doctor is paid a lower hourly rate than a barista at Pret be taken seriously. It takes the figure of £14.10 an hour – which employees at Pret can earn if performance-related bonuses are added – and compares it with the basic pay of junior doctors, without adding the many extra payments for which they qualify. Neither does it factor in the spectacularly generous NHS pension.

In fact, junior doctors in their first year of training earn £36,583 when payments for shift-working and overtime are added on – putting them comfortably above median UK earnings. By their second year, their median pay rises to £43,115. Five years after graduation, according to government figures, people who studied medicine at university earn an average of £52,900 a year. That is more than graduates in any other subject: those who study economics come closest to medics, yet still earn 25 per cent less.

The Daily Telegraph recently revealed that there were more excess deaths in Britain last year than in any year since the NHS was founded, excluding the duration of the Covid pandemic. This is the real healthcare crisis today: a nation that is paying for world-class care is instead given mediocre outcomes by a system that no longer works for staff or patients. If junior doctors really do want to protect the NHS, as they claim to, they should vote to end their strike and work overtime to clear the huge backlogs. The NHS may very well be on the brink, but it is these strikes – not government underfunding – that are threatening to tip it over.