On Monday 18 September (at 12.01am), the Times dropped its leading editorial opinion piece on the ongoing industrial action of the British Medical Association (BMA), “scheduled to roll out this week on a far more coordinated and systematic basis than previously”. (The Times view on health sector strikes: Uncaring profession)
In summary, the editors’ opinion is: “For the first time, NHS consultants and junior doctors will this week strike on the same day. This reckless escalation makes them unworthy of public respect.”
“Something extraordinary will happen on Wednesday. For the first time in the history of the National Health Service both consultants and their junior colleagues will strike together, resulting in almost all planned care coming to a complete stop.
“Consultants are striking tomorrow and Wednesday; junior doctors will walk out on Wednesday, Thursday and Friday. And they are threatening to continue joint action on three days in early October – during the Conservative party conference – and quite possibly during the remaining life of this government.
“One would imagine that for hospital doctors to abandon their professional and moral obligations in such a deliberate and callous way they must be driven by the need to right some terrible wrong – the announcement of mass redundancies in the NHS, for example. In fact junior doctors are striking for a 35 percent pay rise. That’s right, 35 percent. Their argument is that this figure, redolent of a South American basket case economy, is their due because of real-terms earnings cuts over the past decade.” (Our emphasis throughout)
Yes. Doctors have been driven by the need to right a terrible wrong. Real-terms pay cuts of 35 percent are, in fact, a terrible wrong. And if any Times journalist doubts it, let them volunteer for the same. It is not ultimately the journalists, of course, but the finance-capitalist moguls who control the media group who are really expressing these opinions – hoping to convince the nation of their cause, and to demoralise and divide the doctors engaged in the struggle.
In this vein, they continue: “The radical faction heading the junior doctors’ committee of the British Medical Association (BMA), the doctors’ union, knows full well that this is a national phenomenon. But it has convinced itself that its members have some supernatural right to special treatment. Presumably, this is because doctors themselves are special.”
All workers are facing a crisis in their raised costs of living in every respect and their decreasing wages. It is not their ‘special nature’ then, but rather their character as workers that leads doctors to fight for pay rates to keep pace with inflation. This is no more than the normal working of ‘market forces’ – something that both the Conservative government and Labour opposition like to hold aloft as a commandment of their capitalist religion.
Of course, in this matter, the Times takes the side of the capitalist class against the workers. It is nothing if not consistent.
In reality, the BMA and doctors as a profession have singularly failed to mount effective resistance over at least a 20-year period of steady real-terms pay cuts. Consultants’ pay in England has fallen by more than 35 percent since 2008, falling far more severely than comparable professions and the wider working population.
As the BMA has pointed out: “We don’t care for 35 percent fewer patients, carry out 35 percent fewer procedures or work 35 percent fewer hours. Consultants have lost faith in the so-called pay review process, which has been repeatedly interfered with by government – underlined by this year’s insulting 6 percent award: a real-terms pay cut of around 5 percent.” (Consultants’ strike ‘for the survival of the NHS’ by Ben Ireland, BMA, 20 July 2023)
Decreasing the NHS staff wages bill – to privatise the NHS and maximise profit
Doctors’ pay has fallen far more than that of the wider workforce. In this regard, they have indeed been singled out for ‘special’ treatment by the government; both because doctors’ pay was higher than average to start with, and because the agenda of health service privatisation, with maximisation of profit, demands a lowering of the wages bill right across the health sector.
The staff wages bill (along with insufficient government funding and the lack of social care for those patients ready for discharge) was cited by the Circle Health group as the reason for its failure to manage Hinchingbrooke hospital at a profit – as the Financial Times pointed out when Circle pulled out of its ten-year contract after a disastrous three years in charge, back in 2015.
“But the healthcare industry insisted that the pipeline of other NHS contracts remained strong and pointed to an increasing number of integrated social and healthcare contracts awarded to the private sector, including Circle’s £125m deal to provide musculoskeletal services for 440,000 NHS patients in Bedfordshire. Virgin, which holds 325 NHS contracts, said it had been in the market for ten years and would continue to ‘pursue opportunities with the same vigour’ as before.” (Circle ends NHS hospital deal amid losses and criticism by Gill Plimmer et al, 9 January 2015)
Richard Branson remains the nation’s largest GP practice manager, with more than three million patients in Kent, Surrey and Sussex. “Private provider Virgin Care has won almost £2bn worth of NHS contracts [between 2011-16]. Virgin Care and its subsidiaries [then already held] at least 400 contracts with more than 40 CCGs across the public sector, which … amount to £1.8bn. Virgin … secured over £1bn worth of NHS contracts in 2016/17 alone, which amounted to a third of the total value of contracts won by non-NHS providers in that period.” (Virgin Care wins £2bn worth of NHS contracts in the last five years, Pulse, 6 August 2018)
Let’s not forget that the Covid pandemic was used to build up record-breaking waiting lists in NHS hospitals, on the back of which, other than the corrupt granting of £450bn in ‘emergency Covid contracts’ and ‘bail-outs’ to private business. (Research briefing: Public spending during the Covid-19 pandemic by Philip Brien and Matthew Keep, House of Commons Library, 12 September 2023)
A further £10bn of taxpayers’ money was pledged by the government to private hospital groups in August 2020 for “buying operations and treatment in the private sector over the next four years to reduce waiting times [!]” (NHS prepares to spend up to £10bn on private hospital treatments by Shaun Lintern, 17 August 2020)
This real haemorrhaging of funds to the private sector is in full swing, and far outweighs the costs that would be involved in funding the NHS adequately, and paying actual NHS staff to do the job.
The subcontracting out of NHS services, with billions in corporate profits being taken from the NHS budget each year, has been accelerating, and is the chief reason that wages are being forced ever lower.
Private healthcare is expensive, impoverishes workers and delivers substandard care
It is worth noting the fate of the patients in the aforementioned NHS hospital when it was in the tender hands of private corporate capital:
“Hinchingbrooke – the flagship of NHS privatisation – was given the Care Quality Commission’s worst ever rating for ‘caring’. Both safety and leadership were also bottom of the heap.
“Circle’s cleverly branded ‘mutual’ model, far from ‘liberating’ NHS professionals to make grassroots-led improvements, had in fact replicated some of the worst hierarchical, bullying practices to be found in the NHS. And it had lost the caring and expertise that are the NHS’s strengths, principally as a result of poor leadership and financially-driven staff cuts to satisfy investors.”
“The CQC notes: ‘We found many instances of staff wishing to care for patients in the best way, but unable to … prevent service demands from severely impinging on the quality and kindness of care for patients.’ It found Circle lacking ‘sufficient appropriately skilled nursing staff’.
“Though the details are shocking, the general picture is unsurprising to anyone except those who bought the ideological hype about private sector magic dust. Circle won the contract by promising what the Public Accounts Committee called an ‘unrealistic’ and ‘unprecedented’ level of savings – urged on by government officials.
“Circle’s full business case said it would achieve this by altering ‘nurse-patient ratios‘, but exactly how was blacked out of the plan when it was eventually published. Leaks suggested plans to cut 320 posts in total.” (Hinchingbrooke – why did England’s privatised hospital deal REALLY collapse? by Caroline Molloy, Open Democracy, 14 January 2015, our emphasis)
Why is doctors’ pay relatively high? Skilled v ‘simple’ labour
In its editorial hatchet job, the Times chews over its familiar refrain: “You are highly paid, how dare you complain or ask for more?” We can dub this the ‘Oliver Twist’ treatment. And it’s the same story when any skilled and organised group of workers take action to preserve, restore or increase their pay.
In essence, the diatribe directed against doctors today is not fundamentally different to the handling of train and tube drivers when they strike to defend their pay, conditions and the safety of their services.
The main difference between doctors and other skilled workers is that it takes so very long to train both ‘junior’ and consultant doctors. Five or six years of medical school, two years of foundation training (‘house’ jobs as they were formerly known), at least three years of junior specialty training (senior house officer roles, formerly), four to six years of senior training (as a registrar or specialist trainee), with perhaps an intercalated research or education degree (two to five years).
Alongside all this is a litany of professional exams to pass, courses and conferences to attend, journal articles to write, skills to be acquired, mastered and objectively verified, clinical competence reviews to be completed – and perhaps a fellowship in an area of specialised interest.
Training the next generation of doctors and allied professionals is an integral part of doctors’ lives and duty: every doctor is also a teacher.
All these steps are competitive; accomplishment and transition from one stage to the next are not guaranteed. Working lives are hugely rewarding, and enjoyable – lifelong learning is a privilege, as well as an obligation – but time, intellectual and emotional pressures are also intense. The support required also becomes expensive, with travelling, living and working combined with child-raising and other family, social and life expenses multiplying in proportion to the time-poverty of the professionals involved.
And no, not everyone can or wishes to do it.
Devotion to duty v the vulgar pursuit of money
The Times, however, thinks that the ‘special’ status of doctors “is that their profession is one of the ultimate expressions of human civilisation: a career dedicated not to gain but to the alleviation of suffering. A profession that is not commercial but caring. How does 35 percent chime with that?”
Hear! Hear! The London Times, daily journal of the British monopoly-capitalist class, now professes self-righteously that there is some ‘higher expression of human civilisation’ than ‘gain’!
Would the Times rage so, one wonders, if doctors, nurses, radiographers, teachers, train drivers, engineers … in a word, workers, asked for less money? Less culture, less education for themselves, less schooling for their children, less food, clothing and shelter? Less rest and recreation? Less civilisation? A smaller proportion of the wealth created by our collective labour?
This again is a totally false and hypocritical line of argument. Alas, we are not living in a world where all our needs are catered for, planned and provided by a benevolent society and state that has the interests of the workers at its heart. Quite the reverse. Maximisation of profit is derived directly by maximising working hours and intensity and minimising remuneration.
“The bourgeoisie, wherever it has got the upper hand, has put an end to all feudal, patriarchal, idyllic relations. It has pitilessly torn asunder the motley feudal ties that bound man to his ‘natural superiors’, and has left remaining no other nexus between man and man than naked self-interest, than callous ‘cash payment’.
“It has drowned the most heavenly ecstasies of religious fervour, of chivalrous enthusiasm, of philistine sentimentalism, in the icy water of egotistical calculation. It has resolved personal worth into exchange value, and in place of the numberless indefeasible chartered freedoms, has set up that single, unconscionable freedom – Free Trade.
“In one word, for exploitation, veiled by religious and political illusions, it has substituted naked, shameless, direct, brutal exploitation.
“The bourgeoisie has stripped of its halo every occupation hitherto honoured and looked up to with reverent awe. It has converted the physician, the lawyer, the priest, the poet, the man of science, into its paid wage labourers.” (Manifesto of the Communist Party, 1848, our emphasis)
And as wage labourers in a capitalist economy, doctors, like any other workers, must struggle to preserve their pay and conditions against the encroachments of capital – even when NHS employers are the indirect servants of capital, mediated by the Tory [or Labour] government and NHS management apparatus, which all undoubtedly still serve the capitalist class, and which constantly strive to reduce the social wage of the proletariat just as surely as they press down on their direct wages.
If we don’t pay NHS staff adequately, train them and retain them, there will be no NHS
If pay is insufficient to meet the increased burden of training and the lifestyle involved, then ultimately the profession will fail to attract and retain the skilled doctors that the NHS needs to function. Newly qualified doctors (without the bank of mum and dad to draw upon) are now accruing an average £100,000 of debt during their university study.
“In his foundation year one, on £14.09 an hour, Alistair Ludley accumulated £1,044 of interest on his near £90,000 student loan debts – more than his annual repayment of £903.” Hardly an attractive proposition for the nation’s ‘best and brightest’! (Enough is enough: a life of debt by Ben Ireland, BMA, 24 November 2022)
Such a situation also preserves medicine as an elite profession not accessible to the majority of working-class students. And it is British public-school culture, rather than some special preserve of male doctors, that has a negative impact on the culture of our health service.
And here is where the demands of the doctors as a profession coincide with the needs of the entire working population: we all need the NHS to function well. “To provide high-quality care at the point of need, free at the point of need, from the cradle to the grave.”
The attack across the board on NHS pay, on training bursaries, on maintenance grants and course fees is a veiled but crucial part of the attack on the NHS system of public healthcare provision itself. If NHS workers are not able to preserve their pay, there will be no NHS, with the consequential huge detriment to the life of every British citizen, and with a particularly heavy burden falling on the poorest sections of society – the lowest-paid members of the working class.
Let us not forget that an incredible 14 million Britons are now classed as living in poverty, with a further extra two and a half million people ‘just above’ the poverty line, meaning that relatively small changes would force them below it too. Of these, four and a half million are children and one and a half million are pensioners. (More than 14 million people in UK living in poverty, major report finds by May Bulman, Independent, 17 September 2018)
Many of our poorest fellow workers are in this position as a result of chronic ill-health and chronic unemployment and underemployment. We in the NHS help those workers every day. Without an NHS, such workers will fall even deeper into the ‘classic’ Dickensian poverty of the Victorian era. This is, in fact, what our government is aiming at.
Seemingly not a day passes without the media pushing another major ‘NHS’ scandal. It’s as if there were a joined-up political and media campaign aimed at defaming and destroying the NHS; of undermining the NHS as ‘the nation’s last religion’ – and indeed there very well may be.
But it is not the NHS that is failing. Rather, we are seeing the effects of the deliberate destruction, undermining, under-resourcing, restructuring, dismantling and corporate fleecing of NHS funding streams. The crises that wrack our destroyed ‘public’ system of health provision are then repackaged and sold to us as further evidence that the entire idea of public health provision “from the cradle to the grave, free at the point of use” needs ‘shock therapy’, ‘radical surgery’ and ‘fundamental rethinking’ – ie, a hair of the dog: yet more privatisation!
The policies that have been pursued to destroy our NHS (all pursued illegally, and fraudulently, by successive Labour, ConDem and Tory governments under the guise of ‘improving’ it, one might add) are: introduction of the internal market, patient ‘choice’, decreased clinical autonomy and decision-making, the revolving door between NHS and business management, a target-driven culture, ‘performance-based’ funding (rationing), private finance initiatives (PFI) to ‘build hospitals’ (the great NHS heist), clinical commissioning group (CCG) GP fundholding (dismantling of planning and the takeover by the ‘big four’ accountancy and insurance firms), subcontracting ‘peripheral’ and then ‘core’ services (dating back to the cleaners and building up to entire medial services and hospitals, the Virgin takeover, etc).
The coup de grace will be the rolling out nationwide of ‘clinical networks’, making way for the private health and in particular the insurance industry takeover of NHS funding streams.
If all this seems a bit much, we invite our readers to check out the leading role in the process of Lord Simon Stevens of Birmingham (knighted and then ennobled by Boris Johnson). Stevens was appointed chief executive of the NHS when official ministerial responsibility for health provision was removed by the 2012 Health and Social Care Act under the direction of then Tory health minister Andrew Lansley (does anyone even remember Lansley now?!)
Stevens had formerly advised Labour prime ministers Tony Blair and Gordon Brown and Labour health ministers Frank Dobson and Alan Milburn on the introduction of the private finance initiative to fleece the NHS. He left that job to become corporate executive vice-president and president of United Health’s ‘global health businesses’, spanning the Americas, Europe, Asia and Africa, and was also was a director of Brazil’s largest hospital group Amil.
United Health is the world’s largest health insurance company, with an annual turnover of $400bn. Stevens’ job was helping his bosses to tap into the huge state budgets for healthcare spending around the world. And the NHS was the jewel in his crown – for which he won his enormous remuneration, high-level government access, and his lordship.
When he passed back through the revolving door to take over as chief executive of the NHS, he did so to oversee the final insurance takeover of CCGs – whose task is to reproduce the basis of the US healthcare system in Britain. British clinical commissioning groups will mimic the USA’s so-called ‘health maintenance organisations’ (HMO) – the system that has made US healthcare the most expensive and inequitable (literally the ‘worst’) in the world.
What can we do?
First, don’t be duped. The problem with low NHS pay, including for junior and consultant doctors, is real. As of June 2023, there were 125,572 vacancies in secondary care in England. Of these, 10,855 vacancies were medical, amounting to 7.2 percent of all medical posts.
This vacancy rate is similar to the one seen a year ago. A recent Royal College of Physicians (RCP) census found 58 percent of consultant physicians reported having vacant consultant posts in their department. As a result, the RCP reports that one in five are at risk of burnout, and seven and a half million people are currently waiting for operations or procedures in England.
The General Medical Council (GMC) estimates that 10,000 doctors left the medical workforce in 2021, half of them to go overseas. Current OECD data shows at least 13,000 British-trained doctors presently working abroad. In the Republic of Ireland, the new consultant pay scale starts at the equivalent of around £185,000 – double that offered in England.
Second, be assertive in our demands. The attack on medical pay is part and parcel of the attack on all workers’ pay, and of an attack on the NHS itself.
We should not be shamefaced in demanding pay restoration; this is central to our fight to save the NHS. We must demand more for all, not less for this or that group of skilled and vital workers. The current economic conditions of inflationary crisis are beyond workers’ control and not of our making.
Workers should not accept paying with their poverty to protect the capitalists’ obscene profits.
Third, defend national provision and demand the reversal of NHS privatisation. This must be our consistent demand across all medical, dental and pharmaceutical services. (For more on this, see our party’s resolution on the problems that beset the NHS)