Doctors occupy a unique place in the popular imagination. Of all the people doing good and useful work in the public service – teachers and GPs, nurses and care workers – only junior doctors are taken to be uniformly saintly and clever, overworked and underpaid. Poor Jeremy Hunt, condemned by the cycle of contract negotiations to find himself pitched against them, like a bailiff come to evict the sisters of mercy.
Hunt didn’t pick this fight, but he’s deploying the strategy of every beleaguered health secretary since Aneurin Bevan: threats, flattery, promises and pledges. In the two years since the first chapter of this saga was written, one has followed the other in a torrent of futility.
This is because, while many people make invaluable contributions to the health service, in the end the doctors run it. And in the face of external challenge – as Huddersfield’s emeritus professor of health policy recently pointed out – they are implacable, unflinching defenders of the status quo. More cohesive than the miners, more determined than the NUR and more confident of public support even than the nurses, these are the people whose decisions shape the way money is spent in the NHS, and the way that most of us will experience it.
Junior doctors are not well paid: they start at £22k, go up to £34k when they begin specialist training, and at the top of the junior tree – that is, in their late 30s – they can reach £69k. This is not chicken feed, but it does not compare with the kind of pay that science graduates in many other professions can expect. Plus, they have a crazy pay scheme that more or less incentivises dangerously long hours of work.
Hunt now says he is offering to raise the basic pay by 11% in return for chiselling off the barnacled accretions of special payments for unsocial hours and some specialities. It’s the kind of thing that obviously needs doing, but is fraught with unintended consequences.
Meanwhile the doctors, as usual, have hunkered down and formed a square, the way they do each time contract negotiations are opened, which is why it never gets any better anywhere in the medical profession.
Alan Milburn spent years fighting consultants, and the dispute was resolved only when he was succeeded by John Reid. Alan Johnson later fought GPs. As another health secretary, Ken Clarke, once said, mention reform to doctors and they feel nervously for their wallets.
Hunt says he wants to make sure there are more doctors working at the weekends, and the contract changes are really all about making that affordable. Like so many political contests, his case rests partly on a myth. Patients admitted at the weekend are more likely to die because they are usually sicker than patients admitted during the week. But there are fewer services available too. Jeremy Hunt is right to demand a proper, seven-day NHS. It is just that skimping on the pay of the people who keep hospitals working is the wrong way to do it.
Take a new piece of research, published earlier this week. It showed that a quarter of all cancer patients were diagnosed only in accident and emergency. In hospitals in London and the south-east, the disease was often so advanced that a quarter of them died within two months.
In the context of the £116bn the NHS will spend next year, the pay of fewer than 50,000 hospital doctors is not going to matter a row of beans. In the context of the lives of individual doctors, it is going to matter very much. In the context of Jeremy Hunt’s political future, it could be decisive.
The NHS is better value for money than any comparable health service. But in contrast with the rest of Europe, spending is rapidly falling as a share of national income. Hunt is locked into a no-win confrontation about a piddling amount of cash that – if the ballot that goes out tomorrow supports strike action, as it looks as if it will – could cost hundreds of lives.
Voters never trust the Tories on the NHS. Here’s Hunt’s chance to turn that round. First, retreat. Second, ask the junior doctors themselves to devise a pay scheme that incentivises best use of staff time, spreads cover across the week, and adequately rewards highly trained, sought-after, skilled practitioners. Third, find the money.
The alternative will be more and more of the people who can afford it going private. And that will lead to the slow deconstruction of the NHS, more certain than anything that could be achieved by any government’s privatisation policies.
