A four day junior doctor's strike will start tomorrow. After a long holiday weekend tomorrow would usually be a day of excess demand in the NHS, with everyone and everything stretched to its limits. What this strike means is that the resources to meet that demand will simply not exist. There is no point pretending otherwise: people will suffer and some might die as a result.
Except that is true every day in the NHS now. Recently, excess deaths (i.e. deaths above average rate seasonally and population adjusted) have been running at up to 10% a week. Many have been due to Covid. Others have probably been related to it. The government's reaction is to actually refuse to make Covid vaccines available to most people, to cancel data collection on the issue and to pretend the problem no longer exists. That is not normal behaviour in the face of a medical crisis.
Just as it is not normal to let 7 million people be on waiting lists requiring medical appointments and to pretend that nothing can be done about that.
And as it is not normal to try to run hospital services in buildings that are falling down, like that in King's Lynn is, and to pretend that forty new hospitals are being built, but not in King's Lynn.
Nor is it normal to refuse to make a reasonable pay offer to those you employ and on whom you are utterly dependent when you know that they have the option of leaving and working elsewhere, even if Canada and Australia are currently the preferred alternates.
None of this is normal. But nor too has the financialisation of doctor's pay arrangements been normal. Of all professions outside the church many, including doctors, thought that their work was a vocation. Pay mattered, but the calling was what distinguished the profession.
And then doctors were charged up to £100,000 for their training. They began to come out of medical school burdened with interest charges designed to be penal and with excess tax charges of 10% likely to persist for much of their careers. Just as their senior colleagues were burdened with excess tax charges on their pensions, junior doctors were penalised with them for simply choosing the career.
To top that, and to break what Tories saw as the power of overpaid consultants, politicians have since 2010 pursued a policy of deliberately underpaying junior NHS doctors. The aim was to reduce their status. They were to be put in their place. They were to become the fodder for recruitment by private medicine that would offer them more pay to break the NHS. The real decline in pay exceeds 25 per cent. That was not accident. It was design. The Tories thought they could trap the junior doctors into being the agents of change. Their hope was that the frustration of those doctors would break the NHS.
To some extent the Tories were right. Junior doctors realised they cannot afford to work for the NHS and enjoy anything like the lifestyle that their older colleagues did at the same stage in their careers. The financial placed burdens on them, and the deliberate underpayments, guaranteed that.
But the junior doctors aren't stupid. That's hardly surprising. They are recruited precisely because they are not stupid. They worked out the game. They saw that the end point was destruction of the NHS. Even now they are winning the PR game with Steve Barclay, the health secretary, precisely because they are able to call out his refusal to make a pay offer to resolve the dispute simply because they have more wit than him.
For that sane reason they can see that the Tory end game is the destruction of universal, high-quality health care for all, free at the point-of-supply. They have fought to defend this. I applaud them for doing so. That is why I support their strike this week. They are striking to save the lives the government threatens week in, week out.
But junior doctors are also people. And they can do the sums. The burden being placed on them is intolerable, as it is on most young people. The financialised obligations of debt, high costs of housing, high taxation and the cost of living have eaten into the fabric of their lives. It is staggering that somehow this burden is accepted by so many.
I think this strike is pivotal because my suspicion is that it is the signal that this acceptance is over. Doctors have never wanted to strike. It goes against all they want to do. But they are doing so, and I suspect support for the strike amongst doctors and in the public will be very high. That is because what they are saying is that they have had enough. This time it is pay up or they quit. They will go and work in finance, and take the money that goes with it. Or, more likely, they will leave the UK and never come back. Their need for a life demands that, and the government is proactively denying them that life.
The conflict is actually quite simple in that case. It is between the goal of financialising everything, and everyone, and the chance of a life well lived. The doctors see no chance of that life well lived, in or out of work. The government thinks money is everything. The dispute is about clashing philosophies. There is the belief that life is there to be lived, opposed to the belief that we are just slaves (I use the word deliberately) to servicing finance.
That conflict is existential. That is why this dispute matters. It matters most because there is no sign that either major Westminster party shows the slightest sign of understanding how badly they have got their approach to this issue wrong, with noises from Labour being almost as inappropriate as those from the government.
This dispute is about saving lives. But that is an issue much bigger than providing care to those in hospital beds this week.
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“The conflict is actually quite simple in that case. It is between the goal of financialising everything, and everyone, and the chance of a life well lived.”
It is strange indeed that the Neoliberal ascendancy wish to financialise everything, yet Neoliberal economists refuse to recognise, still less acknowledge, that money is fundamental to economics: a mystery wrapped in a recondite penumbra.
Indeed
And well put
Austerity due solely by Tory policy has caused 300,000 excess deaths https://lordslibrary.parliament.uk/mortality-rates-among-men-and-women-impact-of-austerity/
The government is offering 2%, inflation is currently at 10%, and MPs have had a 28% pay rise in the same time frame.
The motive is clearly the privatisation of the NHS, which has been carried out by stealth over the last 20 years (by both governments). Why? The PPE scandal is an example, people can make outrageous and immoral amounts of money by blackmailing people over their health.
Private Finance Initiative (PFI) schemes have already siphoned £250-billion from public services into private hands.
Read: How to Dismantle the NHS in 10 Easy Steps by Dr Youssef El-Gingihy
https://www.amazon.co.uk/How-Dismantle-Easy-Steps-second/dp/1789041783/
Watch: The Great NHS Heist https://vimeo.com/ondemand/thegreatnhsheist
https://www.youtube.com/watch?v=ro-oU0u8Jos
Thanks
Also read NHS Under Siege by John Lister and Jacky Davis. The fight to save it in the age of Covid.
https://www.hive.co.uk/Product/John-Lister/NHS-under-siege–The-fight-to-save-it-in-the-age-of-Covid/26978622
“The government is offering 2%, inflation is currently at 10%, and MPs have had a 28% pay rise in the same time frame.”
Are these staggering figures correct? How could the Tories even begin to justify a 28% increase for MPs when 2% is all they say they can afford for people in critical jobs? It’s time for a new Reform Act.
Self interest and a hatred of the NHS is a powerful combination
Annual salary of Members of Parliament (MPs) in the United Kingdom from 2010/11 to 2023/24. https://www.statista.com/statistics/388885/mp-salary-uk/
“MPs’ pay has increased by 28% since 2010.” – Civil Service World, https://www.civilserviceworld.com/professions/article/mps-pay-rise-is-another-dash-of-salt-in-the-wounds-for-civil-servants
“MPs’ pay will increase by 2.9% in April”, BBC News, 9 Feb 2023, https://www.bbc.co.uk/news/uk-politics-64581869
Bravo, Richard, for an excellent summary.
The callous cruelty to those who who have no choice but to use the NHS and the hypocrisy of the government statements is an appalling indictment of their ability to, and suitability to govern.
An excellent post I must say.
It is the class war against the middle class in this case that in reality provides many of our medical professionals that caught my eye a while back. These aren’t miners or postal workers.
It was a stark warning to those falling for the allure of identity politics not to take their eyes off the ball.
And what what is this ball I speak of?
My view is that society at the moment is ridden by interest groups – many entirely valid – no qualms there (Black Lives Matter, LGB&T etc) and some not (placed there by bad actors to disrupt). These groups though have been set against each other by austerity or on purpose to compete with each for the niggardly resources our ‘masters’ let us have. It keeps us angry and it keeps us occupied.
The key issue is that each group focuses on their needs and do not see the bigger picture. This is why when I heard the idea of ‘white privilege’ (which to me – sorry – is just another iteration of a old problem) I was so dismayed.
The bigger picture is exactly Richard what you say above – the existential threat – between a life to be lived and slavery. What we are in is not the process of ‘levelling up’ but a process of levelling DOWN for working people (labour), whether black, white, working class, middle class, whatever.
It’s going to be a real tragic mess when workers are denied proper working wages, training and conditions but still fall out with each other over sub identities when in fact from an economic point of view they are actually all the same identity – exploited, under valued and worked until they drop.
As I’ve been telling everyone I know ‘In the future we’re all slaves now’. I’ve also been know privately to use the word ‘negro’ instead of ‘slave’ as a hat tip to the history of the U.S. Southern Confederacy – not because I’m a racist BTW. Here’s why.
As you know, I’ve been reading Clara Mattei and the long unfinished, contemporary use of austerity to control labour – it’s a must read and has helped me see things a little clearly. Austerity is not just a policy, its a process of run-down. But to what?
In 2017 Nancy MacLean wrote ‘Democracy in Chains’ – an astonishing book about how embedded old southern slavery state attitudes were in modern libertarian/neo-liberalism. One example I remember was that when the federal government banned single race schools in the southern states (segregation) to get around this, Southern pro-segregation public legislature at state level offered whites the opportunity to go to private schools by offering vouchers to opt out of the un-segregated state system.
That an education voucher system idea – born of racism and sedition – found its way into our education system didn’t it in the UK to encourage parents to opt out of the state system – is frankly incredible but when you think about, deeply troubling.
But why stop there? Why not export the idea of slavery too? I mean not having to pay for your labour must have resulted in huge profits to plantation owners. It was the U.S. South’s economic model. And rich families running our shires and cities and our politics. The anointed rich and powerful.
What is it that they say? ‘The South will rise again’. Oh, I think so! But this time, as they they try to bring the past back, the objective of the southern state slavery model is world domination. It is now the economic model of world wide capital itself.
So, you are right Richard, it’s existential: Slavery is back on the agenda for every working person, every vocation, every colour, creed, gender, everywhere. Honestly! And fighting it must unite creed, colour, gender of class or we are lost.
This is all so true.
The extraordinary thing is that ‘we’ – and certainly the oppostion parties cannot bring ourselves to acknowledge what kind of an autocratic quasi-democratic system we have.
In Putin’s Russia its clear, in Orban’s Hungary its clear, in Xi’s China its clear in Erdogan’s Turkey and Mhodi’s India its pretty clear , but we are much more complex – in the UK it is not clear. No one voted for what has happened over the last ten years , but that’s what we’ve got.
Maybe we are all too afraid, reluctant, or lazy so that we cannot acknowledge we are in a life (and literally in the case of the NHS) – death fight. We are all more vulnerable while the hospitals are not functioning during the strike – but this is one the doctors have to win.
If £14 an hour is true, it’s crazy and I don’t understand how any doctor could accept it. We pay our cleaner (once evert two weeks) £20 an hour.
Some information about pay on here.
https://morningstaronline.co.uk/article/b/thousands-of-junior-doctors-launch-four-days-of-strikes
I hope nobody’s waiting to have their appendix out.
Junior doctor is a misnomer as well.
The calculation of an hourly rate is difficult because there are many variables.
If you believe FullFact, the £14 per hour figure is probably an underestimate – or at least only represents a very small number based on specific assumptions, such no additional payments for working nights or weekends and taking no holiday. Most junior doctors will be earning around £40k or £50k, or say £20 to £30 per hour. After nearly a decade of graduate study, that is still comparable to your cleaner.
https://fullfact.org/health/bma-junior-doctors-hourly-pay/
Pay scales here. https://www.bma.org.uk/pay-and-contracts/pay
The misnomer is that they are junior doctors by then
The Fullfact website says that: “£14.09 [..] represents the hourly basic pay for the lowest-ranked doctors, who make up about 11% of junior doctors in general”.
Fullfact also conclude that “The average junior doctor makes much more than this. Depending whether you include extra earnings and time off for holidays, it’s probably between about £20 and £30 per hour.”
We’re not told the source of the extra earnings, perhaps they have to work extra shifts in order to get the value of salary they received in 2010.
Either way, if a 28% pay increase is good enough for MPs in the same time frame, and they are getting an automatic 2.9% increase next year, then it’s good enough for other NHS staff who have been offered just 2%
The average junior doctor has several years service. Those on £14 are starters.
Very good and informative post and comments! Thank you!
It seems that there is a strong and persistent drive to create an underclass of people who cannot afford to eat, clothe or house themselves or even bring up their own children even if they work hard all the hours God sends. This underclass includes large numbers of people whose work is not considered ‘skilled’ such as carers and cleaners but, as anyone knows who has used the help of carers and cleaners, these are skilled jobs.
There are people who do not clean well or with care and those who have the know-how and interest to do it well, who understand that different material need cleaning in different ways. Those who have needed personal care know all too well the difference between someone doing the necessary in a caring job and a carer who has a real ‘feel’ for and understanding of the needs of those who suffer ill-health and who treats them as a person like themselves; who relates to them – but you don’t need a university degree to do that and having one would not give you the human understanding or necessary skills. Doctors and nurses are considered skilled and cleaning and caring are not considered skilled jobs but all of them require the skill of human understanding and skilful handling of others, physically and in other ways. For example, it seems that most medical staff are not trained in how to move a patient with minimum shock and pain. The ability to sense by touch and eye the state of another’s body and move accordingly is apparently not considered ‘skilled’ but personal carers also need it.
The sudden jolt produced by moving a damaged or affected limb too quickly produces muscular contraction and will make it more difficult to assess as well as leaving the person in radiating pain for some time. To avoid this the movement must be started slowly and gradually not ‘efficiently and fast’. The patient can then relax. I guess that applies to a lot of things…
Similar problems affect education which was de-professionalised at a certain point and teachers were deprived of respect for their knowledge and skill (soft and hard); they had to account for themselves all the time as if, without this accountability, they would of course commit some kind of criminal act; they had to be tested as if this would prove that they were doing a good job. Too often the accountants were and are often people who do not understand or have little experience of the work they are assessing. They have moved ‘up’ – away from teaching. On rare occasions I have encountered some helpful assessors/external examiners who can contribute to professional development
There is a great emphasis on the remote: AI, IT, Messaging, Bots are all heavily and increasingly relied on. Government has used the widespread attitude that what really matters is (remote – in various forms) management and control of funds (requiring skill) and people to drive down the value of practical, hands-on work and human skills of various kinds that managers manage and funders fund. When this happens and no-one is really interested in what is going on on the ground (other than its cheapness), the motivation to ‘do a good job’ and attend in detail to what is needed is eroded. Even the most able and most committed, lose heart – why would they not? Meantime, the entitled walk high on the reef of life, colour, imagination, skill, care and hard graft that produces the wealth they live on and continue to accept pay rises, bonuses and privilege. apparently without realising that the reef beneath their feet is dying from exhaustion, depression, ill-health and want of attention, care and fellow-feeling. Keeping all the various balls in the air at once is exhausting. If you’re tired and no-one actually notices the difference between a job well-done and slipshod work, will you put in the extra, unpaid time to ensure something is excellent? And for how long?
We need a complete review of what is valued and considered valuable. I’ve always thought that schools should be run by teachers who engage administrators and managers to serve the job of the school, not the other way round. Pay gaps between CEOs and senior managers and those who produce and maintain the wealth and reputation of organisations should not exist in the way they currently do. These gaps, this dismissal of the needs, all kinds of needs, of others is immoral, unethical and, to the extent we indulge in it, erodes our own humanity. It’s also unsustainable.
Everyone needs to understand not only that we are responsible for global warming and the planet but for co-existence with one another – “my life is my brother” – there is a close connection between them – globally and locally.
My areas of expertise are music performance, teaching and research and I’m not knowledgeable about law, politics or economics but I know what I have seen and experienced over time as a professional in underfunded fields with some longterm health issues that in recent years have required more than my usual use of the NHS and also social care.
Too much is about a certain kind of appearance. Even fund-raising requires descriptions and claims and it is these claims and descriptions that are evaluated. No-one looks closely or even at all at what is actually happening on the ground or what ground level events and conditions might mean. Heads are firmly in the Cloud and clouds and are encouraged to remain there, it seems.
This not only applies in the UK. For most of my life I have worked as a freelance here and widely overseas. Sadly, this pattern of disease is very widespread.
Thanks
Please note the US health industry takes 18% of the GDP and still does not cover the whole population, How does that compare with the UK?
Does UK business realised the consequences of privatising health? They will have to pay their workers more to keep them healthy or pay their health insurance. This could like the USA wipe out all manufacturing in the UK
https://www.nakedcapitalism.com/2023/03/salve-lucrum-the-existential-threat-of-greed-in-us-health-care.html
The UK spends under 10% – lower then most equivalent countries
I wish people wldnt just say “the nhs” like theres only 1.
Which one?
There IS supposed to be just one NHS in this country. However, in some families not even one generation will have lived their lives under the NHS. That’s why IT needs to be saved. We have not had what we paid into all our working lives. We have been robbed of it.
As weownit says, WE OWN IT. We should fight to keep it.
https://weownit.org.uk/act-now/nhs-privatisation-kills
I have been a doctor for 31 years. From a working class family – I was able to go to university because my fees and maintenance were paid as a grant for all six years of medical school. Once I graduated my first junior doc job was for a 91 hour week. The first 40 hours were paid at a normal rate, the next 51 at 30% (at the time this was overtime at less than £1 an hour). We moaned a lot – not about the pay but the consequences for patients and us of our exhaustion. But this isn’t a ‘you were lucky’ post. You have hit the nail on the head. We understood the pay as payback, then, for the training we had been given at public expense.
Now junior doctors have paid £9250 a year in educational fees, plus rent/maintenance of at least that much again (often much more – you won’t find Uni rent plus food for £9k pa in London), for 5 or 6 years. They have paid for their education and are paying it back every month, direct from their pay slips.
Nurses, too, like my niece, now pay for their education – as do paramedics like my son and physios like my daughter.
If I were health secretary I would be giving serious thought as to whether there is an option for the government to write off the fees debt in return to a 6 year minimum commitment to the NHS for doctors, and three for nurses, physios and paramedics.
I now your story on pay
My wife graduated as a doctor in 1987
Don’t forget that the likes of student loans are charged interest at RPI plus up to 3%, currently capped at 6.9%. if you owe £30K you could be charged £2K per year. https://www.moneysavingexpert.com/students/repay-post-2012-student-loan/
I would argue that the cost to government is not financial (taxes do not fund government spending), but the cost to the public is a failing NHS and an estimated 330,000 excess deaths due to austerity.
Scotland – Gov’t SNP – strikes averted after negotiation.
Wales – Gov’t Labour – strikes averted after negotiation.
N Ireland – no functioning Gov’t – talks with UK Tory Gov Secretary of State stalled.
England – Gov’t Tory – strikes ongoing due to Gov’t intransigence.
What is wrong with the Tory mindset that they alone are not prepared to negotiate with Health Unions to resolve pay issues in a critical service? It’s worth noting that the governments in Scotland and Wales are funded by block grant allocation of gov’t spending in England and so have constrained funds, yet have managed to settle their pay issues and keep critical health services functioning.