The biggest political question of the day is whether the nurses will, as a result of their union ballots, reject the government's pay offer today and so return to industrial action in the NHS.
I am not presuming to know what around 1.2 million NHS staff who are affected by this pay offer will decide, but indications from Shaun Lintern, who is easily the most reliable health correspondent at present, suggest that rejection is likely.
If that happens, I am not surprised. The reason is obvious. The pay offer includes a one-off settlement that will not be consolidated into base pay. As I have argued on this site, the consequence of that is that the pay offer looks like a perpetual 6.4% cut in pay for the average NHS employee. Why anyone would want to accept that deal is very hard to imagine. As a result, I hope that this offer is rejected.
There would be major political consequences arising from this rejection. Firstly, the government policy of apparently dealing with pay deals one at a time would have failed. Their strategy would be in tatters.
Secondly, the government's knowingly exploitative offers based upon non-consolidated one-off payments would have been exposed as the sham that they very obviously are. The precedent for others to reject such offers would, therefore, have been created.
Thirdly, the stress in government employee relationships would rise significantly as a consequence.
Fourth, and very obviously, the risk of simultaneous strikes by nurses and junior doctors in the NHS could make healthcare in the UK undeliverable during strike periods in the future.
Fifth, and perhaps most importantly, the question as to what our public services are really worth would come to the fore in the political agenda in a way that none of these disputes has, as yet, achieved. This is, I think, overdue.
The widest spread sentiment that I come across amongst people that I talk to at present is that nothing now works in the UK. That feeling is totally understandable. When some of our most basic services, from sewage, to health, social care, the justice system, and education, can no longer function in a way that everyone who is now alive knows has been possible throughout their lived experience to date, it is hardly surprising that this sentiment is so commonplace.
Nor is the reason for this failure hard to identify. If, as has been apparent since 2010, the government refuses to invest in these services, refuses to provide fair pay deals for those work for them, and demands more from those who are engaged in them whilst paying them less, then the exodus of staff from them and the resulting increase in stress on those who remain is hardly a surprise.
What is surprising is the absence of any form of effective opposition to the government on these issues. The best that Keir Starmer and Wes Streeting can suggest when commenting upon these pay disputes is that the pay demands of those working for the NHS and other public services are unaffordable, but that the government should get around and negotiating table, which apparent willingness to talk is the only difference in their position from that which Rishi Sunak, Steve Barclay, and other ministers, appear to have.
There is no apparent understanding anywhere that if the whole basis of government-provided services in the UK is to survive then paying people sufficiently to secure their services is a pre-requisite. Instead, the dogmatic belief that the proportion of GDP expended on such services must not increase prevails, without any politician, apparently, noting that the failure to make these payments is one reason why the denominator in this equation is so low. By that, I mean, that our GDP has not grown precisely because we have not invested in such a critical part of our economy, which has not only stymied growth in the sector but also prevented it from happening elsewhere.
So limited is the understanding of economics among our political classes that none of them apparently believe the government expenditure does, in itself, add to our national income if it delivers services that people want and need, which in all the cases that I refer to is what will happen.
What is more, there appears to be literally no understanding of the multiplier effect of government expenditure, which I last referred to on this site a couple of days ago. That making payments to people who are likely to spend the entire benefit of their pay rise might, in itself, provide the necessary boost that our economy is lacking is, apparently, beyond the comprehension of our politicians.
So too, is there no apparent understanding from our politicians that making a pay offer that will guarantee perpetually lower pay in these public services will only condemn them to get worse.
There are three possible conclusions. One is that our politicians are, as a class, stupid.
A second is that our politicians do, as a class, wish to undermine public services to the point that they fail.
The third is that our politicians are so captured by an economic philosophy that is, in itself, antagonistic to everything that the state might do that they are unable to think for themselves and understand the harm that they are doing. Philosophy is, of course, neoliberalism.
So, a poll:
Why are our politicians unable to understand that making decent pay offers is essential if our public services are to surive?
- They are slaves to neoliberalism and think they must do this (48%, 139 Votes)
- Our politicians do, as a class, wish to undermine public services to the point that they fail (45%, 130 Votes)
- They are too stupid to undertsand this (3%, 8 Votes)
- I'm abstaining, but show me the results anyway (3%, 8 Votes)
- They are acting in good faith and do not think we can afford to pay (1%, 4 Votes)
Total Voters: 289
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I think everyone agrees that core problem of health provision in the UK is lack of staff to do the job. This cannot be solved in a year or two – it will take a decade or more. Even if you up the number of university training places there are no vacancies in hospitals for those graduates because all the existing staff who would be doing their “on the job” training are flat out trying to treat patients. A “surge” won’t do it – it must be a decade (plus) long process.
Do note that this is all true whether you want private or public provision. The idea that privatisation will solve the problems of healthcare is ridiculous. Indeed, privatisation will merely bid up the wages of existing staff who would then deliver the same for more cost! Striking nurses and doctors would, in the medium run, be financially better off with privatisation… so, yes, they really are striking for our interests rather than narrow personal gain. The government’s attempts to demonize them are seen by most as the nonsense they are.
People could be lured back
Maybe
There should be an all of the above option. They are trapped by neoliberal thinking, are too stupid to think again and are acting in good faith believing that they must undermine public services.
Sorry
Did not think of that
Might use in future
Sorry – me again!
I think you have identified the key problem – the wide spread belief that there is a limit to how much Government can put into the “black hole” that is the NHS budget. The belief must be shown up as the nonsense it is.
If we need more of something we have to provide the resources to deliver it – that is a fact. If we believe that the most efficient way to deliver these services is through government then government spending will (and should) rise as a proportion of GDP. It is very simple.
Currently, the UK is thinking about whether, in a post-Ukraine invasion world, we need more defence capability. If I suggested that we leave that provision to market forces I would (rightly) be laughed at. No, defence MUST be delivered by the State and its provision MUST lead to a rise in Government spending as a portion of GDP. Not even the ERG would challenge this. Why should health provision be different?
So, my long term solution is that if we assume 1% trend GDP growth we should allocate half of this to health spending (or 0.5% of GDP). I think this could be “sold” to the public.
This would represent a 5% (real terms) increase in health spending each year for the long term which might be about enough. Of course, this is a “steady state” solution and we would need a surge of spending now to prevent collapse – but beyond that we need a political consensus that health spending must rise by 5% per annum (real) and that this will mean an ever larger share of GDP taken by the organisation that delivers this care – ie. The State.
If you saw Newsnight last night you will have heard Prof. Marmot hit the nail on the head – we are an individualist society… but it was not always thus. I blame Thatcher.
So do I
I can’t vote on this. All options apply. Even, bizarrely, the good faith option applies. Many believe the public sector is pure overhead cost burden, unaffordable and needs to be undermined to fail. Do they know they are neoliberals ? Probably not because they are too stupid.
It’s a package. I want to tick all the boxes. I think they all apply.
I’m presuming that option 1: “They are too stupid to undertsand this” is the one that right thinking people should opt for.
But I don’t really get why we should want the government share of GDP to always be increasing. The consequence is that more of the activities in a society are decided by politicians and voting for a different set of them will change their policies but won’t raise their intelligence.
They clearly understand how governement spending works when it comes to privatised delivery of NHS services, PPE contracts, test and trace contracts, giving people shopping vouchers instead of money etc.etc. It’s just that they have a fundamental belief that everything government does should benefit rentiers and monopolists (i.e. their Party donors) rather than ordinary people. Even when it looks like they are helping ordnary people.
Nadine Dorries actually said it out loud and in public, didn’t she?
I totally agree with your point about the perception that the country is breaking down – it is widely felt, but also – more worryingly – I see a willingness to press on that seems to be bereft of any new ideas – even from voters.
The things is, it’s not the country that is failing really, there are so many people still trying to do their best, a country is much more than its rancid political management class – its the political system that is failing – and this is where Stymied could aim for – his own hinterland – Parliament, the lack of constitution – an admission of total political failure by political colleagues all put into perspective with new ideas. Sadly this is not how he is responding.
As someone who recently got a load of back pay after a below inflation pay rise (as I belong to a union which fought for it – please note) my tax and NI payment was huge. And this point needs raising time and time again – the Government would get a return on doctor’s and nurses (if it were higher) new pay – they would get a lot of it back. So whatever figure they are working on that makes the wage demand ‘unaffordable’ needs to take off the NI and tax? It would claim back a certain portion of the higher wages, which would make the award of better pay more affordable because they’re all stupid and think taxes must pay for everything anyway.
And, the pay would stimulate the real economy too as you point out.
What we get instead is being told on C4 News last night that strikes are depressing GDP, that we are too regulated, that our corporation tax is too high blah, blah, blah (it has nothing to do with high interest rates, BREXIT, residual Covid).
This is why to me my only conclusion is that we are being subjected to some sort of ‘shock doctrine’ whose only purpose is to create crises so that vested interests can swoop in and take control.
You may be right
Ministers, and some of the gullible public, do not understand (deliberately or through ignorance) that public spending is a political choice and not determined by whatever may be in the metaphorical coffers of the Treasury or the Bank of England. For example, ministers decide whether to let children go hungry or even semi-starve or produce a new Trident nuclear submarine weapons system or provide expensive missile systems and tanks for Ukraine while old people are suffering from a lack of basic facilities in care homes. Ministers are making these choices while diverting our attention by promoting the most excruciatingly racist policy towards migrants by prison ships and the complete demonization of people from other nations escaping persecution or climate displacement.
Funding to ‘sort out’ these problems only requires some strokes on a keyboard to ‘produce’ the money, within the limits of our economy and society to produce the goods or services required for a basic civilised life for everyone..
I wonder if part of the problem is the loss of Health Care Public Health, as a consequence of the 1990 changes to NHS.
Prior to then, the Sec of State was required to arrange similar service to all the population of UK. There was rationing via waiting lists, which were sorted on an urgency basis.
Post 1990, the mantra was that the market would decide, so high need communities started to loose GPs, and big hospitals subtly started to pressure smaller ones to close, on cost effectiveness grounds, dialysed as safety grounds.
We’ve know for ages that big hospitals >400 beds are less cost effective than two or more smaller ones. Thus the oils network approach gave the system flexibility and resilience.
Following the changes in 2003, HCPH was effectively consigned to the scrap heap, and the supremacist biggest hospital trusts taking over smaller ones sped up. We know from economists evaluations these take overs did not improve care, not save money, indeed they generally cost more, as the evidence suggested.
Further the reduction in bed numbers was not based on any population need basis rather on annual throughput, i.e. Assuming training by reassuring list was a desirable thing.
Once targets for waiting list came into force, the queue discipline changed from most needy first, to first come first served, with some exceptions. This created perverse incentives, that might not have mattered whilst funding was rising as it was then, and waiting list fell. But once training by waiting lists returned in 2012, the target perversely, makes long waits wait longer, as they are already in breach, and urgent cases get delayed, so near beaches can be treated, whilst emergency or very urgent cases still get priority though it disrupts the smooth operation of the waiting list, and inevitably people are bounced.
So how can we retrieve the situation. First, get Government to recognise that All Public Health practices are arms of the state, they are incumbent on government’s to do, as part of the defence budget, PHLS was originally part of MOD…
Second, re-establish HCPH as a core examined competency in PH practitioners (including evaluation)
Next abolish the market in health care return the duty of provision to parliament, as Sec of State’s have shown they are incapable and unwilling to accept that responsibility & privaledge.
Finally as Cook showed, accept health care is a complex adaptive system. So relies on well trained experienced professionals to keep it safe. No amount of processes or procedures can make it fail safe, it requires alert professionals to detect the subtle difference between a trivial symptom and the harbinger of doom. It is not easy, or cheap.
I suspect the same applies to all public service issues. But I used to work in the NHS from the dark days of the winter of discontent until recently. Whilst also being a chronic patient for 50+ years, so have seen the changes from both sides.
I am curious as to your claim that big hospitals are less efficient.
How do you cover ICU in smaller hospitals?
And does there have to be site specialisation?
http://www.matchesinthedark.uk/spending-chains-sankey-diagrams/
The above has a nice easy explanation of multipliers and national income. It also contains these statements ‘ The NHS is the great engine which drives the UK economy.
Here’s one thing that recent Chancellors of the Exchequer never seem to mention: The fiscal multiplier engine has a reverse gear. Take £1 million out of the NHS and you take £4.3 million out of the economy. That’s what austerity is really about.’
I really do not get such diagrams
I know they work for some people
I am a fairly logical person but they just leave m,e thinking there must be a better way to explain this
It’s a good job we are all different