Streeting should stand firm in face of doctors' risible demands
No country can claim to be in the forefront of democracy and development unless it can ensure the health of its citizens. Whatever its woes — and they are many — the National Health Service does keep most Britons in better health than many people on other continents. Partly that is thanks to pioneering excellence in medical research. And partly it is the result of a long tradition of top surgeons and physicians whose skills underpin specialist units attracting doctors from overseas. The consultants know it. They are proud of it. And, to their discredit, they are ready nowadays to exploit it.
NHS consultants earn, on average, £145,000 a year. It may not be the salary of an investment banker. But it is considerably more than most people are paid. And there is ample opportunity to supplement this salary with private practice and filling in as a locum at the going rate of £200 an hour. Consultants have been awarded a pay increase of 4 per cent for the coming year, a figure above inflation. The British Medical Association, the doctors' union, has described this as an 'insult'. It insists that a pay rise of 35 per cent over the next three years is needed to restore consultant pay to 2008 levels in real terms. Otherwise, the BMA says, it will support a strike if an 'indicative ballot' shows that this is what senior doctors want.
The consultants' claim is risible. It is not only unaffordable in today's straitened times and given the parlous state of NHS finances; it is based on the threat of holding the health, and sometimes the lives, of thousands of patients to ransom. It is a maximalist demand, backed by possible strike action, similar to the bullying approach of the rail unions. Consultants ought to be able to see that their claim has far less validity or public support than the claims by nurses and resident — once known as junior — doctors. They, too, insist that their pay needs to catch up with what they once enjoyed. They, too, risk losing public sympathy, following earlier strike action. But millions of Britons have seen their take-home pay fall in recent years. Comparisons do not help consultants.
Famously, Aneurin Bevan, the architect of the NHS, bought off consultants opposed to his proposals for a state scheme, saying that he had 'stuffed their mouths with gold'. And since 1948 they have enjoyed this well-funded quasi-independence from state control, with generous state pensions. They have also enjoyed the fruits of expensive training, provided largely by the state in Britain's medical schools. Doctors, like everyone nowadays, are obliged to pay back their tuition fees — but many will not do so for years. An alarming number will never do so; on qualification they look for more lucrative contracts abroad, often in Australia. As a result Britain has partly depended on an inflow of doctors trained overseas, largely in India, a situation benefiting neither country.
In the long term, the tight restriction on the numbers enrolling in medical schools should be eased; a developed country should never risk a doctor shortage. Also in the long term, doctors, especially consultants, should be compelled, by legislation if necessary, to devote a defined period of their careers to the NHS and serve in areas of greatest need. Other countries make provision for nationwide coverage. The immediate challenge, however, is pay. Wes Streeting, the health secretary, is holding talks with the BMA. He must stand firm in resisting its absurd new demands.
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