Thursday 31 May 2012

The politics of a bad pensions deal: Doctors and industrial action. Painful, but necessary

Doctors and industrial action. Painful, but necessary

I intensely dislike the idea of doctors taking industrial action over pensions for a number of reasons.

1. It is very hard to take action without harming patient care. Even a cancelled minor operation can cause distress, not only to the patient, but also to relatives who may have to rearrange care arrangements etc.
We should also never underestimate the anxiety people feel before they undergo investigations and treatment. Cancellations add to anxiety and uncertainty.
In addition minor complaints can sometimes be early symptoms of a life threatening illness. If these "minors" are not seen due to cancelled clinics, patients could come to harm. Risks are low, but real.

2. Doctors have been angered by the Government's NHS reforms, which are much more likely to be damaging to patient care in the longer term, than the type of industrial action the BMA is planning (which is not that much different to the service that will be provided over the Jubilee weekend). However, industrial action could take the focus off Lansley's destructive reforms and actually divert bad headlines towards doctors for causing the NHS problems. As an NHS campaigner who has worked hard to expose Lansley's NHS privatisation plans, I am very concerned by this. My priority is to defend the NHS and anything that compromises this is a problem.

3.Many of those who have advocated market based reform of the NHS, have done so on the basis of market theories such as public choice theory, which views public service professionals as "rent seeking knaves" who are only interested in enriching and empowering themselves in monopolistic cartels. Industrial action could actually add weight to these arguments and help the arguments of the NHS pro-marketeers and privatisers. The newspaper headlines are certainly laying it on thick when it comes to “greedy doctors” being more concerned about their pensions than patient care.

4. Economic times are tough and many people are really struggling to make ends meet. We should all be concerned by this because there is clear evidence from the WHO and the work of Sir Michael Marmot and others, that poverty causes ill health and distress. It can disadvantage families for life and the generations that follow. Doctors earn good money in comparison to the average wage. Our pensions also look generous, so this could have significant effects on public sympathy and undermine public trust in doctors. At present, doctors enjoy high public trust ratings, with the latest MORI veracity index showing that doctors are the most trusted people in the country. Trust is also fundamental to the doctor patient relationship. Industrial action could potentially undermine that trust.

However, despite these major concerns, I strongly believe in justice, fairness, the democratic process, as well as economic common sense. Anyone who actually scratches the surface of the pension deal can see that Lansley and the Government are forcing a very poor deal on to doctors. Losing a lot of money is clearly an issue to doctors, but it is the unfairness of it all that has really enraged the profession. Doctors are been asked to contribute much more percentage wise to their pensions, than comparable senior public servants. The BMA had already negotiated a long term deal a few years ago too. More details of the unfairness can be seen here.

Since the BMA is a trade union, it had no choice but to gauge the opinion of its members. The result of a survey showed overwhelming anger from its members and support for a ballot in industrial action. That ballot has shown overwhelming support for industrial action. The turnout was 51% and the vast majority supported industrial action. BMA Council were therefore given a clear mandate – TINA.

I couldn't attend the BMA Council meeting when the decision was made to call for industrial action, but as a BMA Council member I fully support the decision of my colleagues to go ahead with it, despite my serious concerns as outlined above. It is vital that the BMA responds to its democratic mandate and tackles this gross unfairness. I've no doubt that doctors will do their best to minimise harm to patients and the BMA will help the profession in this regard. In fact, as previously stated, it is unlikely any action will be much different to the Jubilee bank holiday.

We must get also get the message out to the public that this attack on pensions is a false economy. Increasing pension contributions from doctors and other public service professionals will take yet further demand out of the economy because we will all have less money to spend in our local economies. The private sector clearly needs this demand to expand and help grow the economy. Paul Krugman clearly articulated this on Wednesday’s edition of BBC Newsnight.

The other key message is that the Government is intent on destroying public sector pensions because it is part of the wider political agenda of replacing large swathes of the public sector with the private sector. The attack on pensions is aimed at softening up the profession for transfer into the private sector. This is because current public sector workers are covered by TUPE legislation and the Fair Deal on pensions, which protects terms and conditions, and pensions respectively. The private sector want cheaper labour to compete in the new healthcare market and to maximise profits.
This is all part of the Government’s supply side economic policy, designed to roll back the state and reduce the taxation burden on big business and the wealthy. They also want further labour market deregulation to increase corporate profits and keep wage inflation and hence general inflation low. 

So, in fact, I believe the current fights over pensions are just the start of a much bigger battle which is intrinsically related to privatisation of the public sector. There will more attacks on NHS pensions in the future as the NHS is increasingly privatised and the numbers of employees in the scheme shrinks. This will happen right across the public sector. This is why we need to take a stand now and I am proud that doctors are taking a stand together, just as doctors were the key professional group that campaigned  against the Health and Social Care Bill. If we lie down and just take it, they will simply ride roughshod over us every time. This will make it much easier for doctors to be transferred over into the private sector from the NHS. This ensuing marketisation and privatisation of medicine will result in deprofessionalisation and medicine will no longer be an attractive vocation. This will damage patient care in the long term as the doctor-patient relationship will be undermined and fewer of the best and brightest young people opt for a career in medicine.

So it is precisely because we care about patients, that industrial action is necessary. It is a key part of the fight against privatisation and marketisation of the NHS, which will result in inequitable and poorer care in the longer term.

The bottom line is that longer term benefits to patient care by fighting the privatisation agenda far outweigh the small risks of any short term harm to patients through doctors taking industrial action against very unfair pension proposals, which clearly have a much more sinister underlying political motive.


  1. I completely agree with the vast majority of what you have said, but....
    1.I fear that your first four points are the only points that will be picked up on by the public and the media, and certainly by Lansley et al.
    2.I agree that the government are determined to destroy the public sector, and the assault on pensions is part of that attack. However, the fact is that no matter how many of us would have done just about anything to stop the Health and Social Care bill being passed (and I am well aware of how much you did personally), striking, or even taking a ballot about striking, never made it onto the agenda for the BMA or any other medics union. If it did then certainly neither I nor my husband, both medics, were aware of it.
    3. The public, media, and government will surely get the message that doctors don't care enough about the NHS to take industrial action, but do care enough about their own finances.
    4. Despite your well argued points about attacks on public sector pensions, it is undeniable that doctors are very well paid, and that they get large lump sums and comfortable pensions on retirement. I personally feel very uneasy about my salary when I talk to friends in other professions such as non-medical academia, teaching,and psychotherapy. There are many people with equivalent or higher academic attainments and large responsibilities who can never hope for the salaries that doctors have.
    5. I fear that we are on a slippery slope to demolish our status in the eyes of society. I (at 50) am of a generation of doctors who mostly (I agree not all) entered medicine as a vocation, and had little thought about the financial rewards. We knew that we would have job security and satisfaction and that was enough.
    The various NHS reorganisations have all but destroyed the job satisfaction and successfully pushed many towards seeking financial reward as a replacement.
    Sadly the government will win either way. If our prolonged and intensified industrial action (which it will have to be) succeeds, we will get our money but at a cost that destroys the unique standing of our profession.

  2. Thanks Diana,
    I agree with many of your points.
    It is crucial that BMA gets the facts across, but it will be up against it.
    The big issue was NHS reforms. The BMA should have done more and done it earlier. I did my best to force this issues from within, but with limited success

  3. I am not a Doctor and agree with everything you and Diana say. I have just returned from staying in a hospital with my daughter, who had an operation on the NHS. I am very grateful to the surgeon and love the NHS, and I do accept Clive's points about the unfairness and so (mainly through respect for Clive) reluctantly support the Drs strike. However, I agree with Diana about public sympathy. I support the Drs, but as the graduate wife of a teacher & unpaid carer for elderly parents I do feel that Doctors should be aware of how well off they are and I so wish they had gone on strike & fought for the NHS. Why didn't they? We needed them to speak up for us. It is hard to speak up for them now, and yet I can see from 1st hand experience how dedicated and hard working many are.

  4. Thanks Anne.
    Doctors can only legally take out industrial action for Trades Union disputes ie terms and conditions.
    We could have argued on that basis about the bill, but it would have defeated the object of fighting for an NHS, which is comprehensive, fair and equitable. It would have been spun about "greedy doctors" again
    Best wishes,