15 February 2016

On the NHS, the Tories are betting against the free market


Jeremy Hunt’s decision to impose a new contract for junior doctors has left the government and the medical profession in a state of open warfare. And in gambling that doctors will eventually settle down and accept this new deal, Hunt has also left the Conservative Party in a very odd position: namely, betting against the free market. 

It’s not often pointed out, but the NHS – in terms of the way it treats its staff – is a command economy of the most traditional kind. Junior doctors put their lives in the hands of the government: in the early years of their training, they might be posted to any part of the country, to do any kind of work. While the managers do everything they can do accommodate people’s wishes, it is not unknown, for example, for husbands and wives who meet as junior doctors to be posted to completely different areas.

Their willingness to put up with this treatment – partly out of loyalty to the health service’s principles, partly because of the promise that things will be easier when they become consultants – is the fuel that keeps the NHS going. In particular, it enables managers to find bodies for unpopular jobs or antisocial shifts, not least late nights and weekends in A&E.

Yet over the past few decades, the pressure on doctors has – as they are only too willing to tell you – has ratcheted up. The new contract is seen by medics not as a one-off change to their terms and conditions, to be taken on its merits, but as the latest in a series of provocations, from Labour and Tories alike, which have pushed them to breaking point and beyond.

There’s no denying, of course, that there’s an element of self-interest in the doctors’ opposition to Hunt’s contract. For example, the staunch support from senior doctors for their juniors is at least in part due to a fear that their own perks and privileges may be next in the firing line.

But at the same time, this is only to be expected: doctors, like the rest of us, want to get the best deal they can. Furthermore, they have a point. An academic study cited by Allister Heath of the Telegraph recently showed that British doctors are uniquely badly paid in comparison with those of every other major developed country.

The assumption underlying the government’s strategy appears to be that the doctors are whining, but will settle down – not least because they have nowhere else to go.

But the thing is, they do: one human body is, when you get down to it, much like another. The same skills that let you treat cancers or sprained ankles in Birmingham, England, will come in just as handy in Birmingham, Alabama.

Already, scores of British doctors have been taking advantage of the fungibility of their labour. More than a fifth of medics working in Australian hospitals were trained in the UK; the number working in the US has also shot up. And this could create a vicious circle. More doctors moving overseas or dropping out means more pressure on those that remain. Plugging the gaps means recruiting doctors from abroad or relying on locums, whose high costs are a major contributor to hospital deficits.

Which leaves Jeremy Hunt in an invidious position. He insists that his new contract will not damage doctors’ pay or make them work longer hours. But doctors believe that it will leave them worse off financially, as well as normalising unhealthy, unsocial and possibly even unsafe working hours.

The resulting situation is richly ironic. It is an article of faith on the Left that the Tories would like nothing more than to privatise the NHS. Yet now, it is Hunt who is hoping that junior doctors can still be persuaded to treat their relationship with the NHS as spiritual rather than contractual – that their passion for healing will outweigh the prospect of better money, better hours or better treatment elsewhere. If he’s wrong, then he could soon have an even bigger problem on his hands.

Robert Colvile was comment editor at the Telegraph and UK news director at BuzzFeed. He now writes on politics and technology.