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Should Doctors Strike?
Like De Gaulle had of France, I have always had a certain idea of the medical profession, and industrial action (by which, of course, is meant inaction) has never been a part of it. Doctors should not refuse to work except if the seriously unethical is demanded of them by their employers, or perhaps if they are paid starvation wages; and though various British governments in the past decades can be reproached with many things, they have never demanded the seriously unethical of British doctors nor paid them starvation wages.
Recently, I received a circular communication from the British Medical Association informing me that members (of which I am one) would soon be balloted about industrial action. This was because the government is refusing to negotiate seriously about doctors' pensions. It was intransigently demanding that doctors should work longer, and pay larger contributions, in order to receive a smaller pension than those retired doctors received now.
The BMA assured the voters in this ballot that the industrial action would not harm patients. I found this somewhat mystifying: what is it, then, that doctors could refrain from doing that would not harm patients, and whom would they harm by it instead? Surely everything a doctor does should be to the benefit of patients, either directly or indirectly; and if there is something that he does that is not for the benefit of patients, he is wasting his own time and the money of those who pay him.
Let us leave this mystery aside. Likewise the financial aspect of the question: though I find the argument put forward by the British Medical Association, that there is no need to change because the NHS Pension Scheme is currently "in surplus" not altogether a convincing one. It decidedly does not mean that the scheme is quietly building up its assets or investments so that they may pay dividends later to retired doctors. I quote from a government document describing the pension scheme:
The NHS Pension Scheme is an unfunded occupational scheme backed by the Exchequer, which is open to all NHS employees and employees of other approved organisations. The Scheme provides pensions, based on final salary, in varying circumstances for employees of participating employers. The Scheme receives contributions from employees and employers to defray the costs of pensions and other benefits.
In other words, it is a very large pyramid scheme; and all that a surplus means is that it is currently able to meet its obligations with something to spare. Mr Madoff could have said the same for many years: that, after all, was how he made (if made is quite the word I seek) his money for many years.
The monetary source of the pension payments contributed by doctors (currently 14 per cent of their salary) is a mixture of general taxation and government borrowing. During our so-called boom years, much of this taxation was itself derived from borrowing, though private rather than public, so that the need for public borrowing appeared muted even as public expenditure and obligations, including the pay and pensions of doctors, rose precipitously. When the collapse came, the government was left with the obligations, and public borrowing rushed in, or had to rush in, where private (which clearly the government had not discouraged, to put it mildly) could now no longer tread.
For the BMA to describe the pension scheme as being in surplus is therefore foolish or disingenuous. It is only natural, and all but inevitable, that doctors, having had their seven fat years, should now have their seven lean. The increased expenditure on the NHS, of which a considerable part found itself into the pockets of the doctors, was responsible in no small part for the financial mess in which we now find ourselves; it is not only necessary, but just, that they should now have to retrench. And even after this retrenchment, they will still have more than a living wage from which they should be encouraged to save privately for their old age.
One of the most unfortunate aspects of the doctors' threat to take industrial action is that it reinforces the impression that those who work in the public service are motivated more by the desire for private gain than by the desire to serve the public. After all, the doctors are among the best-paid of all public servants, and quite a number of them have the opportunity to supplement their incomes by private work. No one likes to see his income decline, but there are some things that ought to be accepted and suffered in dignified silence. In Ireland, that is precisely what the doctors have done.
I am not one of those who believe that the notion of public service is always and only a fig-leaf for private ambition, any more than I believe that all professions are always and only conspiracies against the laity. On the contrary: I am quite often moved by the willing and enthusiastic service I receive from public servants - for example, from librarians - who are not at all well-paid, and who often go beyond the call of duty on my behalf. They cannot possibly be motivated by the desire for self-advancement, but only by the prospect of helping and pleasing me and other members of the public.
Such devotion to public service will, however, be undermined by the naked rent-seeking behaviour of the doctors - if, that is, they vote for industrial action, whatever it might be. Of course, this rent-seeking, which is bound to become more desperate and ferocious the more the economy, with few prospects of real growth, comes to be seen as a zero-sum game, will not be confined to the doctors.
The fact is that there has never been, is never, and never will be any industrial action over the manifold failures of the public service to provide what it is supposed to provide. Whoever heard of teachers going on strike because a fifth of our children emerge from 11 years of compulsory education unable to read fluently, despite large increases in expenditure on education?
If the doctors vote for industrial action, they will enter a downward spiral of public mistrust of their motives. They should think twice before doing so.
First published in the Social Affairs Unit.