IT REALLY is time public sector unions stopped taking the lazy option. And those representing the medical profession, above all, should be showing the rest of their comrades leadership – for decisions made over the nation’s healthcare are a matter of life and death.
Yet the doctors’ union is threatening to strike over the current pensions offer, while the nurses and midwives unions are both opposing the coalition’s NHS reforms. It is time to face facts. In the name of patient care and professional integrity, unions are a million miles from where they should be on both these issues.
On pensions, the status quo is not viable. These pensions are underfunded to a staggering extent. Doctors pay in only 8.5 per cent of their salary, while the cost to the taxpayer of the employers’ contribution is equivalent to more than 40 per cent. Even under the government’s current plans, doctors’ contributions will only rise to 14.5 per cent.
Someone has to pay for these pensions. It seems unions still haven’t woken up to the fact that the government has no money of its own. It is the private sector that will end up footing the bill for the shortfall in the pensions of these already very handsomely-paid doctors. More important still, the degree of underfunding is such that future generations of the private sector will also have to help pay off these obligations. At a time when private sector workers are facing tougher pension conditions, they are effectively being hit twice.
On NHS reforms the situation is just as bad. The current NHS structure is simply not delivering. International comparisons reveal that medical outcomes are dreadful, despite spending rises and the exemption of the health budget from the cuts. Structural reform is long overdue.
We now spend over 8 per cent of GDP on health. It is the second-largest area of expenditure for the government after welfare. Yet in the developed world’s league tables we fare appallingly. One study by the Taxpayers’ Alliance estimates that compared to other European countries an extra 12,000 deaths occur a year in the UK due to inferior healthcare. We have poor cancer survival rates and comparatively high deaths from circulatory disease. Data from overseas suggest that either European-style, insurance-based funding or, better still, a savings account system as in Singapore would produce better health outcomes at a lower cost.
In the face of these statistics, change is both inevitable and essential: we have a system we cannot afford and that doesn’t work. Across the health service, we have lost sight of the people it is meant to be there for – the patients. Quality has declined and it is time we found ways of bringing in more accountability and putting the people it is there to serve back at the heart of its mission. This means structural reform, and on a much more radical level than the coalition is talking about.
Changing how the NHS is funded can be only part of this. The way the medical profession works must also be modernised. Central pay bargaining and the negotiation of pension arrangements at a centralised level is not conducive to creating a workforce that cares or performs to the best of its abilities. There should be much more differentiated pay across the sector and regions.
We also need to consider ways to deregulate healthcare to improve competition. At the moment the centralised nature of the system means that only 17 per cent of healthcare funding in the UK is private. There are all kinds of restrictive practices, for instance the systems by which doctors are licensed, that make it hard for private providers to compete fairly. The nature of the current system also creates ill-feeling towards the private sector, as there is not enough competition to drive down private prices.
In the face of these great national issues, medical unions are refusing to engage. They should be the very ones leading the charge for constructive reform on all these issues, preserving the future of their profession and improving the quality of its work. They should be proposing a sensible and reasonable model for reform to the structure of the NHS, as well as to pay. Yet where is an alternative from unions that will deliver for patients? Where is their comparative study of insurance models across Europe or of the impact of health savings accounts?
Unions must grasp the reality of the crisis we face. Innovative thinking in healthcare is in the interests of both patients and medical professionals. What a tragedy then, that it is unimaginable for Britain’s doctors to be in the vanguard of improving our broken system.
Ruth Porter works for the Institute of Economic Affairs (iea).
Compared to Europe, bad healthcare causes 12,000 extra UK deaths a year.
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