Letter to a Tory MP
To Sir Roger Hapless MP
Widget Bottom and Little Toading West
23 April 2023
Dear Sir Roger
I’m writing to you against the background of the recent junior doctors’ strike, with potentially more to come, and of the ongoing strikes by nurses. I’m sure that like your parliamentary colleagues you will come under a great deal of pressure from your party to join in the criticism of these strikes, and of the BMA and RCN. I would urge you strongly to think before you do so.
Treated with respect?
The strikes are partly about money, but also about the fundamental principle of being treated with respect. Over my 44 years in medicine I have had contact with many junior doctors and I can say categorically that their circumstances and the respect with which they are treated in the hospital workplace have fallen dramatically in this period. Since 2008 there has been a significant (26%) drop in real terms in junior doctors’ incomes, and it has been rightly estimated that it would take a 35% increase to restore them to the previous levels. The starting salary for a foundation year one (F1) doctor is £14.09 per hour, i.e. under £30,000 per annum. Many unskilled workers are paid more than that. I was moved recently by the story of a medical colleague who in his mid 20s was being paid at £14.09, but who at the age of 16 – eight years earlier – had been paid £25 per hour as a tutor.
Bear in mind that many of these doctors have spent five years (or in Oxford six years) as undergraduates, and in many cases much longer if they have done an intercalated degree. By the time they qualify they will typically have amassed a debt of £50,000 or more, which they must pay back out of their earnings. While in theory they work a 40 hour week, this is often exceeded substantially because of understaffing on the wards.
NHS staffing – government can’t deny responsibility
I need hardly tell you that the poor level of NHS staffing is to a great extent as a result of the present government’s policies. An already dire staffing crisis was greatly exacerbated by the loss of freedom of movement, something which of course has hit the UK to a vastly greater extent than any other European country. The Nuffield Trust has recently estimated that the UK now has 4,000 fewer doctors of European Union origin than it would have had if freedom of movement had been preserved, with or without Brexit. And working conditions have led to huge problems in retention, with many medical staff choosing to work in Australia and other countries, and in many cases, having experienced the much better remuneration and working conditions prevailing there, choosing not to return to the UK. It is hardly surprising that they are welcomed, given the worldwide shortage of doctors.
I can assure you that nobody becomes a doctor or nurse believing that it will make them millionaires. Generally speaking we are talking about people with considerable talent who might well have higher earning potential in other walks of life. They are choosing to work in the NHS because of a spirit of public service, but they do have a breaking point and it would be inexcusable for government or employers to try to use their dedication as a pretext for exploiting them. You can imagine how irritating it is when we hear politicians saying “it’s a vocation” as if that were some excuse for underpayment.
I have sometimes heard it said that young doctors should tolerate low pay and poor conditions, because their long term earning prospects are good. Firstly this is an oversimplification. Many senior doctors are poorly paid, but as in sport and entertainment the public often hear of the outliers at the top of the pay scale. Furthermore, professional pressures are such that many senior doctors are forced into retirement at a much younger age than they would choose. In reality a great many of our medical colleagues are ‘junior doctors’ for in excess of half of their working lifetimes, and during these years they’re carrying out work of great responsibility, including for example a very large proportion of the operations done in hospitals. They are at a stage of their lives when they have high outgoings and are raising young families, so even if it were realistic, the prospect of high earnings tomorrow would be no compensation for penury today. Add to all that that today’s doctors, unlike their predecessors, have to pay the cost of expensive hospital parking and unsubsidised meals (assuming they even have time to eat).
Is a doctor worth 1% of a minister?
If ministers try to tell you that £14.09 is an appropriate starting salary for a qualified professional, please remember what they themselves think they are worth. Recently ex-health secretary Matt Hancock made it clear that he did not think it would be worthwhile getting out of bed for a day’s work unless he was paid £10,000. Imagine what he would have asked for if he had not been already triply discredited* in his parliamentary career. Kwasi Kwarteng made a similar estimate of his value. Junior doctors’ rate of pay is approximately 1% of what the two ex-ministers were expecting to be paid. Please reflect on that.
The situation for nurses is in many ways even worse. With a starting salary of £20,000, the loss of student bursaries, the need to pay back student loans, and poor career progression, many nurses are living hand to mouth, often being compelled to use food banks. Many experienced nurses are being paid very significantly less well than their opposite numbers in the retail sector and enduring far worse working conditions. No wonder so many are leaving for other jobs or indeed other countries, never to come back.
Strikes in the NHS are extremely rare. It is only when they are driven to it by extreme circumstances that healthcare professionals will choose to strike. In view of the overwhelming support for strike action among junior doctors, you will understand that that point has now been reached. This is not a case of manipulation by ‘Trade Union Barons’. Please remember that in the case of the nurses one of their unions, the RCN, recommended a settlement to its members, but it was the grassroots who voted – against its advice – to continue striking. Feelings are strong.
Unfortunately this is not how the government sees it at the moment. On the contrary, the health secretary‘s response has been to double down and to refuse to negotiate unless the strikes are called off. This is doubly ironic since at present no further junior doctor’s strikes are scheduled. ACAS has agreed to be involved and the doctors are willing, but the government is not. Such a response can only serve to escalate the situation.
Yet more toxic legislation
More broadly, the government’s response is the new strikes (minimum service levels) bill, currently at report stage in the Lords. This has the effect of removing statutory protections against dismissal from certain groups of workers who choose to strike. Ministers have the power to decide from time to time how those groups will be defined. Government argues that in bringing forward this bill they are bringing the UK into line with some other European countries. Apart from being ironic in the context of Brexit, that is a gross oversimplification – the countries in question have in many respects better worker protection and different industrial relations structures.
Doctors or nurses who strike are not acting maliciously. They are not lacking in competence or goodwill. They are skilled professionals whom the NHS cannot afford to lose. By, in effect, threatening them with dismissal for striking, all the government will achieve is to accelerate the haemorrhage of NHS staff. It is not the healthcare professionals, but the NHS, which will suffer.
I hope you will use your influence to prevent this bill from becoming law unamended, and to help your colleagues understand how damaging this government’s confrontational policy is to the future of the National Health Service.
Instead of demonising our healthcare staff, should we not learn to respect and cherish them? Before long it will be too late.
To quote Prof Philip Banfield, BMA: Doctors are the solution not the problem
Best wishes,
Dr Peter Burke
The author is secretary of the Oxfordshire division of the BMA but is writing in a personal capacity.
*Over Covid breaches, I’m a celebrity, and the WhatsApp leaks.
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