As seems to be the case with virtually everything these days – Covid, the cost of living, the Ukraine war – the junior doctors’ strike has given rise to a lot of discussion about the wrong things, in the wrong way.
To date, the focus has been on three big issues:
- The demand for a 35% pay rise
- A concurrent four-day strike period, directly after a bank holiday weekend
- The woke politics of the leaders of the junior doctors, in particular Dr. Rob Laurenson
All of this is understandable. A rise of 35% sounds like a lot (and it is); a four-day strike is hugely disruptive; and Laurenson seems almost a comic stereotype of a hard-left youngster with a very comfortable bourgeois upbringing and woke ideas. He also managed to arrange the strikes while he was away on holiday.
However, I think some context about how the NHS is managing its labour force will be helpful to many readers. This demands we address the tough conundrum of why the NHS is so bad at managing people.
The basic question that the people of the U.K. face in dealing with this issue is: How do we get better quality healthcare and better returns on our money? The structure of the NHS has much to do with answering this.
The envy of the world?
The NHS is the biggest employer in the U.K. In fact, it is practically a monopsonist. That is a fancy way of saying that it employs virtually all of the doctors in the country, in one way or another.
I am a chartered accountant by trade, but my parents and one of my brothers are doctors. I have been amazed by stories of just how wasteful the NHS is in the management of its workforce.
In my analysis, I will refer frequently to a recent piece by Kate Andrews in the Spectator, where she explores what junior doctors really earn. I build on this with my own data and arguments.
Let’s start with some basics. An F2 doctor (basically a doctor with one year’s post-graduation experience) can expect to earn roughly £40,000 gross per year, with uplifts for anti-social hours and London weighting. These uplifts can take that salary up to around £55,000 to £58,000 per annum.
However, an F2 has not decided on what specialism to pursue. In order to become a specialist, the doctor will need to join a training programme, which can take anywhere up to seven years to complete.
The NHS, in its wisdom, offers trainees a salary of £40,000 per annum for doing this. In other words, after a year or two earning around £55,000 a year, you have to take a pay cut in order to advance your career in the long run.
Once you are in that training scheme, your pay will begin to rise over time, but earning much more than £63,000 per annum as a senior registrar (the grade just below consultant) is unusual. That is, after many years of training, far more experience and steadily increasing responsibility, you might see your pay rise by about £8,000.
This goes some way to explaining why so many F2s now defer entering training – often by many years. The numbers doing so have risen from about 30% in 2010 to over 65% in 2019 (the latest year for which figures are available).
Then there is the locum issue. Locum rates vary hugely across the U.K. Locums working in the sticks (e.g. rural hospitals or the outer reaches of Northern Ireland) can earn £90,000 per annum putting in a normal working week, even in the most junior roles. Moreover, you are offered the best shifts. The nasty hours go to the full-time employees, at whatever grade.
Some locum roles offer as much as £80 per hour for an F2-equivalent role – that is £160,000 per annum.
On top of paying the locums these rates, the NHS also pays substantial fees to the locum agencies. Including agency fees for nurses (which will account for the bulk of this), these fees recently came to £3 billion per annum – just for finding the staff the NHS needs.
Andrews talks about the absence of a market rate for junior doctors, because the NHS is basically the sole employer in the U.K. However, this needs more analysis.
Firstly, NHS managers have created a much higher market rate within the U.K. by way of the locum roles. Secondly, they have created a higher market rate for F2+ roles (repeated taking up of F2 roles by doctors who theoretically have gone past that stage) than for specialist training roles. Thirdly, consider the mere existence of other countries – notably Australia – which pay better for less onerous roles. This means there is a higher market rate than the NHS is offering to doctors who would follow the conventional route of F2 followed immediately by specialist training. This is financially not a very smart move.
No one, as far as I can see, has addressed this. But junior doctors are human beings, and they will behave accordingly. As Charlie Munger, Warren Buffett’s less famous sidekick, says, “Show me the incentive and I’ll show you the outcome.” The mess the NHS has made of its medical labour force is living proof of this.
NHS or America?
In any discussion of the health service, the debate too often moves to a binary choice between the loving bosom of the NHS and the horrible capitalist mess which is America’s healthcare system.
Too rarely do we discuss how countries such as Australia, Germany, France and the Netherlands, to name a few, handle their healthcare. Those countries don’t seem to indulge in cringeworthy public worship of their socialised medical systems. Nevertheless their health outcomes on many important indicators are better than ours. Some of them spend a little bit more on healthcare as a percentage of GDP than we do; some of them spend a little bit less.
The American model really is bad. It is hugely expensive, terribly wasteful and has exceptionally poor outcomes in terms of population health and overall life expectancy. The U.K. seems to be heading in the same direction, but with a large public system.
Can we learn from other countries? One key thing to establish is whether successful systems distort the medical labour market as much as the NHS does.
Anecdotally, Australia is the Shangri-La for modern medics. Pay is better, conditions are vastly better (more respect, superior management, computer systems which work etc.), and many health outcomes are better than the U.K.
Interestingly, Australia currently spends much the same on healthcare as a percentage of GDP as the U.K. does. And even more interestingly, until they brought in this revised system a decade or so ago, their public medical system was hardly the world beater it is today.
Compared to what?
Andrews’ article refers to “average earnings”. But is being a doctor an average career?
Leaving aside the structural questions of the market for medical earnings, how do we benchmark a career in medicine against other careers? We’d have to start by accounting for things like the amount of education and training; academic demands; levels of responsibility; and nature of the hours demanded. Medicine is at the extreme high end of all of these. It also stands alone if we account for the need to perform some unpleasant and emotionally draining tasks.
This takes us back to incentives. A healthy market has a way of taking all of this into account. People choose careers based on things like aptitude, passion and work ethic. The price of their labour responds, and, in turn, so do their decisions.
By way of a very quick comparison, a newly qualified solicitor working in a commercial firm can expect to earn £100,000 a year, including bonus, even outside London. Doctors know this.
Instead of intelligently working with price signals, the NHS appears to be throwing money at the problem – with very little accountability.
Public sector spending: Wider context
It may come as a surprise to readers that the annual cost of the full 35% pay rise demanded by the doctors comes to £2.1 billion, according to the Government’s own figures. In the context, this sounds like a small number.
It seems strange that the Government has been so tough on this issue, given its gross irresponsibility with public funds elsewhere.
For example, the U.K. spent £2.3 billion on aid to Ukraine last year, and expects to do the same again this year. HS2 is due to cost far in excess of £100 billion for no discernible benefit. Indeed, the plans for platforms at Euston have cost roughly £2 billion already.
The taxpayer pours many billions of pounds into green subsidies of one form or another. Virtually all of this ends up in the pockets of the rich who have invested in the various recipient companies.
And as we know all too well, the country spent roughly £500 billion during the Covid crisis. This sum would cover the cost of the junior doctors’ pay rise for 250 years. Consider just the ‘track and trace’ debacle, which cost the taxpayer roughly £40 billion, or 20 years of the junior doctors’ pay rise.
To me, this raises an important question about what we do and don’t talk about. As we all remember, debate over pandemic spending was suppressed. Even now there is precious little discussion of it.
Our public discussion currently focuses on junior doctors as the enemies of the day. This after lionising them for a couple of years ago while they were on message and backing the ludicrous Covid restrictions.
But if we really want to save money and improve healthcare in the U.K., we should be talking about locum rates, locum agency fees, NHS management costs and economic incentives generally. We aren’t.
Lutatius is a pseudonym.
To join in with the discussion please make a donation to The Daily Sceptic.
Profanity and abuse will be removed and may lead to a permanent ban.
Till the lunatic Starmer gets in….why were conservatives ever funding this bs.
Because they’re just politicians, like all the rest.
It was a very normie post, apologies.
“No current plans to do so”
I seem to remember:
”We have no plans to introduce a vaccine passport”
Is there a general election coming up?
No need to fund GDI any more – they did more than ‘uphold [the govt’s] values’, their control & censor ideology is now fully embedded.
They won’t notice. It’s already privately funded by busybody billionaires with highly questionable motives.
No government (ie our) money should be spent on this tripe.
What is disinformation? Who decides its definition? Why does the government think that countering ‘disinformation’ is its job? And more to the point, why is this unelected buttock faced multi-millionaire grifter in the cabinet?
They can counter “disinformation” if they like. They can do so by putting out what they think is the right information and then let each of us decide what we think about it all.
The best response to bad information is good information, not shutting people up.
But this assumes this is all actually in good faith and the government is actually worried about bad information. What they’re really worried about is perfectly good information that is a threat to established power. And of course, they can try to counter that with bad but more persuasive information, but that doesn’t really work. Censorship is the only real remedy to inconveniently true information.
Accusing others of lying to cover or promote their own lies is just yet another form of gaslighting of the population.
I do believe in the ‘Online Harms’ bill there is legislation that addresses censorship of true but problematic information.
“problematic” ——-Usually because it interferes with and has the potential to lower confidence in government policies on the 5 main agenda’s. —–Equality Diversity Race Gender and Climate
why is this unelected buttock faced multi-millionaire grifter in the cabinet?
Nobody in the cabinet is elected, they’re all appointed by the monarch on advice of the prime minister (which is itself principally appointed by the monarch as he sees fit although the convention is that it should be the leader of a party which commands a majority in the house of commons).
Yes but ideally in order for our dropped and run over pizza of a democracy to be taken seriously they have to be an elected MP surely? And Cameron is not.
I don’t think so. At least, that’s not mentioned in here:
https://commonslibrary.parliament.uk/research-briefings/cbp-9877
On a not unrelated note, UK Column delved into C40 cities and the big players & Foundations behind it….It seems Sadiq Kahn is just a small fish in this Globalist agenda.
“….It seems Sadiq Kahn is just a small fish in this Globalist agenda.”
Yes, but he’s ambitious Ron.
But why (if it still is) is the Conservative party funding Hope Not Hate HNH the far left pressure group that Reform didn’t have to spine to tell, go do one!
Correction: The taxpayers will no longer be funding the global disinformation index. Fear not, the government will have something else planned to fritter our taxes away.
That’s for sure. And they almost certainly have some other way of censoring and don’t need the GDI any more.
Penny Mordaunt has simply re-directed the funds as the article I have posted from Off-Guardian makes clear.
Oliver Cromwell’s speech shows politicians haven’t changed much …
“It is high time for me to put an end to your sitting in this place, which you have dishonoured by your contempt of all virtue, and defiled by your practice of every vice; ye are a factious crew, and enemies to all good government; ye are a pack of mercenary wretches, and would like Esau sell your country for a mess of pottage, and like Judas betray your God for a few pieces of money. Is there a single virtue now remaining amongst you? Is there one vice you do not process? Ye have no more religion than my horse; gold is your God; which of you have not barter’d your conscience for bribes? Is there a man amongst you that has the least care for the good of the Commonwealth?
Ye sordid prostitutes have you not defil’d this sacred place, and turn’d the Lords temple into a den of thieves, by you’re immoral principles and wicked practices?
Ye are grown intolerably odious to the whole nation; you were deputed here by the people to get grievances redress’d, are yourselves gone! So! Take away that shining bauble there, and lock up the doors. In the name of God, go!”
Oliver Cromwell’s speech to Parliament on April 20, 1653.
A very nice Philippic.
A key requirement for countering disinformation is the ability to recognise it. I don’t think anyone in government or opposition has that skill. The skill they are required to have is the ability to present whatever the government line currently is in a convincing manner, or to put it another way, lying with a straight face.
Thus we have Zelensky a paragon of virtue, whose every word is the shining truth and Putin who is a slippery-tongued dissembler. There is Biden, the virtuous leader of the free world and Xi, a ruthless dictator.
Then back home we have Sunak and Starmer, but no-one can really tell the difference, they just have different flavours of the same “truth”.
As this article makes clear the UK government is still fighting the good fight on the “misinformation” garbage and so ‘Just Call me Dave’ is, no surprise, telling porkies. And look at who funded the guide:
https://off-guardian.org/2024/05/08/new-guide-teaches-uk-mps-to-spot-conspiracy-theories/
“The report was co-written by “experts” representing several non-governmental organisations, and fact-checkers including:
FullFact – funded by (among others) Google, Facebook and the Open Society Foundation.
The Institute for Strategic Dialogue – funded by (among others)
the Bill & Melinda Gates Foundation, Google, Facebook, over a dozen national governments and the UN.
Global Network on Extremism and Technology – The academic research arm of the Global Internet Forum to Counter Terrorism, a thinktank “designed to prevent terrorists and violent extremists from exploiting digital platforms”…and which is funded by (among others) Facebook, Amazon, Youtube and Microsoft.
In short, it’s all a rather incestuous funding pool of the same handful of tech giants and billionaires paying “experts” to tell them what they want to hear.
But we probably shouldn’t judge until we’ve read the “guide” itself, which is tricky because it doesn’t seem to be publicly available (seriously I looked everywhere, if you’re aware of a copy online post it in the comments and we’ll add it the link here).
Fortunately, our old friends at the Guardian have given us a little taste, here’s three things they’re warning about.
The Great Reset, which the Graun describes as…
…a vague set of proposals from the World Economic Forum to encourage governments to move to adopt more equitable policies, the concept has been hijacked by conspiracy theorists claiming it is a bid by a small group to exert control.
…which is wonderful, because it’s essentially admitting it’s true and then pretending it’s not.
The Great Reset is, indeed, a WEF initiative. It was launched in June 2020 with the backing of world leaders and captains of industry, it aims to totally and completely rebuild the way our society works, including how we travel, what we eat and where we live.
You can read about it in Klaus Schwab’s own words here, or see their handy diagram:
How is that NOT “exerting control”? How does one go about transforming the farming, travel, taxation and employment policies of every nation on Earth without “exerting control”?
Eating Insects is another “conspiracy theory”, apparently. With the Guardian warning that:
[conspiracy theories] have included claims – fuelled by attempts to reduce meat consumption – that the WEF wants to make people eat insects.
The only problem being that the WEF really does want people to eat insects:
Like, a lot:
You know what? The Guardian wants people to eat insects too. So does the BBC. And Time. The list is endless.
This is – to use an overused word – gaslighting of the highest degree.
They are at once saying “hey, we all need to eat insects to save the world”, and then claiming anyone who repeats it back at them is a conspiracy theorist.
To encompass how mad this is you have to picture it being done on an interpersonal level.
Imagine a double-glazing salesman comes to your door, wearing a double-glazing company logo and holding a double-glazing sales catalogue and says “I think you should buy some double-glazing”.
To which you reply, “No thanks I don’t need any double glazing.”
At this point the man screams “Double glazing? Who said anything about double glazing!? You lunatic!” storms off down the path, gets in his double-glazing van and drives away.
It’s just that insane.
Climate Lockdowns are the third “conspiracy theory” the Guardian warns us about, claiming:
The ISD identified “climate lockdown” as the catchphrase for the conspiracy that the climate crisis will be used as a pretext for depriving citizens of liberty.
But climate lockdowns are not a conspiracy theory either, they were first posited in a report in October 2020 published by Project Syndicate and the World Council for Sustainable Development. The proposed lockdown included banning private vehicles, the consumption of red meat and “extreme energy-saving measures”.
Since then we have been inundated with peer-review studies, claiming lockdown is good for the environment.
The Guardian itself headlined, in March 2021:
Global lockdown every two years needed to meet Paris CO2 goals – study
It was such an unpopular story that they sneakily changed the headline.
It’s fairly clear that “climate lockdowns” are far from a conspiracy theory, that they were planned and then abandoned (or delayed) due to public anger at the first lockdown.
*
The report is on the ISD Global website:
https://www.isdglobal.org/wp-content/uploads/2024/05/Conspiracy-Theories-Guide.pdf
I’ve had a quick scan through. It appears to be the usual double-down, deny-everything propagandist guff, complete with picture of Trump under the QAnon heading (as if that applies to the UK). It also seems to claim that everything should be treated as potentially anti-semitic (‘Numerous conspiracy theories are rooted in anti-Jewish racism.‘) – the list of conspiracy theories on page 11 has anti-semitism linked to every single one. WTAF?
There is of course absolutely no mention of all the ‘conspiracy theories’ which have been proven to be factually correct.
They might take a leaf out of their own recommendations:
1. Check before sharing. It is vital to check that information has a solid factual basis.