General   (General discussion, talk about anything.)

First Mate. The piece from today's Telegraph.

There is a way to make doctors’ pay competitive – but the BMA won’t like it
The NHS is one of the UK’s last socialist relics – there is no real market in healthcare

KATE ANDREWS
6 January 2024 • 6:00am

It’s not often that advocates for socialist systems rely on free market arguments to make their case. But times are tough over at the British Medical Association (BMA), where the junior doctor strikes are, for now, the outlier within the NHS.
There have been breakthroughs in pay negotiations for nurses and consultants, but the leaders behind the junior doctor strikes insist that the Government’s offer of roughly 12pc is not anywhere near close enough to the 35pc they are demanding.
Perhaps strike leaders have registered what many of us already know: that market-based approaches almost always lead to more prosperous outcomes.
To get that sky-high pay rise, they have to lean into the unfamiliar. But it’s becoming increasingly obvious that those who are trying to wedge more market-based arguments into the NHS pay debate misunderstand the fundamentals.
The argument goes that Britain must compete with other countries for doctors, or risk even more brain drain from the NHS. We’ve heard a great deal about medics fleeing our broken health service. The number of medics applying to work abroad hit a 10-year high last year, according to the General Medical Council.
Doctors emigrating has long been a problem for the NHS – not to mention taxpayers, who are estimated to cover 72pc of the £420,533 it costs on average to train a doctor to consultant level. But the dire state of the NHS has workers picking up the pace: the 8,625 who applied for a certificate to work abroad last year represented a 20pc increase on 2022.
The British Medical Journal reported in 2022 that four in ten doctors plan to leave Britain as soon as they are able to do so. Among that 40pc is the co-chair of the BMA’s junior doctors committee, who indicated just last week that he’d consider a move to Canada.
In an ideal world, Britain would be competing with other rich nations – not just to keep its own doctors in the UK, but to attract the best and the brightest medics from abroad.
But expecting the UK to do this is a bit like expecting a shopkeeper slapped with price controls to sell their products for more money. Where socialist rules dominate, markets struggle to function. And the NHS is one of the UK’s last socialist relics. There is no real market in healthcare.
This is a political choice. Politicians in every major party have spent decades insisting that the single-payer model not be touched. Organisations are vehement that reform stays off the table.
This means NHS workers often have very little choice over when, where and how they receive or provide healthcare. The system is deliberately designed that way. Britain has one of the most centralised systems for healthcare in the developed world: a state-funded and state-run model where patient choice is limited.
Most other developed countries have gone down a far more pragmatic route. They’ve taken the principle of universal access to healthcare and applied it through a variety of mixed models, including social health insurance schemes, healthcare savings accounts and often some level of state provision.
This is what organisations including the BMA often gloss over when discussing pay. They will mention countries like Australia, where UK doctors often relocate, and point out that pay is better – while ignoring how the model of healthcare is vastly different.
In 2022, Australia’s spend on its hybrid healthcare system, as a proportion of GDP, was a percentage point less than the UK: 10pc compared to the UK’s 11.3pc. Still, pay is higher, work-life balance is better, and patients broadly fare better.
This is a familiar story when comparing the UK to its counterparts in Europe, not to mention countries like South Korea or Singapore (the latter of which Labour’s shadow health secretary Wes Streeting visited last year, along with Australia, to learn about how these systems work).

It’s the regulated markets in healthcare that tend to prove outstanding in the league tables, as they get money flowing to the right places more effectively – including on salaries.
Meanwhile, Britain has become an outlier in its decision to rely almost completely on tax receipts to fund the NHS, which funnels through layer after layer of bureaucracy.
The NHS has become world-famous for providing the worst kind of service: one that is very expensive but also fails to get good results (even with record levels of cash, the Institute for Fiscal Studies reported last autumn that “evidence strongly suggests that the NHS is less productive now than pre-pandemic”).
It’s not just a rotten system, but an unsustainable one. The Government is taxing and spending at record levels, and still it cannot fully explain how it will fund all of the public sector pay rises it authorised last summer, based on recommendations from independent pay review bodies.
No one can begin to fathom where the £50bn needed by 2036-37, as calculated by the IFS, to fund its long-term NHS workforce plan, will come from.
If organisations like the BMA were serious about getting their members better pay, they would warmly embrace some of these tried and tested models that are far more efficient about prioritising where funding is directed. Or, at the very least, they would be calling for labour market reforms within the NHS, to do away with rigid pay structures.
Yet the BMA’s priorities indicate another motivation. This was the union, after all, that voted to cap medical placements back in 2008, and used the consequences of that decision more than a decade on to walk out of wards, citing understaffing. The union doesn’t even stick to its warped line of “free market” reasoning – if it did, it would have never backed the consultants striking, as their pay sits closer to the top of international rankings.
Perhaps there is something ideological at play: a desire to retain power within a monopoly, evidenced by the union’s decision to carry out the longest strike in NHS history during the most dangerous time for the beleaguered healthcare service.
The pretence that the strikes are about patient safety is gone. Talk of reform is treated as blasphemy. The sole purpose of these strikes is pay – but only under very specific conditions, where the unions retain their power as the sole provider of care.
It’s a terrible deal for patients – but it’s a bad deal for BMA members, too.