Minimum service levels didn’t work on the railways – could they deal with the medical unions?

Earlier this month, I wrote about how both Labour and the Conservatives have failed to find a way to adequately confront the problem of strikes in the public sector, and specifically the NHS. Today, the Tories announced that they would ban doctors from striking; how does that rate as a solution?

One can see the attraction, in theory – although obviously much would depend on whether or not such a prohibition was actually legal under the ECHR (although it is for the police, but that ban was grandfathered in, as it dates from 1919).

There is also an undeniable logic to it. The overwhelming dominance of the NHS in our healthcare mix serves to create a single point of vulnerability not present in other systems; not only is the system exposed to national strikes the way no private-sector industry is, but the unions can also leverage their position in other ways, such as the BMA negotiating with the government a cap on the number of medical traineeships.

That privileged position requires to work a degree of restraint on the part of the unions; if that breaks down, then the whole system becomes unsustainable. This is what happened to the broader post-war settlement in the 1970s, as a generation of ‘right-wing’ trades union leaders gave way to a new one prepared to exploit British politics’ then anathema of high unemployment for all it was worth. Eventually, something had to give.

At first glance, it isn’t obvious why the proposals only compass doctors and not nurses, as a strike by either seems able to bring the NHS to a halt. Perhaps it is simply that doctors are the less sympathetic target at the moment, but if it doesn’t remove completely the risk of a national strike bringing the Health Service to a halt this tactic would seem to risk a lot of pain for inadequate gain.

More seriously, it also seems to be another product of the modern Conservative Party’s one-track approach towards dealing with strikes; if one has a hammer then everything is a nail, and the Tories seem able to conceive of no answer towards problematic strikes than minimum-service laws and other bans.

As we saw with the railways, such laws are not always actually enforceable in the face of union intransigence. But by focusing on a symptom rather than the deeper problem, this approach is also unlikely to cure what ails the NHS.

The problem with the Health Service boils down to the fact that three things are simultaneously true: that the Health Service is one of those runaway revenue expenditure budgets hollowing out British governance; that despite this it never has enough money and backlogs are growing; and that it doesn’t pay internationally-competitive wages for medical staff, who therefore increasingly seek better-remunerated positions overseas.

That third point is critical; at present, the British State spends hundreds of thousands of pounds of taxpayers’ money training up doctors (whose tuition fees don’t cover a fraction of the real cost of training them), only for them to take those skills to foreign countries and bank the dividends privately.

Sadly, doctors will do this without apparently conceding that maybe it would be better if the UK had the same healthcare system as, say, Australia; the NHS remains a sacrosanct model, even if they aren’t personally prepared to work for it.

But our inability to pay competitive medical wages is a big part of the true problem; so is the cost bottleneck our system places on training up British medics via such policies as degree requirements for nursing and barring private hospitals from taking trainees.

Strikes in the NHS are a real problem, arising in large part from the structure of the service, and it is a step forward for the party to have at least some sort of plan for breaking the unions’ leverage. Yet they are also in many respects simply a symptom of the deeper problem – a very strong pain signal, if you like.

Pain is never pleasant. But there is a reason we evolved to feel it, and why people who can’t feel it live at a serious disadvantage and tend to get injured a lot. The danger of banning strikes, without undertaking wider reform of the sector, is that it shuts off the pain signal and allows politicians to ignore the other deep-seated problems with how this country currently organises healthcare.

If Kemi Badenoch is really serious about taking on the BMA, she should find a fiscally-sustainable way to break its chokehold on recruitment and lift the cap on medical places – and ensure that any medic trained at the taxpayers’ expense repays that debt, either in service to the NHS or in cash.