Andrew Lansley will be enjoying his jubilee break. The Health Secretary took enormous flak over his Health and Social Care Bill, particularly from doctors. Yet he still managed to force through massive structural reform that has neither a political mandate nor an evidence base. Since the Act was passed, Lansley-bashing has largely fallen from the news agenda. And now the Government has faced down the British Medical Association (BMA) over pensions, forcing doctors into an ill-advised strike that gifts Mr Lansley the opportunity to get his own back. Let’s hope he resists.
Doctors can never “strike” in the conventional sense. Our supposed dedication to duty in any circumstance is rewarded by public trust, good pay and a gold-plated pension. A new “affordable” pension deal was agreed with the Labour Government in 2008 but the coalition has used the recession to make the case for further reform, which will see the best-paid doctors contributing 14.5 per cent of their salaries as pension contributions, twice as much as some public sector staff on similar salaries to get a similar pension. Anyone under 50 will pay in a lot more and get a much smaller lump sum and less pension. And younger doctors will work until 68.
The response to the BMA’s question “Are you prepared to go on strike?” was overwhelmingly positive. Now the BMA has to spend a fortune on a publicity campaign to reassure us that any “strike” won’t harm patients.
The simplest solution is to treat June 21 as another bank holiday, with doctors providing emergency cover and essential services only. But it only takes a couple of patients to claim they were harmed by the strike for it to become a PR disaster. Mr Lansley knows this and so does Hamish Meldrum, the BMA leader. Dr Meldrum is doubtless praying that the Government will get back around the table before June 21 so the strike can be averted. But Mr Lansley could sit back and watch the BMA self-destruct.
Doctors feel betrayed that a pension contract that they signed up to can be ripped up so readily. But doctors did particularly well out of Labour, with the BMA negotiating handsome new contracts for GPs and consultants that boosted final-salary pensions. Much of that extra income is now being clawed back but doctors will not starve.
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The NHS has to make £20 billion in savings to stay afloat over the next five years and beyond that, we will struggle to care for an ageing population. Doctors too are living longer and accept they will have to pay more. But the suspicion is that such a large pension hit is personal.
Many doctors were tempted to vote Conservative because of the specific promise of no big NHS reforms, only to be presented with a structural reorganisation so huge you can see it from space. GPs with limited or no experience of commissioning are being handed responsibility for £60 billion and are working ludicrous hours trying to keep their practices and commissioning groups afloat. The hit on pensions is not exactly the reward they need to keep motivated.
Some believe that GPs are being set up to fail, so private companies can step in and take control. Companies are often put off bidding for NHS work because of the size of the staff pensions, so any reduction would encourage market competition.
In defence of Mr Lansley, he’s one of the few health secretaries I’ve met who really wants and knows the job. But he still has to convince doctors he’s in it for the NHS, rather than himself or his private sector friends. He should start by swapping vanity for humility, showing some leadership and heading off a shambolic doctors’ strike.
I’m not a member of the BMA but I nearly joined after the July 7 bombings when the heroic council members, led by Dr Peter Holden, tended to the wounded in Tavistock Square. Dr Holden and his colleagues never got official recognition for this, a sign of the testy and often childish relationship the BMA has with government.
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The NHS can only function with a committed, united workforce and a health secretary whom we can trust. Time for everyone to grow up and get back around the table.
Dr Phil Hammond is a GP and comedian