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On strike

As today’s papers report that junior doctors are now preparing for the first five-day strike in NHS history, they drive home how very retro the dispute feels.

Such stories, where employees from one or other of the major sectors of Britain’s economy walked out en masse in an increasingly political confrontation with the Government, used to be commonplace, earning us the nickname “the sick man of Europe”.

Yet now they have almost disappeared, even when the industries they used to plague (such as car-making) continue to thrive.

For this, we have to thank the trades union legislation brought in by the Conservatives during the 1980s. By banning sympathy strikes and flying pickets, the Government robbed private-sector unions of the ability to pick political battles with the state.

Instead they had to focus on relationships with employers, and the result was a transformation of unions into organisations that concentrated on providing vital support and resources to employees, rather than class warfare.

But, as I set out on CapX last year in relation to schools, public-sector unions have not taken this medicine. Because all their employees are employed by one entity, the Government, they are still able to call vast national strikes. The consequences of this are clear to see.

With the junior doctors escalating their threats to hamstring this country’s near-monopoly healthcare provider, and increasing suspicion about the political motivations of the strike leadership, ministers looking for a long-term solution need to ask themselves: do we really need a ‘public sector’ to deliver public services?

Surely there is an essential distinction to be made between the function of the NHS and the form of it. Healthcare delivered free at the point of delivery and accessible to all is surely the priority. But could it be delivered in a new way?

The modern NHS is already on the road to decentralisation, with hospital trusts being granted increased autonomy. But what if we went one step further, and made them legally-independent entities funded by Government grants. They would be responsible for hiring staff on their own terms.

Crucially, this would make medical staff employees of the hospital, not the state, and at a stroke national, politically-motivated strikes would be impossible.

The potential benefits are many and varied. Because union militancy could not easily spread beyond one hospital or trust, it would be discouraged, as patients would steer clear of troubled institutions. Both doctors and management would instead have a common incentive to keep the hospital running as smoothly as possible.

It would also be much harder for unions to demonise managers whom their members worked with than remote ministers, and easier for staff to grasp the financial limitations faced by an individual institution than by the state, which too often gives the impression of being an inexhaustible fund guarded by people very susceptible to political pressure.

Unions would, like their private-sector counterparts, have to focus on providing support and services to their members and finding practical solutions to genuine disputes with individual trusts.

A shift to a private-sector employment model could also, in time, see the organic spread of things like performance-based and regionally-variagated pay, as well as a phasing out of unsustainable public-sector pensions.

This would not be “privatisation”: the Government would still pay for healthcare, which would still be free at the point of delivery and accessible to everybody – more accessible, due to the lack of mass strikes. It would also maintain a regulatory and oversight role to ensure that the sector continued to provide the full range of services patients need.

But such a bold advance of the decentralisation agenda would not only put more power in the hands of the people who actually work in the NHS, but would administer the cure for union militancy that we discovered decades ago.

79 comments for: The doctors’ strike shows why the NHS needs bold reform

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