Trade Unions

It is an interesting time for anyone interested in British health policy. Although the Conservatives are right not to announce any detailed polices at the moment – in fear of Gordon Brown stealing, repackaging and selling them as his own – I nevertheless hope that if they are elected they are able bring to the fore an overall vision and strategy for health policy. It is vital that if they are elected they hit the ground running.

Although not aligned to any particular political party, NFR would like to take this opportunity to offer four key ideas:

  1. NFR represents a growing number of nurses who believe that all healthcare delivery should be returned to the independent sector. We recognise that at its best, this will include a diverse range of for- and not-for-profit providers. Politicians need to end their obsession with the idea of state provision and embrace the independent sector even if this means offering ownership of NHS hospitals and clinics to the people who work in them.
  2. For far too long politicians have allowed the General Medial Council and Nursing and Midwifery Council to be market monopolists. With too many political friends in the British Medical Council and the Royal College of Nursing these institutions should lose their monopoly status in law. Erecting endless road-blocks on the way to genuine consumer empowerment and choice, the next government should face down these middle class trade unions just as Margaret Thatcher dealt with the restrictive practices of the so called working class trade unions in the 1980s.
  3. Similarly, the next government must end health censorship. In today’s internet age it is absurd that advertising by doctors and pharmaceutical companies are still largely restricted or subject to outright bans. The next government must realise that better informed people will be able to make better decisions. While no one will ever have perfect information or knowledge, advertising and the building of powerful brands can nevertheless help to deliver necessary checks against producer-capture and the monopoly abuses of those with professional legislative favour.
  4. In opening up all health provision to the independent sector, actively de-monopolising the medical and healthcare professions, and ending healthcare censorship, British healthcare will be starting to go through the supply-side reforms that it so desperately needs. However, to complete the process, it is vital that the Treasury also complements these reforms with a private funding revolution. Any incoming administration should find ways of making it tax advantageous for people to offer and take out new forms of independent health funding. Trade union friendly societies, churches and charities must be fully empowered to offer new products. While the NHS will remain an important funder for years to come, it is vital that it is gradually replaced with more sustainable and consumer-focused forms of private resource.

          This story is a damning indictment on the monopoly powers of the professions.

          The GMC and the doctors were so powerful in negotiating the new GP contract and opting out of providing 24 hour care for their patients – even though they managed to secure huge pay rises – that patients were the losers and this young mother with so much to offer lost her life.

          Much has been made in the past few days of the news that doctors are no longer going to be allowed to regulate themselves in light of the Harold Shipman inquiry. Apparently, the power of governance is to be moved away from the General Medical Council and into the hands of the NHS and a so-called independent authority.

          For me the proposal has raised a number of concerns. Firstly, it is very unlikely that the doctors are going to take this lying down, what are they going to want in return?

          Secondly, if the NHS is going to be involved in the policing of doctor’s clinical competence does this really inspire confidence?

          And thirdly, if there is going to be an independent organisation established how many seats/places/appointments will the doctors insist be filled by doctors to …ensure appropriate peer review… …monitor clinical competence… or other such weasel words. I am willing to bet that doctors will make up the majority of representatives on theses governing bodies or they will seek regulatory capture by some other means.

          However, the real issue here is that the proposals made by Liam Donaldson will not improve the care given by doctors to patients. Nor will it improve public confidence in the medical profession.

          The time has come for us to think more imaginatively about how we want our doctors trained and regulated. Why should government and the NHS be involved at all? Do we need the government to tell us which washing machine or car is likely to be more reliable or give us better service? No, a multitude of consumer magazines, websites and television programmes are available to help us with our choice. We talk to our friends and family to canvas their opinion and experiences and we make our decisions not based on an in-depth or expert knowledge of the subject but with an informed choice from the trusted bands available in the market.

          Why should our choice of doctor be any different?

          Isn’t it about time the Government stopped treating the public like children who are unable to look after themselves and started realising that there is a population of consumers who are willing and able to take responsibility for their own health and healthcare decisions?

          Here we go again! Another year of healthcare and another year of pay bargaining. I see the DoH in the form of Stephen Johnson has floated a 2% across the board annual uplift for NHS staff, below the retail prices index inflation figure of 3.3% (1). The NHS has never really solved the dilemma of the annual pay round, i.e., whether to have one large national negotiation with all of the health unions or to leave it to the market and allow the Trusts to determine pay and conditions locally. Instead, we always get a fudge where there is much lip service paid to local pay bargaining but Chief Executives are set clear national pay boundaries to stay within.

          Surely the 30 or so existing Foundation Trusts will break out of this and start to set their own pay rates. With a projected shortfall of nurses to the tune of something like 14,000 by 2010-2011 (from the DoH’s own current workforce growth projections) this can only be good for qualified nurses who will be able to negotiate better than average settlements for themselves based on a market shortfall of their skills. It would, after all, be gratifying to see Consultant pay pegged for a while and qualified nurses pay go up in real terms. With a similar excess of consultant grade doctors to the tune of 3,200 by 2010-2011, this is what should happen. It will be very interesting to see if a Labour Government for once, doesn’t ‘stuff the doctors’ mouths with gold’ but allows nursing to catch up the medical profession a bit on pay. I hope they do because it is only this kind of market mechanism that will result in more young people wanting to join the nursing profession.

          (1) ‘Warning over union action on pay’: Helen Mooney, HSJ, pp 9 4th January, 2007.

          Have you noticed how trade union leaders who endlessly bang on about the NHS being a free service and how ‘people’s healthcare is so important that it should be beyond monetary consideration’ are at the same time the most vocal when it comes to obsessively demanding more money?

          Peter Carter of the RCN is no exception. No sooner than he has arrived in post the RCN Bulletin read’s “We will be worse off with 1.5% rise. RCN members angry over pay proposals”. Forget a free NHS here – for the RCN it is all about money, money, money!

          NFR believes the RCN and Unison should get real about nurses pay and stop trying to live in an axiomatic cloud cuckoo land. The bottom line is if you want nurses to be valued and well paid you have to stop arguing such incoherent nonsense as ‘people’s healthcare is so important it is beyond monetary consideration’. In the real world all healthcare has a monetary dimension and we should not be ashamed of this fact.

          Given all healthcare is financially rooted these trade unions should start their campaigns by pointing out that if you want quality healthcare you first have to pay for it and secondly you have to have an institutional framework in place which provides the optimal incentives for the professionals involved to actually deliver.

          On this latter point there are only two possibilities: (a) a state system driven by the vote motive; (b) a market system driven by the profit motive.

          It is only when trade unions fully and openly understand the pros and cons of both these systems and get real about the central importance of money in all healthcare that they will do nurses and the public a favour.

          NFR says stop the flannel and camouflage. The NHS is not free. No healthcare can be. All healthcare in any system is about money and nurses want to be valued appropriately.

          We know that a state healthcare system is primarily driven by the vote motive. Would we and our patients not do better in a system driven by profit and surplus?

          Predictably, the trade union Unison (not to mention the Royal College of Nursing), has signed up to the Trade Union Congress’s ‘NHS Together’ campaign which opposes further NHS private sector partnerships and privatisation.

          Yet, while Unison’s chief comrade, Dave Prentis, tells NHS staff that they “they deserve more than the failed privatisation policies of the past” guess who is simultaneously offering great deals on various forms of independent healthcare?

          Perhaps in recognition of the millions of people who signed up to trade unions during the late 1800s when they offered services via friendly societies (and stopped doing so when they resorted to beer and sandwiches at No.10 while defending failed nationalisations) Unison today has a partnership with the private health cash benefits company Medicash. Like BUPA, Nuffield Hospitals and WPA, Medicash is an independent not for profit healthcare organisation. As such, it “pays back over 80 per cent of contributory income every year to members in cash benefits.

          What is so good about this is that while in 1948 the government promised that the NHS will “provide all medical, dental and nursing care” free of charge – today the Unison scheme points out that it will help to cover the private costs of:

          “expenses incurred for everyday healthcare such as for Optical, Dental and Physiotherapy…”

          For an application and more details, call 0845 600 0151 and just ask for the UNISON plan!