As soon as Margaret Thatcher came into power in May 1979, she instructed senior ministers and civil servants to draw up secret plans to win a confrontation with the National Union of Miners. She had seen how their strikes, supported by other key unions with targeted picketing of ports and coking plants, brought the country to a standstill and destroyed Ted Heath’s Conservative government with power cuts and a three-day week. Thatcher was determined to beat them — and to defy the defeatist conventional wisdom that enabled Britain’s most powerful group of workers to hold the country to ransom.
Sir Robert Wade-Gery, the deputy cabinet secretary she tasked to help draw up the battle plans, told Lady Thatcher’s biographer Charles Moore how the idea of picking a fight with Arthur Scargill’s union was dismissed in the corridors of power. “The woman’s mad,” he recalled people saying. “You can’t win miners’ strikes. All you can do is buy them off.” Yet, as we now know, Thatcher’s preparatory tactics — which included building coal stocks around the country, passing laws to curb union strength and appointing a ruthless ally in Ian MacGregor to run the National Coal Board — eventually won the day.
Her victory, after a year-long dispute, was a defining moment for both Thatcher and the country, paving the way for the liberalisation and globalisation of Britain’s economy, yet leaving a legacy of shattered communities as the mining industry was shredded.
No one in their right mind would wish for repetition, of such a bitterly divisive dispute. Yet, when I see leaders of the British Medical Association talk of being “excited” at the prospect of going out on strike again, it is hard not to wonder if we need a politician with the tenacity of Thatcher to tackle today’s most powerful union and help salvage public services.
For almost a century, the prevailing political view has been to buy off this self-serving union, rather than risk a battle with our widely-admired physicians, regardless of the costly consequences for taxpayers and any corrosive impact for patients. So, extra cash gets pumped repeatedly into health service coffers, only for much of it to end up flowing into the pockets of doctors. Yet with their productivity falling, NHS dissatisfaction rising and health projected to soak up a spiralling share of national wealth — an additional 1% of Gross Domestic Product each decade — this is simply unsustainable.
Thankfully, Westminster is shedding the strange delusion that our NHS is envied across the planet. But the latest 10-year plan, filled with familiar ideas, and talk of tackling bureaucracy by Health and Social Care Minister Wes Streeting are simply not enough for a struggling health service that — in the words of its new boss Sir Jim Mackey — views patients as an “inconvenience”. If we are to have any hope of saving the health service, we need politicians with the bottle to stand up to the arrogant and selfish doctors’ union.
It was Dr Ross Nieuwoudt, co-chair of the BMA’s resident doctors’ committee, who said so shamelessly that “the vast majority” of his 55,000 members “are excited to go again”, anticipating another wave of possible prolonged walkouts. Let us bear in mind these bolshie medics have taken industrial action 11 times over the past three years, leading to about 1.5m cancelled appointments in the chronically overloaded National Health Service before they won a bumper pay deal last year. It was worth 22.3% over two years, thanks to an incoming Labour government. Their actions cost the country £3bn, according to the NHS Confederation. Yet, now they are holding another ballot — closing on 7 July — over their latest pay demands, which are a 29% wage rise.
Nieuwoudt, a surgical trainee from Merseyside, is the joint leader of the rebranded junior doctors part of the BMA, which has been seized by a campaign group called DoctorsVote. These are Scargill’s true successors, despite their white coats, stethoscopes and suits. The medic hastily corrected himself after an outcry over his statement, insisting that he meant “excited as in energised — not excited as in looking forward to it”. Yet, his slip was revelatory. The full-time basic pay for a resident doctor hits £54,300 this year. The latest government offer — equating to a 5.4% rise — is the highest in the public sector. Even Nieuwoudt — who styles himself a “pay restoration enthusiast” on social media — admitted this was “generous” in a radio interview, before insisting that “it needs to be more generous”. But still these activists cannot wait to get out of their wards and back on the barricades.
These militant young doctors want a fresh mandate for what one is terming “terrible disruption”, based on dodgy claims that cherry-pick the data and inflation metrics. The BMA is also holding an “indicative ballot” of senior doctors in a dispute on NHS consultants, the top grade of doctors who reportedly earn an average £145,000 a year. The union wants this to rise more than one-third over the next three years — and if not, they might join residents on the picket lines (when not padding out their pay with private work in a sector thriving from patients frustrated by long NHS waiting lists).
“Still these activists cannot wait to get out of their wards and back on the barricades.”
The BMA, of course, insists it is driven by the desire to protect patients. Yet, do not be fooled: this body has always been ruthlessly focused on protecting the interests of its members — to the extent that it even fought the home secretary to stop 500 Jewish doctors fleeing the Nazis in 1938 from coming to Britain, resulting in only 50 of them being able to find safety in this country. Then it opposed the creation of the NHS that it now claims to defend so doggedly in a fight that a prominent historian waspishly pointed out lasted longer than the Second World War. Labour’s Health Minister Aneurin Bevan — accused by one leading BMA figure of setting Britain on the path towards National Socialism — loathed doctors’ leaders, viewing them as “politically poisonous”, but infamously said he had to “stuff their mouths with gold” to win support. Sadly, this approach has been adopted repeatedly by his successors.
The first significant action by consultants in the NHS was a four month work-to-rule in 1975 in defence of private work, then junior doctors walked out later that year to protect “on-call” and overtime rates. Ministers backed down both times. After Tony Blair’s government ramped up health spending, one BMA negotiator of a notorious 2004 contract for general practitioners boasted that he had led their salaries to soar 60% over three years. Dropping out-of-hours cover in return for a small cut was seen, he said, as “a bit of a laugh” — although this reform lies behind the overcrowded A&E wards and has even led to a rise in avoidable emergency hospital admissions for children. “It’s right we make our GPs the best paid in Europe,” said the Prime Minister, when put on the spot over soaring salaries.
The Tories endured a BMA strike in defence of gold-plated pensions in 2012, then a lengthy contract dispute four years later with junior doctors, whose leaders piously intoned to the public that their wave of strikes was about “safety, not pay”. Leaked WhatsApp messages, however, later revealed that their “only real red line” was over weekend payments while exposing a desire to draw out their action to tie up health bosses “in knots for the next 16-18 months”. Publicly, they said the tussle could be resolved if the government would only negotiate — yet privately, their top official said the “best solution” would be for ministers to impose a deal on them. And the chair of the junior doctors committee urged colleagues to participate in “rubbish” mediation talks “to play the political game of always looking reasonable”.
When you hear hard-pressed doctors complaining today about staff shortages, it is worth remembering also that the BMA resisted the expansion of training places for many years, arguing against “the overproduction of doctors with limited career opportunities” and demanding a ban on opening new medical schools. This stance was backed by a vote at its 2008 conference after impassioned warnings about a glut of doctors lowering standards, which would be “wrong and immoral and a waste of taxpayers’ and students’ money”, in the words of one GP representative. Since that debate, the number of full-time equivalent NHS workers has surged by at least 30%, propped up by heavy recruiting from abroad with international staff now comprising more than one-third of NHS doctors.
When the historian Rudolf Klein reflected on the institution earlier this century, he concluded that “keeping the doctors happy — that’s the story of the NHS.” Now even a Labour government accepts this system is “broken” and the public is losing faith shown by record levels of dissatisfaction. And yet will simply pour in more and more money.
No modern health service is immune to serious problems. And Labour’s instincts are right: to drag the NHS belatedly into the digital era; shift care from hospitals to community services, focus more on prevention and empower patients. But we have heard this several times before over the past two decades. Meanwhile, spending on the voracious NHS keeps on rising faster than economic growth. It accounts for about four in every 10 pounds of the daily state spending budget and is constantly prioritised over all other public services — even defence of the realm at this time of rising threat from hostile nations. And the National Audit Office predicts NHS staffing needs to increase by at least two-thirds more over the next 12 years.
Health soaks up more than double its share of public spending at the turn of the century and roughly four times more than when I was born in the Sixties. Yet, the services have often become shambolic, waiting lists are still appalling and fatal safety scandals keep emerging from maternity through to mental health services. Almost everyone has anecdotes about delayed or dire treatment, despite the best efforts of so many caring, dedicated and skilled staff. But the response of the BMA — persistently exploiting public trust in their profession while bleating about protecting the interests of patients — is to threaten yet more strikes to hoover up more cash for its members. Just as when Scargill badly misled the miners, these militant medics need to be taken down by a bold political leader for the wellbeing of our nation.
