Politics and the NHS

Pay negotiations for Britain’s doctors and nurses are affected by wider issues in politics and the NHS, such as views on privatisation

Further nurses strikes are possible in the ongoing pay disputes between the government and public service health workers in Britain’s National Health Service.  The public is reportedly on the side of the strikers: Majority back NHS strikes despite disruption, polls show.  The government, however, is arguing that its first priority is to control inflation for everyone’s benefit.  It is therefore trying to keep public sector pay as low as possible, to avoid a wage/price spiral in inflation.  The negotiations are complex:

●  The economics of supply and demand for health workers are inexorable.  Employers must pay enough to get the staff they need.

●  The NHS has suffered from staff shortages for years, yet it provides an essential service for which demand is rising.

●  It is funded by taxpayers, and tax levels are politically contentious.

●  There is an underlying ideological divide on privatisation of public services.

The government must take all these factors into account.  It wants to increase its chances of winning the next election, and it knows that its performance on the NHS is subject to intense public scrutiny – so politics and the NHS are deeply entangled.

Pay negotiations in a classical labour market balance the needs of employers against the available supply of labour.  Health service employers cannot get the doctors and nurses they need without offering better terms and conditions.  Nurses can earn more outside the NHS by working for private health providers, or as short-term contract staff, or in other sectors of the economy.

The NHS has been relying on immigration.  It has attracted immigrants from poorer countries that can ill afford to lose their trained staff.  The New Conservative Group wants to cut immigration, though, to meet one of the party’s pledges to voters in the 2019 election.  It has issued “a call to scrap Health and Care Visas, launched to fill gaps in the health and social care sector with overseas workers”, yet it hasn’t explained what it would do about the staff shortages.  And many European health workers have left Britain since Brexit.

The NHS workers had demanded restoration of their loss of earning power under successive Conservative governments.  They had been affected by government cuts imposed as part of George Osborne’s 2010 austerity programme, and they have suffered like everyone else from high inflation.

Public service workers are treated differently from those in the private sector because the government is their employer.  The so-called ‘independent’ NHS Pay Review Body (PRB) was set up to disentangle politics and the NHS.  Its 2022 report recommended an immediate £1,400 increase in pay, plus an average of 4.5%, for nurses and ancillary staff.  Although some staff accepted this offer, nurses rejected it because it failed to restore their earning power.

The Pay Review Body is politically constrained.  It is careful and thorough, but its terms of reference oblige it to work within “the funds available to the Health Departments, as set out in the Government’s Departmental Expenditure Limits”.  The 2022 PRB report had therefore been constrained by political decisions already made in that year’s budget – so in that sense it was not independent of the government.  The 2023 PRB report has now been published, but it has failed to resolve the situation; it acknowledges the financial constraints under which it operates.  Some health unions have accepted its recommendations, but the Royal College of Nurses is still voting against it.

Boris Johnson’s cabinet contained several prominent Thatcherites at the time of the 2022 budget, including Dominic Raab, Liz Truss, Priti Patel, and Kwasi Kwarteng – who had openly advocated privatising the NHS in their book Britannia Unchained.[1]  Rishi Sunak, who was described by The Economist as “a Thatcherite at heart”, was responsible as Chancellor for economic policy.  Margaret Thatcher had privatised many public services and had been seen as winning confrontations with the Trade Unions.  She had been a popular Prime Minister, revered by Conservative Party members.

People’s economic self-interest is an important factor affecting politics and the NHS.  Wealthy people pay more tax than those on low incomes, so they are more likely to vote for a political party that promises to cut taxes.  Tax levels are linked to government spending, so the rich benefit from a policy that cuts public funding for the NHS.  The Conservative Party attracts such voters.

The government is continuing with its strategy of deliberately weakening the NHS whilst misleading the public about its intentions, as reported earlier on this website.  It dare not openly advocate privatisation for fear of losing votes, because the NHS is is popular.  It is quietly strangling the NHS with a prolonged squeeze on health and social care budgets though, so that people will be more prepared to accept at least partial privatisation:

●  Many nurses are leaving the NHS and then returning as contract staff.  High spending on agency staff means that the public service can afford fewer of them.

●  As staff leave, those who remain are put under more pressure and there is an increasing problem of staff sickness.

●  Many hospital beds are taken by people who have been cured but who cannot be discharged because of inadequate social services.  Boris Johnson had claimed to have an “oven-ready plan” for fixing social care, but subsequently admitted that his ‘clear plan’ to fix social care doesn’t exist.

●  Local government is responsible for providing social care.  Conservative government grants to local authorities have been “cut 40% in real terms between 2009/10 and 2019/20”.

One in eight Britons pay for private health services as “underinvestment in NHS is forcing patients to seek private treatment if they can afford it” – so the government’s strategy is clearly working.

Rishi Sunak, the current Prime Minister, is “a pragmatist who tacks to the political winds” according to the Economist article quoted above.  Knowing that the NHS is popular, he wants to appear to be protecting it.  One of his five pledges on becoming Prime Minister was deceptively worded: “NHS waiting lists will fall and people will get the care they need more quickly”.  This pledge might give the impression of being supportive of the NHS, but it is also compatible with the ideological aim of giving more work to the private sector.

Public debate on politics and the NHS should be open about the role of privatisation.  A publicly funded health service is more cost-effective in overall terms than a privatised one, but some people oppose publicly-funded services on ideological grounds or because they want to pay less tax.  The Conservative Party should openly admit to its strategy of privatisation, so that voters can take it into account at the next election.

• [1] Britannia Unchained advocated privatisation of the NHS. A Project Syndicate review of the book described its ideas as “deranged”, noting that its authors were “ignorant of basic facts” – about Californian economic success being largely due to government funding, for example.  Liz Truss and Kwasi Kwarteng were responsible for an incompetent ‘mini-budget’ in September 2022.