Few will miss the National Union of Mineworkers more than Ian Lavery MP. Labour’s trade union spokesman used to run the union, which very kindly continued to pay him after he left its employ to enter Parliament. He also used money from an NUM “provident and benevolent fund” to buy his house.
Mr Lavery
denies wrongdoing over these arrangements, which have a rather old-fashioned feel to them. Indeed, the NUM will soon slip into history; it will this year be legally wound up for lack of members.
The demise of a union that once challenged the government of the day for political supremacy says much about the changing nature of work. It is also a story the British Medical Association and its members might reflect on as they prepare for the first all-out strike in NHS history.
Doctors would doubtless consider themselves rather different to the miners. They’d be right, too. The miners were honest enough to admit that their strike was about money and self-interest.
And with the exception of one strike-breaker in Wales, they didn’t kill anyone to make their point.
How many people die as junior doctors withhold emergency care remains uncertain; doubtless other NHS staff, most of them paid less than doctors, will do their best to avert such losses.
What is certain is that
the strike is about money. By the BMA’s account, talks on a new employment contract foundered over two points. The BMA wanted doctors to be paid more for work on Saturdays. It also wanted doctors to get a larger share of the fines imposed on NHS trusts that make doctors work too many hours. If ministers had agreed to BMA proposals that would give doctors more money, the union would have accepted the new contract without more strikes.
There is no shame in a union seeking to promote members’ interests: that is why unions exist, even if Mr Lavery’s antics suggest otherwise. But the BMA looks increasingly exceptional. Unions have never mattered less in Britain. History is against them.
Fewer than 15 per cent of private sector workers are union members. UK employment is at a record high, but people are not joining unions when they join the workforce. Only in the shrinking public sector are unions still mighty: 55 per cent of state employees are unionised.
When it comes to employment practices, the private sector is a better signpost to the future than the state: companies knew long before public bodies that the days of a job for life and a gold-plated pension were over.
The future of work will mean
freelance, flexible, footloose, economic free agents skipping from employer to employer, job to job. Monolithic blocs of labour, groups of specialised workers committed for life to the same employer, will only become rarer. So the power of the unions that exist to represent such groups will wither.
That trend may yield a shrug of white-coated shoulders.
We’ll always need doctors, won’t we? And doctors will always be different, won’t they? Don’t bet on it.
The doctors’ strike is ultimately about the NHS budget, which already fails to match costs pushed up by an older, fatter population demanding ever more sophisticated treatment. So ministers must squeeze more from the exquisitely trained and paid medical workforce – but there are limits to the productivity gains to be made from tweaking the doctors’ working week.
Having rejected both a spendthrift Labour Party and now Tory welfare cuts, the electorate shows few signs of sanctioning either a major rise in spending (and therefore taxation) or a new funding model for the NHS.
That timidity must eventually mean a fundamental drive to make the service cheaper to run. And there is scope to make medicine – and its practitioners – much cheaper and more efficient.
Ask Devi Shetty, the Indian heart surgeon once called the Henry Ford of medicine, whose chain of production-line hospitals can each do dozens of complex operations every day for a fraction of the cost Western health care systems pay. (His surgeons, many of whom gave up bigger salaries in the West, work six-day weeks.)
Read the George Washington University study that estimates 85 per cent of a typical doctor’s work can be done perfectly well by a “physician’s assistant” with a fraction of the training or wages.
Try
consumer technology that allows patients to monitor and manage their own chronic conditions, even carrying out their own brain scans with an adapted smartphone. Empowered patients need fewer doctors.
Watch robots do the work of once godlike surgeons. A “Da Vinci” robot was used to remove a lung tumour in Darlington this month, the first such procedure in the country. Such robots today are tools used by doctors. Soon enough people without a full medical degree will oversee their work.
Before they follow their trade union down the road to hell, doctors should remember the miners. They went on strike telling themselves that people would always need coal, so the country couldn’t do without them.
