Saturday, June 09, 2012

For the first time in 40 years, UK doctors are taking industrial action...

I am very torn by this. I didn't vote in the ballot - I couldn't decide what I thought. I certainly would never take strike action personally. In general I think the right to strike is a vital right in helping to redress the massive power imbalance between employers and employees. Of course, for vital services, like medicine, striking can never be an option.

In principal, I do think that taking some form of industrial action that did not harm patients could be justified. I am not convinced however, that such a thing is possible. On the other hand, the last time similar action was taken, apparently mortality went down - same number of staff on duty, only doing emergency work.

I am a paediatric surgeon in training and currently I am working in paediatric intensive care for a short secondment. Therefore this action will not effect me in any way - there's no way I could participate.

For most doctors this dispute is about honesty and fairness. And there is a lot of anger about this. It's also worth noting, that it's the same pension scheme for all NHS staff. So it's not just about high-earning doctors. Doctors only make up 10% of NHS staff, around a third are nurses and another ~15-20% are other professions aligned to medicine.

It is true that the NHS pension scheme is a very good scheme but I object to the term 'generous' for two reasons. Firstly, it is a contributory scheme and so - to a large extent - we pay for it ourselves. And secondly, it is part of the terms and conditions that everyone signed up for.

I've done a little bit of reading around this. As a back-of-the-envelope calculation, a lot of consultants will be on ~£100,000 / year. If they have 40 years of service to the NHS they would then be entitled to 50% of that as a pension (forty 80ths). A quick look on one of the many private pension sites tells me that such a pension would require a pot of ~£1.1m. I worked out that my pension contributions of around 8% on current pensionable pay for the years as a junior plus years as a consultant, roughly (without any interest or investment) comes to £500,000.

Notionally, the way the NHS pension scheme works is that the employer puts in a contribution of up to 11%. If you put these two contributions together over 40 years, then this pays for the pension. Over the past 30 years (or longer) the NHS pension has had a significant surplus. Governments of all flavours have decided, rather than investing the notional pension funds to keep the money in the exchequer and act as an underwriter to the fund. That is not necessarily unreasonable - for a nation-state. The excess returned to the exchequer is money the government would otherwise have to borrow. Currently the NHS pension fund is running at a £2Bn/year surplus.

In 2008, the NHS pension scheme was reformed significantly in such a way as to make it sustainable for the long term. Nothing has changed since then, the scheme is still sustainable in the long term. So this is simply a money-grab by the government.

The dishonesty and unfairness of it has angered many.

On the other hand, I daily thank God for the chance to do a job I love. And be paid well for. My income is very substantial and even if they do gut my pension I'll find other ways to save money.

It is worth noting that at my level (6-7 years experience - after 5 years at university) my basic pay is around £33k. I earn a lot more because of the out of hours work we do. I have to pay around £4000 / year in student loan repayments, £1000 / year in professional subscriptions so I can do my job and I have to pay for all my post graduate exams and most of the courses that I need to go on.

I am not pretending that I'm hard up. I'm really not. It's just that when you work a 90 hour week, you do tend to feel that you've earned the money you get. And that includes the pension scheme.

Having said that, I remain uncomfortable with the notion of taking action which runs a risk for patients. However, it is difficult to argue when people say the government has not given us any other option. They have completely and totally refused to negotiate. They have said, this is what is happening. No debate.

One final thought. When I read the various newspaper stories - all united in condemning doctors - I noted that in the comments sections, most of the comments were critical of the reporting and supporting doctors in taking action.

I remain torn. This is grossly unjust. There is no need for this change and the government is consistently lying about it (as they did about NHS reforms). On the other hand, I am a very well paid professional and the abuse and the indignity inflicted on the poor and particularly the disabled is a far greater injustice. So what is right? To stand up to this injustice or to accept that as well-off as I am, it is a minor indignity really? On the other hand, most NHS employees are not well paid doctors who will seriously suffer as a result of this assault on their pensions.


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