A Quick Journey into the State of the National Health System

For those of you not aware there is an attempt by the current Conservative government to change the terms and conditions of Junior Doctors working for the National Health Service (NHS). 


Broadly speaking the Health Secretary, Mr Jeremy Hunt would like to make the NHS a 24/7 enterprise without paying any more to achieve this- or at least that is his stated claim. 


Firstly however I should bring to your attention that the definition "Junior Doctor" is a bit misleading.  In the NHS once you have passed your final exams you are a qualified Medical Doctor but are defined as a Junior Doctor until you become a Consultant.  This process could take 10-15 years with many "Junior Doctors" being in their 30's with families and mortgages. 


It is these Junior Doctors who are the engine room of the NHS.  For the most recently qualified junior doctors, basic pay is around £23,000 a year. There is a 50% annual top up for those who work one weekend in six but that applies both to those who are on call at home and those who spend both Saturdays and Sundays at work. This top up, known as banding, also involves an obligation to work unsocial hours at other times of the week.


Social hours are currently 7-19h00 Monday through Friday.   Some junior doctors are required to work one weekend in four to qualify for the 50% banding with a number even having to do one in two or three. Others receive a 20% banding payment, again, depending on their working hours schedule.
The net result of this is that their current average work week is 48 hours.  The current top limit that they work is 91 hours.


Mr Hunt would like to extend the definition of social hours to include 7-22h00  Monday to Friday and to be extended to Saturday as well.


The British Medical Association (BMA) calculated that these changes will result in decreases for Junior Doctor incomes from 15-30%. 


Mr Hunt's response to this claim is that no Doctor will earn less than they currently earn as long as they work the maximum hours available.


This seems disingenuous to me.  I think he has a broader strategy.  Mr Hunt was co-author of a book in 2009 claiming the NHS was no longer relevant and that it should be dismantled.  This is indeed his goal.


Create enough strife in the system and then bring in private sector alternatives.  But he is overlooking certain figures.  Current health expenditure in the UK was 8.46 per cent of GDP in 2013. This compares to 16.43 per cent in the USA, 11.12 per cent in the Netherlands, 10.98 per cent in Germany, 10.95 per cent in France, 10.40 per cent in Denmark, 10.16 per cent in Canada and 8.77 per cent in Italy.
Current expenditure per capita (using the purchasing power parity) for the UK was $3,235 in 2013. This can be compared to $8,713 in the USA, $5,131 in the Netherlands, $4,819 in Germany, $4,553 in Denmark, $4,351 in Canada, $4,124 in France and $3,077 in Italy.

In the USA, despite the current health expenditure figures there were some 45 million Americans without healthcare. 
These figures were the driving force behind Obamacare  which has brought health insurance to approximately 16 million Americans who were previously uninsured.


Looking at the figures it must be that the UK government's desire to dismantle/privatise the NHS is on ideological grounds because by most accounts the NHS ranks very high when compared internationally.
So the Conservatives point to the fact that the NHS is around £750 million in debt.  They wheel out this number to show that it is inefficient, and then wheel out the old chestnut that the private sector is more efficient than the public sector, as so adequately demonstrated by the privatisation of the Rail and Prison sectors.


Of course it could be more efficient- what couldn't?  But that should not be used to suggest that the solution is to cut costs to try and balance its budget.  That would only accelerate its demise.


The truth is that it is underfunded.  That means it is understaffed.  That means that it is constantly being jerry rigged as opposed to being properly funded, and managed. 


Fund it properly.  Staff it properly.  But stop asking for it, a health system, to generate profits.
We don't ask the Police.  We don't ask the Fire Service to be profitable. 
We do ask that they are well run.


I am not convinced that Jeremy Hunt is the right man to oversee that undertaking.