The price consultants should pay for higher wages

Who would have thought it? Two years and a bit after junior, sorry, resident, doctors staged strikes in successful pursuit of a mammoth pay rise, NHS consultants have decided they would like a bit of the action. They claim, as they would, that it’s only about restoring the value of pay as it was 17 years ago – 17 years, no doubt, carefully chosen to maximise the claim, otherwise, why not ten years, or even five? In the media, their representatives also refer to lawyers and bankers as equivalent professionals whose pay now substantially exceeds theirs.

Not unsurprisingly, the general public response, as per social media, has essentially boiled down to ‘greedy sods’. And it is hard not to agree. With average salaries above £150,000 – plus extra for so-called out of hours work, plus however many hours set aside for private practice, which can multiply that two- or three-fold, as well as gold-plated pensions – NHS consultants are well-off by any national standard. With their strings of qualifications and six-figure student debt, however, the consultants might deserve a more considered response. So here it is.

Whenever nurses or paramedics, for instance, have argued that they might warrant pay rises on a par with those of the junior doctors, they are roundly told not to compare different branches of the health service with each other. Well, the same goes for the consultants and the supposed peers they name. To compare their monetary rewards with those of bankers and lawyers is wrong.

They chose to do what they do for several reasons. Money may have been one of them. But comparative salaries ebb and flow. Time was when the rewards for teachers and lawyers might have been closer than they are now, and for junior bankers, ditto. But there is such a thing as competition. There are also huge disparities in banking and lawyers’ salaries according to the location (London, outside London), seniority and specialisation.

Then there is job security. All right, so junior doctors have to work and study hard to become consultants. Once there, however, they have a highly-paid – highly paid, that is, by the standards of those who are not top-flight bankers or lawyers – job for life. Neither the security nor the pension applies to most of those in banking or the law – which may, of course, help to explain why their pay, when they are working, has risen above that of the NHS privilegentsia.

These are all reasons to view the consultants’ claim with less sympathy than they clearly expect. And there are others. Maybe one reason why their pay has not risen higher than it has reflects the number of overseas junior doctors and consultants working in the NHS, who may not think their pay too bad by international standards (which it isn’t). And why is the proportion of overseas doctors, including at consultant level, in the UK so high? Partly because the doctors’ union, the British Medical Association, has objected to increases in the number of medical schools and training places in the UK. Has that effective closed shop, perhaps, actually had the reverse effect of the one they had hoped for on pay and conditions?

As I said, it is not hard to detect that the general public is poorly disposed to the prospect of consultants’ strikes. Disproportionate support, on the other hand, judging by media interviews, comes from articulate family members of aggrieved consultants – medicine being a profession in which an unusual number of children follow their parents, so it can’t be that bad a deal, can it?

Whether and how to negotiate will now be up to the Health Secretary, Yvette Cooper, who has kept the lowest of low profiles in the three months she has been in the job. But she should bear in mind not just the NHS finances, but the public mood – especially in light of the Budget. If there is no money to improve the defence of the realm, then there should be no money for well-rewarded hospital consultants, who already have outlets for further enrichment (then have the nerve to complain about ‘burn out’).

If there is one piece of advice most wage-earners and NHS users would like to give Cooper, I suggest it is this. Her predecessor quickly caved in to the junior doctors, agreeing not only a substantial, way above inflation, pay-rise, but setting no conditions for it. This was not only an abject climbdown, but an irresponsibly missed opportunity to improve the service for patients.

Cooper, it should be hoped, is made of sterner stuff. And there are two conditions she should set at the outset. The first is that NHS hospital consultants have to be part of a service that is 24/7. Not ‘on call’ from distant country homes, but actually there, in the hospital, as part of a rigorous, properly staffed, shift system. Some progress towards this was made during the pandemic, but the relapse was swift. In my experience, hospitals are as consultant-free on weekends and holidays as they were before. This means late diagnosis, late discharge, and hospital beds occupied that don’t need to be occupied.

The second is that they should not just give up any remaining objections, but actively encourage, a big increase in medical training places in the UK and ensure that they go to UK-based students. Many of the new places created in recent years have been restricted to overseas students – which has made the whole exercise counter-productive. A small step was taken in the right direction with last year’s decision to end preference for overseas graduates for hospital specialist training – extraordinary, though it is, that this was ever the case. But the whole length, structure, and provision of training needs to be rethought, and that needs the BMA’s cooperation.

If the consultants do go ahead with their strike for higher pay and shorter hours, that will be a pain in every sense for patients and for the NHS. For the Secretary of State, however, it offers an opportunity to bring this part of the NHS into the modern age and improve value for money. She should not pass it up.