By SUSAN ADELMAN, MD
The British have a one-payor public healthcare system, the National Health Service (NHS), which pays for most medical care in the UK. For the rest, many NHS doctors also see patients privately, and a number of others have strictly private practices. As our English cousins explained, the NHS has been breaking down and running short of money for years. Now, the aftermath of COVID and the onset of serious inflation have stimulated widespread strikes. And for the first time, both junior doctors and consultants are walking out together nation-wide for three to four days at a time. The issues are both financial and matters of patient care. Doctors complain of being forced to work long hours without a break, and junior doctors have suffered a pay cut of 26.1% since 2008.
The British Medical Association (BMA) represents 75,000 doctors. It has requested raises of 12% for consultants and 35% for juniors, just to match real salaries paid in 2008. Last year junior doctors were offered a 2% increase. More recently, the government offered raises of 6% to 8.8%. They say it is their last offer. So far, negotiations with both consultants and junior doctors have been stalled since May, and the BMA announced that 98% of the junior doctors who took part in a second ballot voted to keep on striking until early 2024. With an overall turnout of 71%, the union easily met the 50% threshold stipulated under British trade union law.
Tens of thousands of junior doctors already have walked out five times in 2023. Their strike in early October, along with consultants, was timed just as the ruling Conservative Party opened its annual meeting in Manchester. By then, 800,000 appointments had been cancelled, costing at least 1 billion pounds ($1.27 billion dollars).
A third of all medical students threaten to leave the NHS after graduation, many bound for Australia. Other issues include a shortage of beds and a shortage of money to pay for the social services needed to free up more beds. In addition to doctors, much of the public sector is going on strike. Even the rail network, though privatized, has gone on strike.
Hospital dental trainees announced a strike, and so did the members of the British Dental Association who have not gone private. So have members of the Royal Society of Radiographers and the members of Unite, a union representing nurses, cleaners, and porters, among others. Interestingly, the members of the Royal College of Nursing held a union vote, but they failed to get a mandate to go on strike.
Most UK healthcare workers, except doctors, dentists, and senior managers, are paid on a scale made up of pay bands, with annual changes recommended by independent pay review bodies, based on information they gather from employers, unions and the Department of Health and Social Care. The Government then decides whether to accept these recommendations.
Our English cousins write that the public generally is sympathetic, because “the pay, conditions, and shortages are appalling.” They say junior doctors in the NHS earn a minimum wage, have “untenable hours and the burn out rate is huge.” This is despite waits for an NHS appointment that can be “weeks, months, years.” A non-emergency x-ray may be delayed for weeks or months too, and then it can take three weeks to get the result. Our cousin says that, with one exception, she has never been able to see the same GP twice at her assigned practice. The appointment time is 10 minutes, and you must rush to get in your questions. Private insurance is not available if you have pre-existing conditions. The cost of private care is exorbitant. She is frightened of what will happen if she becomes seriously ill.
The BMA has 173,000 members, two thirds of all practicing doctors. The NHS has 164,000 doctors, 150,000 of whom are in primary care. So, the system is not entirely public, but we should note that even in the United States, in October, the over 75,000 workers at Kaiser Permanente went out on a three-day strike, most of them in California. Doctors and many nurses are not on strike. The strikers include some nurses, emergency department technicians, pharmacists, optometrists, home health aides, medical assistants, and dental assistants. They asked for a $25 minimum wage, with increases of 7% per year for two years, followed by 6.25% per year for the next two. Kaiser offered between $21 and $23 next year.
In short, when money is tight, inflation is rampant, and those who control the budgets make trade-offs, healthcare is balanced against the cost of widgets. If we want to move all of American healthcare to a one- payer system that resembles the NHS, across the puddle there is a perfect template for what to expect.