It is with a heavy heart I have to listen to the news about the junior doctors strike. I am sure that they are only striking to save the NHS, to make patients better, and to find homes for motherless kittens. If there was any way of doing these things otherwise they would have done so.

I am also sure that the health minister only wishes to improve the lot of the NHS staff, to try and force them to accept more money and longer holidays in return for reduced working hours. If they could understand they would no doubt agree.

Industrial action in the NHS throws our inability to discuss healthcare provision into sharp relief.This battle about terms and conditions is waged via a proxy war about principles and morals. The disinformation on both sides is staggering. Both cite aims of defending and improving health care rather than honestly discuss the issues of working hours and remuneration. Saviour Jeremy Hunt simply wants to help the NHS work a seven day week with nary a thought about costs, while the saintly junior doctors only want to protect the poor and resist the lure of working in countries with offer better salaries.

Obviously doctors have the right to strike. Every working contract should be entered into willingly and freely. If the terms are wrong then the worker should refuse them and withhold their labour. The only reason that this is a problem  is that the NHS has a near monopoly of healthcare provision. When providers in a monopoly withhold services there are no easy alternative providers and harm can result. The NHS, as a monopoly, makes wage negotiation a political event rather than a contract negotiation. This is damaging both for the public and for the medical staff.

In a mixed healthcare economy there would be varied providers with varied contracts.During industrial action consumers of healthcare can obtain the services they need from other agents and thus minimise any risk of damage. While this is clearly of benefit to the consumer it is also of benefit to the worker. The managers of a healthcare provider faced with a strike by clinical staff, when there are alternative providers, is under much greater pressure to negotiate successfully. If they fail to do so they, the managers,  experience the harm (not consumers) as both consumers, and possibly clinical staff, move to alternative providers.

This is how competition improves services. Organizations with better services for patients need to recruit better staff to deliver this. They need to attract them by offering advantageous contracts. It is in a free market that unions and workers can put pressure to improve working conditions, while at the same time this competition improves products and services. This fails in a state monopoly: services stagnate and deteriorate (the NHS is no longer providing the standards of healthcare that other comparable European countries); while working conditions fail to improve (as workers have no choice but to accept the state’s terms)

We need to develop a mixed economy in healthcare, not just to improve the lot of patients but to help clinical staff find their voice and power. We might finally be able to stop these sterile and disingenuous arguments about who is the true saviour of our beloved NHS.

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