The Primer: Politics and picket lines

The run-up to Christmas feels different this year with nurses and paramedics spending the festive period on the picket lines.

The largest walkouts in NHS history are inherently political and opinion is divided across the spectrum about whether strikes should be happening, if pay demands are reasonable, and if they are affordable.

Underpinning it all are increasing risks to patient safety (as controversially outlined by the UK’s four chief nursing officers in a letter leaked to The Times), staff exhaustion, and rising apathy with government as threats of New Year strikes loom.

Social policy fellow Tony Hockley wrote in commentary for Politea “while health ministers pretend that there is a trade-off between ‘front-line NHS care’ and pay, the reality is that pay is central to patient care and the dangerous state of the NHS”.

He warned that Britain has tried to “buck the market” in staff for decades, with “inevitable and unacceptable consequences”, citing scandals such as Mid Staffs. 

Speaking on Sunday with Laura Kuenssberg, Cabinet Office secretary Oliver Dowden reiterated the government’s “resolute” position on pay, saying it would be “irresponsible” to let public sector pay and inflation get “out of control”.  

Penny-wise and pound-foolish

Tortoise’s Matthew d’Ancona summed the mood up well: “The voters are perfectly capable of concluding that it’s all the strikers’ fault; and that it’s all the government’s fault.”

In commentary ahead of Thursday’s first nurses’ strike he warned prime minister Rishi Sunak will pay a heavy price for walkouts. 

Mr d’Ancona claimed Royal College of Nursing general secretary Pat Cullen’s offer to government if Steve Barclay agreed to meet was “politically smart”, given the RCN privately is thought to be willing to drop its 17 per cent pay demand in line with the 5 to 11 per cent offers accepted by Scottish workers. 

The Tortoise piece added: “If the government had responded positively – well, there was at least a possibility her members might have ended up with a halfway decent pay deal.”

Another strike-themed commentary in the Financial Times confronts the narrative that government cannot afford to raise pay in line with wages in the private sector.

Martin Wolf argued taxes could be raised if the will was there, adding: “It is in effect a political decision to make public sector employees pay for the government’s underfunded promises.”

He suggested government should keep pay in line with the private sector’s, especially where it has significant recruitment and retention problems.

He wrote: “If this means it has to reopen spending plans that no longer make sense in today’s debased pounds, so be it. What is happening now may be penny-wise, but it is pound-foolish.”

Streeting vs the BMA

Another political headache was born this week - this time in the shadow cabinet - by Labour’s Wes Streeting amid major fallout over comments about private healthcare.

He told The Telegraph he had been “mucked around” by the NHS after trying for months to get a scan to confirm his kidney cancer is gone. 

The paper said for Mr Streeting: the personal could not be more political – as he announced Labour would take on those holding back the service during strikes, including some of the most powerful health unions.

It was a pretty striking headline: “Labour vows war on health unions”, although one Mr Streeting said he had not expected.

However, the shadow health secretary took particular aim at the British Medical Association and suggested his criticisms of the NHS, particularly GPs, had led to them “painting him as some sort of heretic”.

He told The Telegraph: “I am just not going to allow vested interests and producer interests to stand in the way of the reforms that will deliver better outcomes for patients.”

His comments incited a debate about NHS reform and angered many doctors who took to Twitter to air their frustrations.

Centre for Health and Public Interest director David Rowland argued in The Guardianpushing more NHS patients to be treated in private hospitals will “undoubtedly … expose them to a greater risk of harm” – citing high-profile scandals such as that of Ian Paterson. 

He said Labour “should know better” and suggested Mr Streeting’s “recent embrace” of the private sector either stems from “naivety about how it works” or is “part of the Labour leadership’s attempts to turn it into a party of the centre right”.

He added: “Given the main constraint on clearing the backlog is not operating theatres but consultants, surgeons and anaesthetists, it makes no sense to suggest that the private sector can come to the rescue of the NHS.”

Meanwhile, The Spectator’s Kate Andrews’ take was more favourable in depicting Mr Streeting as a Labour MP “willing to speak up, more and more, about the deep unfairness of the system for patients and workers”.