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Editorial Wednesday 30 May 2012: Doctors, politicians, strikes and professionalism

Doctors dominate the news today, with the smaller splash of Alan 'Quiff Of Doom' Milburn's social mobility tsar-ing report - and the rather bigger news of the BMA vote for the first strike in four decades over pension reform.

First up, former SOS Milly, who has issued his progress report on what has happened since his 2009 'Fair Access To Professional Careers'.


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The Government's Independent Reviewer on Social Mobility and Child Poverty (for such he is) sings straight from the Psalter Of Blair that social immobility and rising inequality "is not merely a job for government. Of course, government needs to provide a lead, set an example and create the framework for change. But social change is primarily driven from below, not above".

It would be comical if it were not such utter bullshit. Within a few lines, we read that "universities, colleges and employers – if they open their doors fairly – can then harness and grow it ... the professions sit at the heart of this agenda for change".

Oh Milly.

Oh Milly, Milly, Milly.

Silly Milly! Universities, colleges, employers and professions are a lot closer to the top than they are to the bottom. Government funds the first two, and regulates the last two, so if they are not making any progress, guess who can do something about that?

Indeed a few pages later, he describes the ongoing upper-middle-and-upper-class hold on the professions as "social engineering on a grand scale. The senior ranks of the professions are a closed shop. If social mobility is to become anything other than a pipedream they will have to open up". Open up from the bottom up? Might be a proctologist's dream, but frankly, I doubt it.

Milly also says that "medicine lags behind other professions both in the focus and in the priority it accords to these issues. It has a long way to go when it comes to making access fairer, diversifying its workforce and raising social mobility ... overall, medicine has made far too little progress and shown far too little interest in the issue of fair access. It needs a step change in approach". The chapter on medicine doesn't describe anything that looks like a step change.

I can't be bothered with the rest of a report of such dazzling intellectual incoherence.

Striking stuff
The BMA membership voted by significant majorities of over 50% of the membership (a high turnout) to hold a day of industrial action, which will take place on Thursday 21 June.

This is of course in the middle of the NHS Confederation conference, which means that doctors not dealing with emergency work will have the time to watch live-streaming of the speeches from Chairman Mal, Comrade Sir David and Andrew Lansley (saviour, liberator). With every cloud comes a silver lining.

It's four decades since doctors have chosen formal industrial action. Their pensions were already reviewed in 2008, when the normal pension age for new staff increased from 60 to 65, and employers' contributions were capped, while contributions from doctors increased by up to 2.5 per cent.

Let's Oliver Twist again ...
The Government has pulled its favourite dance move: the Oliver Twist ('please sir, may I have some more?'). Its final offer was a deal whereby there would be a switch from a final salary scheme to a career average revalued earnings (CARE) scheme for hospital doctors (GPs already have CARE pensions).

The accrual rate offered was 1/54th of pay, so the pension would be based on 1/54th of doctors' pensionable earnings in every year of their career. Pension benefits that you have built up so far (“accrued rights”) will be protected in full and paid from the Normal Pension Age, which for the new scheme, is to increase in line with the State Pension Age, with doctors at the start of their careers having to work to the age of 68 to be able to draw a full pension. Contributions will also increase from April 2012, with the highest earners contributing over 14% of salary by 2014.

Doctors within 10 years of retirement on 1 April 2012 will not have to work longer or receive worse pensions as a result of the changes, although they would still pay more in contributions. A degree of protection for those within 13 and a half years of retirement would also apply.

The politics of protest
The politics of this are interesting. SOS Lansley has promised no U-turn on BBC's The World At One (an ironic title, given this subject).

Our Saviour And Liberator said, "I don't think public will remotely understand" the strike, and did not miss the opportunity to point out that doctors are no longer relatively badly-paid by comparison with colleagues in Europe.

It's certainly a big risk, and industrial action affecting provision (which this will), even of non-urgent care, needs to be regarded as a weapon whose power is inverse to its frequency of use.

The Government's moves are all obvious: greedy doctors, well-paid, playing golf, we're-all-in-this-together-unless-we're-paying-the-50p-income-tax-rate, do you know how much Labour paid these guys?

All of which will tick some people's boxes.

The BMA have got quite a job to sell this strike to the court of public opinion. It's do-able: they would point out that their members have highly-responsible jobs (and would you like to be treated by a badly-paid doctor - oh you wouldn't?); link it to the Government's deficit-cutting haste (why should retiring doctors have to pay for bank bailouts?); and most urgently of all, find a form of industrial action that will not affect direct patient care but perhaps still create policy challenges for the government.

More to the point, doctors as a profession (if not necessarily the BMA as a representative organisation) have got something that the Coalition Government certainly had to start off with, but seem to be losing, and that politicians as a breed are shaky on: public goodwill and trust.

This contrast is less useable for the BMA, but not un-useable. It has to be implication, as MPs do enjoy democratic legitimacy.

The BMA's tone needs to be spot-on. more in sorrow than in anger (although the ballot result shows that doctors are not just angry but furious about this). Hamish Meldrum has been a master of this. BMA members need to seek a new chair who can do reasonable and urbane but firm.

Interesting times ahead.