The perennial political football - Credit, public domain

We hear today that there are notspots of truly appalling health and social care in Britain. Obviously, this should not be. For two reasons, one being that isn’t the point of having the government doing these things so that we don’t get the patchy coverage which a purely market system would give us? The other being that clearly we’d much prefer if people did in fact get what they’ve been paying their taxes to get. It’s all a bit of a swizz if we’ve got to pay and don’t then get, isn’t it.

The true lesson to take from this being that we’ve got to abolish those national pay scales:

Watchdogs have warned of a “growing injustice” as they reveal for the first time the country’s black spots where patients are routinely denied access to decent NHS or social care.

The Care Quality Commission today says social care has passed a “tipping point” in many parts of the country, leaving Accident & Emergency (A&E) departments under so much pressure that safety is compromised.

Obviously, that’s bad, it is supposed to be the National health service after all.

But we cannot ignore the fact that not everyone is
getting good care. Safety remains a real concern:
40% of NHS acute hospitals’ core services and 37%
of NHS mental health trusts’ core services were rated
as requires improvement on safety at the end of July
2018. All providers are facing the same challenges
– in acute hospitals, the pressure on emergency
departments is especially visible – but while many
are responding in a way that maintains the quality of
care, some are not.

OK, so what’s going on here? Well, one contributory factor is the manner in which we have national pay scales:

We do know that national pay for nurses kills people. National pay, by definition, cannot reflect local employment markets nor living standards. Having the one rate thus produces a shortage of nurses in high cost of living areas and that really does kill people. Our answer should thus be to get rid of the entire idea. Devolve pay down to the actual employer.

No, really, we do know that national pay for nurses kills people.

So, obviously enough, to stop killing people we should stop having national pay settlements. And it is worth noting that those blackspots, the notspots, for care are in the richer areas of the country….

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A stark way of putting it but I can’t see the flaw.

The usual logic is NHS good therefore NHS workers good. Therefore public support NHS workers’ interests. But the national pay scale regimen divides NHS workers into two groups: overpaid or underpaid according to their local employment market. Yet their common point of interest is both groups would like to be paid more. So the national union comes in and naturally enough pursues that point of common interest, which as you say is not in the public good.


A “purely market system” would NOT give us “patchy coverage” — because there is money to be made improving the coverage in those patches. It is a national pay rulebook that continually diverges from actual supply and demand of medical skills in all towns.

Yes, abolish national pay scales — hopefully without simply throwing more money at the NHS. Then try to write a rule that will take the medical care monopoly and “force it to run like a business.” What you need is not more pretend; what you need is a business.


So, if I was Jezza, I would take the cited study to heart. After all it states that ‘When the competitive outside wage [taken to be private sector remuneration] is higher than the regulated wage, there are likely to be falls in quality’. Improving services is a good platform on which to campaign so why not promise to (i) increase the wages of the NHS brothers and sisters in those notspots while also (ii) promising to increase the pay of all the comrades in the (un)civil service more broadly, my indolent brother-in-law included. Plaudits all round, standing ovations, all hail… Read more »


The problem is that neither the government, the Civil Service or the Trade unions have even a basic knowledge of numeracy. A TU rep of my acquaintance couldn’t understand that the “feminisation” of General Practice would,in the current regulated medical training environment, lead to shortages.
“They can job share” but couldn’t understand that if 40% are only working 50% of hours that’s only 20% coverage.