After Easter, Junior Doctors in the NHS went on strike as part of an ongoing dispute concerning pay and working conditions. I appreciate that there will be diverse and passionate views about the strikes among my readers. Those views will reflect personal experience of the NHS, whether or not you personally know junior doctors.
My aim in this article is not to change minds about the rights and wrongs of this (or any specific) industrial action. I have my own views on such things but I believe that this is an area where Christians are free to disagree. As with other recent examples including teachers, nurses, train and bus drivers, I know that the decision to go on strike will not have been taken lightly by union members.
I personally would have preferred it if the strikes had not happened and hope that the industrial action can be brought to an end soon. However, I recognise that this will take movement on both sides. The Government are going to need to demonstrate a willingness to negotiate in good faith. I suspect as well that there is the need to step back and look at the bigger picture and whether significant reform might be needed including how we train, support and reward medics throughout their careers.
Now, the first thing we need to do when thinking Christianly about a dispute like this is to seek to know the facts of the matter and to understand reasoning. As I said at the outset, there will be different and passionate views but we want them to, as far as possible be shaped by facts and reasoning, not just by our emotions. So, here’s my reasoning. I recognise that because of the complexities of the matter, that it will be possible for us to agree on the facts and even to follow the reasoning but still reach different conclusions.
First of all we do need to recognise the challenges that Junior Doctors are facing and the affect that has on health care. There’s been much discussion about the £14 an hour figure and whether that’s accurate. It’s based on a starting salary of £29,384 for a 40 hour week. It’s true that there are additional payments on top for working further and antisocial hours but I suspect it would still work out at about £14-16 an hour.
I’ve seen arguments made that this means Junior Doctors are paid the same as bakers, doormen and teaching assistants. We’ll talk a little bit more later about how we value different jobs. However, it is worth observing that this figure only applies to those in the first year of their career and is in fact comparable with other starting salaries for graduates including teachers, lawyers, and engineers. None graduates may be paid a similar amount at that stage in life but are much, much less likely to see that figure increase substantially or to receive the additional benefits that come with graduate careers in both the public and private sector.
So, when we are talking about pay and benefits, it is worth remembering that people make decisions about career paths based on what those things will look like across a person’s whole employment. To put things in perspective, later in the doctor’s career they are likely to be earning between £80k to £100k with additional bonuses available of up to £40k. There are other benefits available including pensions.
On the other side of the coin are three other important factors to consider. First, that medics will start earning significantly later than other graduates and this also means that they will have accumulated more student debt, potentially around the £100k mark. Incidentally, in my opinion, student debt shouldn’t apply to those in public sector jobs. We all benefit significantly from the training that doctors receive, so we should be contributing to that through the tax system. Secondly, I do wonder whether the stage at which medics begin to be paid isn’t a little arbitrary. We know that those junior doctors remain in training for some time to come. What would happen if we shortened the medical degree to a standard 3 years, not to reduce the training but to increase the period of time in which a doctor was able to work whilst continuing to train and prepare for specialisation at the same time?
The second factor we need to consider is that doctors have been affected substantially by pay freezes and inflation so that in real terms, their income has fallen substantially over the past decade. There’s some debate about the extent of that fall and that depends a little on which inflation you measure and other factors such as the raising of tax thresholds. However, as with a number of other professions, the reality is that this fall has been significant and has contributed to the cost of living crisis.
The third factor we need to consider is that whatever we think of the level of pay, we cannot ignore that for much of their career, doctors experience difficult conditions in terms of anti-social and long hours in what is a highly stressful career. Some of that stress and pressure is unavoidable due to the nature of the job but a significant amount of it is down to the current state of the Health Service and that has been affected by policy decisions over the years. Those are the kinds of things that the Government needs to address as well as looking at pay.
The second half of my reasoning concerns the impact that strike action has. I know from experience that the possibility of looming strike action increased the anxiety of many patients and their families. Further, whilst every effort has been made to minimise the impact on emergency care and urgent operations, I don’t believe that we can avoid there being a substantial impact on those things. Consultants will have been covering A&E during the strikes but this means that they will be returning to an area of practice where they have not had significant exposure for many years and there will be differences in terms of what is required from an A&E visit to routine surgery or consultations. They will then have a backlog of their own work to catch up on. We also need to consider that whilst urgent surgery is being protected, treatment that is considered minor and less urgent may well become more urgent and carry greater risks the longer it is delayed. I believe that this is something that the pandemic brought home to us.
So, as a general point, we want to take time to think through the facts and reasoning and make sure that our own point of view isn’t driven by instant emotional reaction whether for or against industrial action. However, I also think that this strike highlights a specific where we might need to be challenged about how we think as Christians and that concerns money and the way that we value things.
There are again two parts to this. The first goes back to the point about incomes falling in real terms. Now, I believe that where possible we should seek to protect people against this, particularly where it means that they risk falling into hardship. However, noting that most, if not all of us have been experiencing a real terms fall in income and cost of living pressures, this does touch on our attitudes to wealth, poverty, comfort and hardship. Should we as Christians expect that our own personal income and living standards will continue to increase? Should we see being comfortably off as in effect an inalienable right? In particular, as Christians are we ever, even a little bit tempted to conflate material success and comfort with blessing and God’s favour? Whatever our views on the specific dispute, our thinking in this area should be challenged.
Secondly, a lot of commentary around the strike has been concerning the value we place on specific jobs and services. Those in favour of strike action have asked us to think about he value that we place on life saving surgery. Those against have asked whether we value working class js differently to professional and graduate careers. It has also been argued that whilst other professions may not seem to be so overtly about care and saving life, they do touch on those things. An engineer designing a flight system or architect working on drawings for a new office block are making potential life of death decisions. A lawyer who represents an asylum claimant may well save that refugee’s life by protecting them from return to torture and certain death. And yes, even the church pastor’s intervention in offering timely, compassionate counsel may be physically life saving as well as spiritually if they help a person to turn away from destructive paths.
So how do we approach the question of value? The truth is that we cannot put as figure on life saving treatment (although of course the private insurers and pharmaceutical companies attempt to). So, how do we show that we value life and the people who seek to preserve it? Are there ways that we can do that, even though we cannot put a monetary value on it? Do we demonstrate in our views and decisions that our lives are not motivated by questions of monetary value?
However, I also want to push us a bit further. Whilst we cannot really put a monetary value on that organ replacement, cancer treatment or eye sight saving surgery, does that mean that those things are of infinite or ultimate value. If so, do we risk thinking that physical life and health must be protected at any cost? This pushes us to ask two further questions. Do we value the person more for what they do or for who they are, a person made in God’s image? Most importantly, do we see that there is something of greater importance than physical health and life, the question of spiritual health and eternal life?