Health Matters | Paul Corrigan's blog

At all times in the development of the NHS this is an important issue. The NHS depends on all its staff for it to work at all – let alone well. So for it to produce any outcomes at all it depends upon the active involvement of hundreds of thousands of staff at all sorts of grades.

• The position and the actions of the representative organisations of these staff are very important.

• The position and the actions of the staff themselves are even more important.

A part of this blog will explore the similarities and the differences between those two issues.

The BMA is often referred to as the ‘strongest trades union in the UK’ and it is worth exploring why that is the case.

Initially it’s important to try and explore how and why the representatives of the medical profession have got themselves in such an unusual ideological position as to be against the involvement of the private sector in the NHS.

This is not new. In February 1948 over 90% of the BMA had been balloted and said that they would never work in the NHS. Their leaders took this as a major endorsement of their position and went hard at the Government. In July, 6 months later, nearly all members of the BMA joined the new NHS.

I make this point not to attack them for changing their minds. I think it was very, very important for the NHS that the nation’s doctors did change their minds and have been active in the NHS. The point that I make is that the BMA takes up ideological positions that are, in themselves, unimportant as a set of ideas. The ideas only matter as they add bargaining power to their members.

Today, in 2010, the BMA is against the involvement of the private sector in the NHS.

This is a truly weird position for an organisation where well over half of the members are either a part of the private sector or earn money from private sector health care.

Most GPs who are members of the BMA work for themselves and their colleagues in small businesses called “practices”. It would be very easy for the BMA to put their anti private sector stance into practice in the NHS.

It would be interesting to see what the BMA would say if the Government suggested that all GPs should leave the private sector and work for large public sector organisations – say Local Government. If all GPs became local government staff then this would truly be a big blow to the development of the private sector in the NHS.

But the GPs don’t want to do this as they like being in the private sector.

A considerable number of hospital doctors that work for the NHS and are BMA members earn money from private sector suppliers of health care. If the BMA wanted to follow its position of being against the private sector it could pass a resolution to expel all members who earn money from the private health care sector. This would be another enormous blow to the private sector in health care.

With these two actions the BMA could virtually finish off private health care in the UK.

Take my word for it, the BMA is not going to do these things.

Its ideological stance against the private sector is an attempt to bolster its members’ bargaining strength with the Government. It recognises that if there are alternative suppliers of private sector GPs services and alternative suppliers of secondary services this weakens the BMA’s position in negotiating with the Government, Trades Unions are always in a stronger position if their members are a monopoly of the staff in the industry.

The problem that competition from outside NHS providers causes the BMA is immense. If those alternative suppliers can demonstrate that they can develop better value for money than existing NHS provision then the competition between the existing NHS suppliers and new suppliers creates new forms of working with new terms and conditions for staff. If the competition wins, then their terms and conditions become the norm.

The BMA, like any trades union, works best when there is a monopoly and they, as an organisation, own the relationship with the monopoly. Their problem is not only has that gone and there is no single organisation calling the shots, but they are faced with a Government both of whose political partners agreed that there should be more competition with and within the NHS.

So faced with a Government that has been elected on such a policy, expect the BMA to become more and more anti private sector and anti competition. In the face of this any sort of Government worth its votes will know why their position is there and will point out the BMA does not win votes from voters, but Governments do.

It is interesting that other NHS trades unions and professional organisations also take up anti competition positions. Many of them have members that work for private sector organisations in health care and sooner or later these members will raise questions about their representation.

There is a further important issue for the BMA and for other professional organisations and trades unions. All of these are national organisations with national officers and positions. These national organisations work in their own best interest if there are a set of national negotiations for all terms and conditions for doctors, nurses and ancillary staff. National trades unions need there to be national negotiations to demonstrate that they have a unique position for their members.

Of course on a day to day basis a lot of trades union and professional activity takes place at a local level with local employers and employees discussing all sorts of issues. But whenever anyone suggests that negotiations over pay and conditions should take place with local employers many national organisations – and nearly all of those in health – fight this tooth and nail.

They claim this is the case because their members would lose out without national bargaining; but there have been many times, and many places, where trades unions represent their members locally and can strike better deals than a national set of negotiations.

In the 1970s local negotiations through the shop stewards movement obtained very good rewards for members and my 8 years in Coventry at the time left me, along with the rest of Europe, marvelling at what was called the Coventry tool room agreement – reputedly the best deal for skilled manual workers in Europe.

But for the moment national trades unions and national professional organisations only feel they can gain their members allegiances if the national offices are the people who negotiate their conditions.

The problem is that this assumes that the NHS is a single national organisation where terms and conditions can be negotiated once at the national level and where a nurse in a hospital in Newcastle needs to have the same basic terms and conditions as one in Norwich. Labour markets do not work this way. There are some national labour markets but most labour markets in England are much more local than that.

NHS organisations need to negotiate for their members within those labour markets and not at an abstract level.

Irrespective of the ideological positions of the trades unions against the private sector involvement in the NHS it will be this national/local differentiation that will be the crucial issue for the next four to five years.