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Talking Politics
983
before what was being spent, and where, and why, and to whose advantage. This same kind of operation is in progress in the Department now, in the hope that much more effective monitoring can allow money now being wasted to be redeployed where it is most needed. There is, too, a conviction that at times like these spending on manpower must come first, even if spending on buildings is held back. ever
Talking
Politics
NURSES AND CONSULTANTS
After ten eventful weeks in office, the Social Services Secretary, Mrs Barbara Castle, now has a fine array of interests clamouring at her gates. From the consultants at the top of the financial tree to the nurses and others on the lower branches, a crescendo of instruction is now making itself heard, the main purport of which is: we must have more money. The nurses seem to grow in militancy hour by hour. There are stoppages already enacted and many more threatened: in one London hospital, nurses are reported to be contemplating a boycott of the private A group which has once or twice before sector. threatened to use the weight of its bargaining power, but has always, in the end, chosen restraint, is now, no doubt instructed by the settlements extracted by other groups more rigorous in the pursuit of their self-interest, ready to break new ground in prosecuting its cause. It was, of course, well known well before Labour came to power that the nurses would have to be given a new deal. Indeed, it became the unfailing fashion of Conservative Ministers before the election to point out, whenever they referred to the upgrading which the miners could clearly expect through the procedure for adjusting pay relativities, that the nurses and teachers would obviously have a strong case as well. The difficulty is that the Relativities Board is now doomed and so far nothing has appeared to take its place. The Government’s strategy in dealing with the nurses, it can be assumed, must therefore be to emphasise past blessings-a pay deal only recently concluded, the additional money made available as a result of the Briggs Report-and to hold out the certain hope that the forthcoming Royal Commission on incomes will do as much for the nurses as the Relativities Board would have done. The difficulty is that the Royal Commission does not exist and no-one yet knows when it will. No Department has been more constantly in the public eye since the election than Mr Michael Foot’s Department of Employment, and though the Royal Commission is a high priority it has had to take its place behind other more urgent considerations-most of all, the scrapping of the Industrial Relations Act. For the Ministers at the D.H.S.S., one suspects, the suspense must be getting unbearable. Because there are a lot of nurses, the settlement will be inflationary. There will have to be settlements for other groups too: the physiotherapists, speech therapists, remedial gymnasts, all the groups whose staff shortages are regularly complained of by M.P.S, will have to be accommodated too. Yet Ministers still seem less bowed down by their financial problems than might have been expected. There is a feeling in the D.H.S.S. that times of financial stringency can often be turned to some advantage. It was under the disciplines of poverty that Mr Denis Healey examined and reconstructed the operations of the Ministry of Defence, asking more searchingly than
Capital spending generates savings on capital spending revenue
too.
spending, imply savings
revenue
must
so on
To this extent, the Conservatives’
expenditure cuts of last December, the effects of which are only now becoming clear, may help the new Government in the pursuit of this strategy. The problem of the consultants is financially easier but politically more difficult. Because they are relatively few, a handsome increase for them would be much less expensive than a less handsome increase for the nurses. This is, however, a Government committed to redistribution. Mr Foot, who is regarded by the Left as the keeper of the Party’s conscience in Cabinet, was saying on television last week that top people in Britain (including himself) were " ludicrously overpaid ". So it is inevitable that if the consultants are to be paid substantially more money-and it is clear that they will be-something will be required in return. Mrs Castle has already made it fairly plain what this something will be. The price of more money will be acquiescence in Labour’s policy of separating private practice from the National Health Service. In consequence, the scenario for the negotiations, as so often in the politics of medicine, looks a fairly vivid one. Already there have been the expected reports of firebreathing from the profession. The profession, said one newspaper last week, was reacting " with contemptuous mirth " to suggestions that in return for higher salaries consultants might have to forswear private practice. The B.M.A.’s Dr Brian Lewis, it was reported, foresaw a doom-laden scenario in which Commonwealth doctors would be held back by the imposition of higher standards, our E.E.C. arrangements would mean a large-scale migration of doctors to Europe, while a Democratic victory in the 1976 U.S. presidential election would lead to the setting up of a state health scheme which would coax even more British doctors away. Any battle in which one side is armed with the brain drain and the other with the Labour manifesto should be a
lively
one.
One very important consideration in the negotiations, which may not be openly discussed but which will no doubt be very much in people’s minds, is the possibility of an election some time this year. June now looks unlikely, though by no means impossible: October is a good bet: there are more Labour M.P.S than there were who now talk of an election next spring. The likelihood, at any rate, is that these negotiations will not be concluded before the next election. If the Conservatives return in that election, then the threat to private practice vanishes. If Labour returns with an increased majority, then the willingness of Ministers, and the Party pressures upon them, to get tough on private practice will increase. DAVID McKIE.
before what was being spent, and where, and why, and to whose advantage. This same kind of operation is in progress in the Department now, in the hope that much more effective monitoring can allow money now being wasted to be redeployed where it is most needed. There is, too, a conviction that at times like these spending on manpower must come first, even if spending on buildings is held back. ever
Talking
Politics
NURSES AND CONSULTANTS
After ten eventful weeks in office, the Social Services Secretary, Mrs Barbara Castle, now has a fine array of interests clamouring at her gates. From the consultants at the top of the financial tree to the nurses and others on the lower branches, a crescendo of instruction is now making itself heard, the main purport of which is: we must have more money. The nurses seem to grow in militancy hour by hour. There are stoppages already enacted and many more threatened: in one London hospital, nurses are reported to be contemplating a boycott of the private A group which has once or twice before sector. threatened to use the weight of its bargaining power, but has always, in the end, chosen restraint, is now, no doubt instructed by the settlements extracted by other groups more rigorous in the pursuit of their self-interest, ready to break new ground in prosecuting its cause. It was, of course, well known well before Labour came to power that the nurses would have to be given a new deal. Indeed, it became the unfailing fashion of Conservative Ministers before the election to point out, whenever they referred to the upgrading which the miners could clearly expect through the procedure for adjusting pay relativities, that the nurses and teachers would obviously have a strong case as well. The difficulty is that the Relativities Board is now doomed and so far nothing has appeared to take its place. The Government’s strategy in dealing with the nurses, it can be assumed, must therefore be to emphasise past blessings-a pay deal only recently concluded, the additional money made available as a result of the Briggs Report-and to hold out the certain hope that the forthcoming Royal Commission on incomes will do as much for the nurses as the Relativities Board would have done. The difficulty is that the Royal Commission does not exist and no-one yet knows when it will. No Department has been more constantly in the public eye since the election than Mr Michael Foot’s Department of Employment, and though the Royal Commission is a high priority it has had to take its place behind other more urgent considerations-most of all, the scrapping of the Industrial Relations Act. For the Ministers at the D.H.S.S., one suspects, the suspense must be getting unbearable. Because there are a lot of nurses, the settlement will be inflationary. There will have to be settlements for other groups too: the physiotherapists, speech therapists, remedial gymnasts, all the groups whose staff shortages are regularly complained of by M.P.S, will have to be accommodated too. Yet Ministers still seem less bowed down by their financial problems than might have been expected. There is a feeling in the D.H.S.S. that times of financial stringency can often be turned to some advantage. It was under the disciplines of poverty that Mr Denis Healey examined and reconstructed the operations of the Ministry of Defence, asking more searchingly than
Capital spending generates savings on capital spending revenue
too.
spending, imply savings
revenue
must
so on
To this extent, the Conservatives’
expenditure cuts of last December, the effects of which are only now becoming clear, may help the new Government in the pursuit of this strategy. The problem of the consultants is financially easier but politically more difficult. Because they are relatively few, a handsome increase for them would be much less expensive than a less handsome increase for the nurses. This is, however, a Government committed to redistribution. Mr Foot, who is regarded by the Left as the keeper of the Party’s conscience in Cabinet, was saying on television last week that top people in Britain (including himself) were " ludicrously overpaid ". So it is inevitable that if the consultants are to be paid substantially more money-and it is clear that they will be-something will be required in return. Mrs Castle has already made it fairly plain what this something will be. The price of more money will be acquiescence in Labour’s policy of separating private practice from the National Health Service. In consequence, the scenario for the negotiations, as so often in the politics of medicine, looks a fairly vivid one. Already there have been the expected reports of firebreathing from the profession. The profession, said one newspaper last week, was reacting " with contemptuous mirth " to suggestions that in return for higher salaries consultants might have to forswear private practice. The B.M.A.’s Dr Brian Lewis, it was reported, foresaw a doom-laden scenario in which Commonwealth doctors would be held back by the imposition of higher standards, our E.E.C. arrangements would mean a large-scale migration of doctors to Europe, while a Democratic victory in the 1976 U.S. presidential election would lead to the setting up of a state health scheme which would coax even more British doctors away. Any battle in which one side is armed with the brain drain and the other with the Labour manifesto should be a
lively
one.
One very important consideration in the negotiations, which may not be openly discussed but which will no doubt be very much in people’s minds, is the possibility of an election some time this year. June now looks unlikely, though by no means impossible: October is a good bet: there are more Labour M.P.S than there were who now talk of an election next spring. The likelihood, at any rate, is that these negotiations will not be concluded before the next election. If the Conservatives return in that election, then the threat to private practice vanishes. If Labour returns with an increased majority, then the willingness of Ministers, and the Party pressures upon them, to get tough on private practice will increase. DAVID McKIE.