This is not the right time for another pay claim by NHS unions

On Monday, NHS unions plan stoppages ‘short of strike action’. It may not feel like it if your hospital treatment has been cancelled or you are lying in a ward with fewer nurses to look after you.

The stoppages come after strikes back in October failed to move the government to raise its pay offer for NHS staff. A pay review body recommended a 1% increase for all NHS staff, but the government argues that this is unaffordable and unfair. After all, the 3% ‘increment’ rise puts more money into the hands of higher-paid NHS workers than lower-paid ones.And some 55% of NHS staff already get an annual 3% rise: so the government is saying that any extra cash for wages should go to the workers who do not get this. So it is proposing a 1% rise for the others, but not an extra 1% on top of the existing 3% increments.

Extending the 1% rise to all NHS workers, says the government, will cost around £300 million. Some 75% of hospitals’ budgets is staff costs, so the extra cost that the union proposals would impose on them would mean cutbacks in staff – some 4,000 nurses lost this year, and another 10,000 next year. That could leave hospitals unsafe, risking another Mid-Staffordshire disaster.

Many members of the public would say that NHS staff should count themselves lucky. Average pay in the UK grew just 0.1% last year, and many businesses are hanging on by the skin of their teeth. But NHS pay has been rising since 2012. More than 5,000 nurses were recruited last year, and more midwives too. Public sector pay is generally higher than private sector pay for the same job, even before you count the more secure and higher public sector pensions. Lower paid workers, including those in the NHS, have been helped by the rise in the tax threshold to £10,000. Moreover, the £133 billion NHS budget – some 18% of public spending or over £2,000 per man, woman and child – is ring-fenced, so there is no chance of it falling – unlike the fortunes of most high-street businesses.

And if you want to know how bad things can really get, look at Portugal, which slashed its health budget 17%. Our public finances are not quite in that much of a mess, but things are still tight. The UK has economic growth of 3% but it is still fragile, and there are lots of things that could still spell disaster – a potential crisis in the eurozone, ebola, tension with Russia, you name it. The British government is 1.45trillion in debt, and adding to that debt by another £100 billion a year, despite creaming off 40% of the national income in taxes.

This just is not the right time for another pay claim. And certainly not for another Winter of Discontent (with images of ambulance crews dropping ‘non-emergency’ cases off in the snow to find their way home). The mind shivers. It is clear the government cannot budge, so why don’t we all go back to work and try to get Britain out of this mess?

Dear Dr. Sarah Wollaston MP

I write this open letter to you in the hope that you have been grievously misquoted by the Daily Mail. For it would be painful to have to believe that a sitting MP, and a qualified doctor to boot, could be quite so ill-informed about food, prices and obesity. It is thus my hope that your words have been manipulated by the newspaper rather than that you actually believe any of this tosh.

For example, you are quoted as saying that:

‘There is a huge amount of personal responsibility. But it is now so serious we need to state to step in and take some measures.

‘The choice is you either do nothing and carry on saying it’s all down to personal choice and you continue to pick up a huge bill through the NHS.

‘We have to take out junk food calories and help to get people moving and more active.’

The problem there is that obesity does not cost the NHS anything at all. Indeed, the price to the NHS of obesity is negative. The reason being that the NHS is a system of lifetime health care and those who are obese die earlier. Yes it is true that they incur healthcare costs while alive and fat: but these are more than outweighed by the savings to the NHS when they are dead and buried and not requiring those longer years of health care.

This means that there are substantial private costs to people of being lardbuckets, entirely true, but it is not true to then say that there are public costs to their being so, as you well know.

‘One of the reasons why the most disadvantaged people are running into difficulties is partly because the healthy food is more expensive.

‘If you are struggling on a budget, you are much more likely to pick food on special offers. But all of the special offers tend to be on crisps, sweets and junk food.

That is also not true. Rice, beans, onions and tomatoes may not be a very interesting diet but it is still both healthier and vastly cheaper than any form of junk food calorie for calorie, whatever the BOGOF or discount that is being offered. This is something that we both know and so for the Mail to be quoting you as it did is obviously something you’ll want to correct.

And finally the paper seems to be making a good attempt at making you look like an idiot:

She warned voluntary agreements with big chains had not worked and regulation was now needed to force stores to offer discounts on fruit and vegetables.

This is price fixing and price fixing does not work. By definition price fixing does not work: clearly a Tory MP is well aware of this fact for the following obvious reason. If we fix prices below the market clearing price then we will have fewer suppliers willing to produce at that price. We will also have more people desiring to consume that good or service at that price: the result is instant shortages of those goods and or services. We need only to look at the provision of toilet paper in Venezuela, well reported recently, to see that. Similarly, if we fix prices above the market clearing price then we find that consumers desire to purchase less of these goods and services while producers will be squeezing every extra unit out they can. Leading, as the European Union showed us when they did it, to vast gluts in the form of butter mountains and wine lakes.

Price fixing thus leads to either dearth or glut unless we fix those prices at the market clearing price itself. In itself that has a problem for as you well know we don’t in fact have any other mechanism than the market itself to work out what that market clearing price is. But even if we did, again as is obvious to both of us, what’s the damn point of fixing prices where they would be anyway?

Quite clearly you’ll want to make sure that the Daily Mail corrects this terrible misrepresentation of what any sane or sensible person could possibly believe on this subject. My suggestion is that you start by calling 020 7938 6000 and ask for a certain Mr. Paul Dacre. He should be able to sort out matters for you.

Yours etc

Tim Worstall

The NHS is meant to be for patients, not staff

Jeremy Hunt has annoyed people today by refusing to give NHS workers a blanket 1% pay rise on top of the incremental pay rise they were already supposed getting. That’s hardly a surprise: the NHS is a religion, and Hunt’s decision is the equivalent of giving the finger to the Pope. But he’s got a point.

According to the BBC’s Nick Triggle, “all NHS staff will be getting at least a 1% pay rise. Just over half receive incremental pay rises each year – determined by their length of service and performance. Those whose incremental increase is less will have their pay rise made up to 1%, but many will get more. Last year, the average incremental pay rise was 3.5%.”

In other words, today’s announcement means that NHS staff won’t be getting an additional 1% pay rise over their existing agreed pay increases. That’s a real terms drop, but lots of the coverage I’ve seen has suggested that this means that nurses won’t be getting any rise at all.

Remember that real private sector wages have fallen every year since 2010. Public sector workers already have greater job security than private sector workers, so it’s difficult to see why they should be regarded as being automatically entitled to pay rises that most private sector workers aren’t getting.

Obviously, there’s no ex-ante reason NHS staff should get a pay rise. The point of the NHS is to provide care for patients, not to provide welfare to NHS staff. Since the NHS’s budget is limited, a pay rise to staff means foregone spending elsewhere.

It’s worth noting that, at least according to the government, this pay rise would be equivalent to 6,000 nurses. Now, I don’t know how the NHS should spend its money – it may well be the case that NHS patients are better served by additional staff or more investment in medical equipment than they would be by this wage increase. Maybe a pay rise is the best way to improve patients’ outcomes, maybe not.

I’m left wondering why NHS pay should be a political issue at all. In the end, this story just underlines the need for devolution of pay bargaining to NHS trusts. National pay bargaining makes little sense given differing labour markets and patient needs across the country. In other words, a pay rise that makes sense for patients in Suffolk may not make sense for patients in Sunderland. We don’t want Whitehall to determine supplies of medical equipment or the allocation of labour hours between staff. Why should pay negotiations be any different?

An alternative ‘Agenda for Hope’

Owen Jones has written a nine-point ‘Agenda for Hope’ that he argues would create a fairer society. Well, maybe. I’m not convinced by many of them. Then again, it would be quite surprising if I was.

But it got me thinking about what my nine-point agenda would be — not quite my ‘perfect world’ policies, but some fairly bold steps that I could just about imagine happening in the next couple of decades. Unlike Owen’s policies, few of these are likely to win much public support. On the other hand, most of the political elite would think these are just as wacky as Owen’s too.

Nine policies to make people richer and freer (and hopefully happier):

1) The removal of political barriers to who can work and reside in the UK. Removing all barriers to trade would increase global GDP by between 0.3% and 4.1%. Completely removing barriers to migration, though, could increase global GDP by between 67% and 147.3%. Those GDP benefits would mostly accrue to the poorest people in the world. We can’t remove these barriers everywhere but we can show the rest of the world how it’s done. Any step towards this would be good – I suggest we start by dropping the net migration cap and allowing any accredited educational institution to award an unlimited number of student visas.

2) A strict rule for the Bank of England to target nominal GDP instead of inflation, replacing the discretion of the Monetary Policy Committee. Even more harmful than the primary bust in recessions is what Hayek called the ‘secondary deflation’ that comes about as people, fearing a drop in their future nominal earnings, hold on to more of their money. That reduces the total level of nominal spending in the economy which, since prices and wages are sticky in the short run, leads to unemployment and a fall in economic output. NGDP targeting prevents those ‘secondary deflations’ and would make economic busts much less common and harmful. In the long run, we should scrap the central bank altogether and replace it with competition in currencies (see point 9, below).

3) Significant planning reform that abolished the Town and Country Planning Act (which includes the legislation ‘protecting’ the Green Belt from most development) and decentralised planning decisions to individuals through tradable development rights (TDRs). This would give locals an incentive to allow new developments because they would be compensated by the developers directly, allowing for a reasonably efficient price system to emerge and making new development much, much easier. The extra economic activity from the new home building alone would probably add a couple of points to GDP growth.

4) Legalisation of most recreational drugs and the medicalisation of the most harmful ones. I think Transform’s outline is pretty good: let cannabis be sold like alcohol and tobacco to adults by licensed commercial retailers; MDMA, cocaine and amphetamines sold by pharmacies in limited quantities; and extremely dangerous drugs like heroin sold with prescriptions for use in supervised consumption areas. The sooner this happens, the sooner producers will be answerable to the law and deaths from ‘bad batches’ of drugs like ecstasy will be a thing of the past. Better yet, this would bring an end to drug wars like Mexico’s, which has killed around 100,000 people in the past ten years.

5) Reform of the welfare system along the lines of a Negative Income Tax or Basic Income Guarantee. As it is, the welfare system disincentivises work and creates dependency without doing much for the working poor. A Negative Income Tax would only look at people’s incomes (not whether they were in work or not in work), reducing perverse incentives and topping up the wages of the poorest earners. This would strengthen the bargaining position of low-skilled workers and would remove much of the risks to workers associated with employment deregulation. Of course, the first thing we should do is raise the personal allowance and National Insurance threshold to the minimum wage rate to give poor workers a de facto ‘Living Wage’.

6) A Singaporean-style healthcare system to replace the NHS. In Singapore, people have both a health savings account and optional catastrophic health insurance. They pay a portion of their earnings into the savings account (poor people receive money from the state for this), which pays for day-to-day trips to the doctor, prescriptions, and so on. The government co-pays for many expenses but the personal cost disincentivises frivolous visits to the doctor. For very expensive treatments, optional catastrophic health insurance kicks in. This is far from being a pure free market system but it is miles better (cheaper and with better health outcomes) than the NHS. (By the way, if you really like the NHS we could still call this an ‘NHS’ and still get the superior system.)

7) A school voucher system and significant reform of the state education and free schools sectors. This would include the abolition of catchement areas and proximity-based admission, simplification of the free schools application process, and expansion of the free schools programme to allow profit making firms to operate free schools. These reforms, outlined in more detail in two ASI reports, would increase the number of places available to children and increase competition among schools to drive up standards.

8) Intellectual property reform. As both Alex Tabarrok and Matt Ridley have pointed out, our IP (patent and copyright) law is too restrictive and seems to be stifling new innovation. Firms use patents as barriers to entry, suing new rivals whose products are too similar to their own. In industries where development costs are high but imitation costs are low, like pharmaceuticals, patents may be necessary to incentivise innovation, but in industries like software development where development can be cheaper than imitation, patents can be a terrible drag on progress. Tabarrok recommends that we try to tailor patent length in accordance with these differences; as a sceptic about our ability to know, well, anything, I’d prefer to leave it to private contracts and common law courts to discover.

9) Last but not least, the removal of the thicket of financial regulation and the promise of bailouts for insolvent banks. Known as ‘free banking’, this system of laissez-faire finance has an extremely strong record of stability – though bank panics still occurred in free banking systems, they were much less severe and rarely systemic. Only once the government started to intervene in the financial system to provide complete stability did things really begin to go wrong: deposit insurance, branch-banking restrictions, and other prudent-seeming regulations led to extremely bad unforeseen consequences. The financial crisis of 2008 probably owes more to asset requirements like the Basel accords, which heavily incentivised banks to hold ‘safe’ mortgage debt over ‘risky’ business debt, than anything else. Incidentally, the idea that having a large number of local banks is somehow better than having a few large banks is totally wrong: during the Great Depression, 9,000 of America’s small, local banks failed; at the same time not one of Canada’s large banks failed. The small banks were more vulnerable because, unlike the big banks, they were undiversified.

Now, if only there was a think tank to try and make these dreams a reality.

No, Britain isn’t a developing country

Britain is a developing country, says Aditya Chakrabortty. He bases this largely on the fact that it is below some poor countries on a number of international rankings. (Never has an article owed so much to Wikipedia’s “List of countries by” pages.) Some of the rankings seem obscure: is Barbados’s superior ‘ground transport’ system worth caring about? Does Mali beating the UK in terms of business investment tell us anything? Others rely on the reader not knowing much about the country Britain does worse than: the UK may have a worse road network than Chile, but Chile’s Public-Private Partnership roads have made it a regional leader in infrastructure.

One thing that Chakrabortty is particularly concerned about is graphene, a super-strong substance first isolated in 2004 and pioneered by scientists at the University of Manchester. What worries Chakrabortty is that South Korean firms are bringing graphene to market much more quickly than British firms. This, he says, is emblematic of “a familiar pattern of generating innovations for the rest of the world to capitalise on”.

I guess that’s supposed to be a bad thing, but it doesn’t sound like it to me. It’s good when inventions spread beyond their birthplace: to use Matt Ridley’s metaphor, the ideas ‘have sex’ and mutate more quickly. Overall, the world – and Britain, if for some reason that’s all you care about – has done well from Tim Berners-Lee’s world wide web being capitalised on by non-Britons in Silicon Valley. Germans are better off that Japanese firms make cars as well as Volkswagen, and Finns are better off that Californians tried to make mobile phones better too.

Chakrabortty might object that he doesn’t mind South Koreans doing well with graphene, he just wishes Britons were too. But why graphene in particular? Chakrabortty’s counterpart in Seoul could write an identical piece worrying about South Korea’s relative weakness in finance, tourism, the cultural arts, or telecommunications. When firms in different countries specialise in different areas it is pointless to look at any single product or sector to judge which country is healthy.

There’s not much point in comparing the growth of rich and poor countries – poor countries are playing ‘catch up’ and can grow quickly by applying innovations already developed elsewhere. But if Britons should be worried about something, it’s the UK’s centralised public sector, which, lacking the profit motive as a crucible for new ideas, is less innovative than international equivalents. For instance, the British health system essentially free rides on innovations in America.

Chakrabortty asks “How can any nation that came up with the BBC and the NHS be considered in the same breath as India or China?”. Good question.