The chances are that readers won't remember doctors taking industrial action – the last time this happened was in 1975 when the junior doctors who will be hit hardest by the Government's changes to the NHS pension scheme, hadn't been born. That doctors have not taken action for more than 35 years gives some indication of how reluctantly we have taken the step to ballot doctors but also of how angry they are at these planned changes.
There is a mistaken belief that all public sector pensions are now unaffordable and in need of significant reform. But not all public sector pensions are the same and these arguments cannot be levelled at the NHS pension scheme. It therefore falls to me, as chairman of BMA Scotland, to explain why my members are contemplating industrial action.
First the facts: The NHS pension scheme was extensively reformed in 2008, and far from being in deficit provides a positive cashflow of around £2 billion a year to the Treasury. In 2008, the BMA agreed to a tiered contribution scheme where those who earned more, paid more in contributions. We also agreed to an increase in the normal retirement age to 65 and, perhaps most importantly, we agreed a cost sharing arrangement where any future cost increases in the scheme would be met by pension scheme members, not the NHS or the taxpayer.
Those changes have proven to be affordable and sustainable for the future.
On any reasonable test, the current Coalition Government proposals are blatantly unfair.Its direction that public sector employee contributions should rise by 6% over the next three years is entirely independent of where each employee group started. So, some groups paying as little as 1.5% will see contributions rise to about 7.5 % of salary, whilst senior NHS workers on the same income will have to pay up to 14.5%. It would surely be more reasonable to level the playing field and bring other public sector schemes into line. Doctors recognise that they, like every other member of society, must share the pain of austerity, but insist that it is a fair share.
Whilst doctors are clearly angry at these reforms, we want to be clear that our argument is with the Government, not our patients. To that end the form of industrial action we are proposing is based on an overriding commitment to patient safety. All emergency care, or other care urgently needed would be provided, with doctors attending their place of work as usual where scheduled to do so. If someone urgently needed care, it would be provided. The difference would be that some services that could safely be postponed would not be undertaken on the day. In hospitals, this would mean that some non-urgent procedures and outpatient appointments are postponed. GP surgeries would not offer advance booked appointments, but would be open and fully staffed so that they could see patients in need of urgent attention.
It is our intention to co-operate with NHS managers to plan for industrial action to ensure that patients are aware of the reduced services that will be available on the day.
There is, of course a Scottish dimension. The Scottish Government runs the NHS pension scheme north of the Border and has told its NHS staff that whilst accepting the need for public sector pension reform, it will follow Treasury direction to increase employee contributions under the cosh of a pound-for-pound deduction from the Scottish block grant if it deviates, and there are now more recent indications of direct Treasury interference over how the Scottish Government is expected to follow its unreasonable policy.
The ballot opens today, and I hope this exposition of the facts behind the dispute helps to bring balance to the public debate.
Dr Brian Keighley is chairman of the BMA in Scotland and a practising GP in Balfron.