Show Hide image

How the “Work Programme” could make the poor poorer

Making work pay is a laudable goal but this scheme isn’t how to do it.

Over the past year, I have sometimes felt as if I were battling almost alone against the coalition's ineptitude. Then, into the fray strode Rowan Williams, the Archbishop of Canterbury, with his critique of government policy in last week's issue of the New Statesman. His comments put the government in a real tizzy, with David Cameron and various ministers trying to defend themselves from the suggestion that they lack a mandate for their restructuring of the British welfare state.

I was struck in particular by Williams's claims that the term "big society" is "painfully stale" and the electorate is "being committed to radical, long-term policies for which no one voted". That seems right. The plans to privatise the NHS, to take the most obvious example, were in neither the Conservative nor Liberal Democrat election manifesto.

I agree with the archbishop's criticisms of the Labour Party for failing to set out an alternative: "We are still waiting for a full and robust account of what the left would do differently and what a left-inspired version of localism might look like." The government has been so hopeless that Labour should be all over it. Tory attack dogs such as Michael Fallon have a point when they ask, "What would you do instead?" Labour needs answers to that question and soon.

The onslaught against the shadow chancellor, Ed Balls, following the leak of old documents with zero news in them, shows that the right fears him. But Balls is the only tiger on the Labour front bench; the rest have been pussycats. Ed Miliband, whose performances at Prime Minister's Questions have been lacklustre, needs to raise his game. It is no good sitting around waiting for hoped-for policy reviews: it is time to get stuck in.

Obstacles to reform

Here is a useful piece of evidence to add to the opposition's arsenal. The full results of a survey conducted by the European Commission in November and December 2010 have just become available. The survey is part of the Eurobarometer series, which asks identical questions in all 27 member countries. The 22,560 respondents were asked whether they totally disagree, tend to disagree, tend to agree or totally agree that the economic crisis "means we should increase public deficits to create jobs". In the table below, I report by country the weighted percentage of those who said they tend to or totally agree.

The high percentages suggest that there is major opposition to the policy of decreasing public deficits. Two-thirds of UK respondents were in favour of increasing public deficits to create jobs - a much higher proportion than in all the other major western countries. This looks like a potential support base for Labour, whose strategy in opposition should be all about the need for jobs, jobs and more jobs, especially for the young.

The coalition's "Work Programme", which was launched on 10 June, is more likely to make the poor poorer than it is to get Britain back to work. To make work pay is a laudable aim but is this the way to do it? The Work and Pensions Secretary, Iain Duncan Smith, and his employment minister, Chris Grayling, face three main problems in implementing their reforms.

First, they promise that the programme will give 2.4 million unemployed people help to find jobs over the next five years, which seems unlikely, given that there are so few jobs available. At present, there are 2.43 million people who are unemployed and a further 2.4 million who are out of the labour force - those who are neither employed nor unemployed but want a job. The Office for National Statistics reported that, on average, there were only 469,000 vacancies available from February to April, which implies only one vacancy for every ten jobseekers. The number of jobseekers per vacancy is likely to be much higher in areas of high unemployment. There remains no evidence that the private sector will deliver the large numbers of jobs the coalition is hoping for.


Jobs for the jobless

Second, the reforms are largely untested and on too small a scale to make a serious dent in the problem. Under the scheme, approved providers - primarily private companies - will try to find work for claimants of benefits in the UK. Seven-year contracts have been agreed and are on a payment-by-results basis, so the worry is that these companies will pick the individuals who are more likely to get jobs and ignore unemployment black spots. The withdrawal of PricewaterhouseCoopers after losing out on contracts amid suggestions that the scheme was commercially unviable was not a good start.

Third, the evidence is that the unemployed are not just a bunch of lazy bastards. The vast majority are unemployed involuntarily. Many have the wrong skills and are in the wrong place. The housing market makes it hard for them to relocate. Some are simply too ill to work. Being jobless makes people unhappy and the longer they are without work, the less happy they are. Being without work is bad for self-esteem and mental health.
Based on my calculations using the 2010 Labour Force Survey, the unemployed are three times as likely as those who are employed to report that they are suffering from depression and bad nerves. It doesn't matter for policy whether their poor mental health is a cause or result of their unemployment. They deserve compassion.

David Blanchflower is NS economics editor and a professor at Dartmouth College, New Hampshire, and the University of Stirling

David Blanchflower is economics editor of the New Statesman and professor of economics at Dartmouth College, New Hampshire

This article first appeared in the 20 June 2011 issue of the New Statesman, Sunni vs Shia

Joe Raedle/Getty
Show Hide image

The proposed cuts to junior doctors’ pay will make medicine a profession for the privileged

Jeremy Hunt is an intelligent man with a first-class education. This makes his ill-fated proposed contract appear even more callous rather than ill-judged.

The emblem of the British Medical Association (BMA), the trade union for doctors in the UK, symbolises Asclepius, who was believed to be the founder of western medicine. Asclepius was killed by Zeus with a thunderbolt for resurrecting the dead. In the same way, the proposed government-led contracts to be imposed on doctors from August 2016 may well be the thunderbolt that kills British medical recruitment for a generation and that kills any chance of resurrecting an over-burdened National Health Service.

The BMA voted to ballot their junior doctor members for industrial action for the first time in 40 years against these contracts. What this government has achieved is no small feat. They have managed, in the last few weeks, to instil within a normally passive profession a kindled spirit of self-awareness and political mobilisation.

Jeremy Hunt is an intelligent man with a first-class education. This makes his ill-fated proposed contract appear even more callous rather than ill-judged. Attacking the medical profession has come to define his tenure as health secretary, including the misinformed reprisals on hospital consultants which were met not only with ridicule but initiated a breakdown in respect between government and the medical profession that may take years to reconcile. The government did not learn from this mistake and resighted their guns on the medical profession’s junior members.

“Junior doctor” can be a misleading term, as we are a spectrum of qualified doctors training to become hospital consultants or General Practioners. To become a consultant cardiac surgeon or consultant gastroenterologist does not happen overnight after graduating from medical school: such postgraduate training can take anywhere between 10 to 15 years. This spectrum of highly skilled professionals, therefore, forms the backbone of the medical service within the hospital and is at the forefront of delivering patient care from admission to discharge.

Central to the opposition to the current proposed contract outlined in the Review Body on Doctors' and Dentists' Remuneration is the removal of safeguards to prevent trusts physically overworking and financially exploiting these junior doctors. We believe that this is detrimental not only to our human rights in a civilised society but also detrimental to the care we provide to our patients in the short term and long-term.

David Cameron recently stated that “I think the right thing to do is to be paid the rate for the job”. This is an astute observation. While contract proponents are adamant that the new contract is “pay neutral”, it is anything but as they have tactfully redefined “sociable hours” as between 7am and 10pm Mondays to Saturdays resulting in hardest working speciality doctors seeing their already falling inflation-adjusted pay slashed by up to further 30 per cent while facing potentially unprotected longer working hours.

We acknowledge that we did not enter medicine for the pay perks. If we wanted to do that, we would have become bankers or MPs. Medicine is a vocation and we are prepared to sacrifice many aspects of our lives to provide the duty of care to our patients that they deserve. The joy we experience from saving a person’s life or improving the quality of their life and the sadness, frustration, and anger we feel when a patient dies is what drives us on, more than any pay cheque could.

However, overworked and unprotected doctors are, in the short-term, unsafe to patients. This is why the presidents of eleven of the Royal Colleges responsible for medical training and safeguarding standards of practice in patient care have publically stated their opposition to the contracts. It is, therefore, a mystery as to who exactly from the senior medical profession was directly involved the formation of the current proposals, raising serious questions with regard to its legitimacy. More damaging for the government’s defence are the latest revelations by a former Tory minister and doctor involved in the first negotiations between the BMA and government, Dan Poulter, implying that the original proposals with regard to safeguarding against unsafe hours were rejected by Mr Hunt.  

The long-term effects of the contract are equally disheartening. Already, hundreds of doctors have applied to the General Medical Council to work abroad where the market price for a highly trained medical profession is still dictated by reason. With medical school debts as great as £70,000, this new contract makes it difficult for intelligent youngsters from low-income backgrounds to pay back such debts on the modest starting salary (£11-12 per hour) and proposed cuts. Is medicine therefore reserved only for students from privileged backgrounds rather than the brightest? Furthermore, the contracts discourage women from taking time out to start a family. Female doctors form the majority of undergraduate medical students – we should be encouraging talented women to achieve their full potential to improve healthcare, not making them choose unfairly between work and family at such an early and critical stage of their career.

Postgraduate recruitment will therefore become an embarrassing problem, with many trusts already spending millions on hiring locum doctors. Most hospitals are not ready for Hunt’s radical reforms as the infrastructure to supply seven-day working weeks is simply not available. With a long-term recruitment problem, this would also be a toxic asset for potential private investors, should the health secretary venture down that path.

Jeremy Hunt has an opportunity to re-enter negotiations with the BMA to achieve a common goal of improving the efficiency and recruitment to the health service while protecting patient care. Although the decision for industrial action should never be taken lightly, as future leaders of clinical care in the UK, we will do everything in our power to defend against such thunderbolt attacks, by men playing god, the integrity and dignity of our profession and on the quality of care it delivers to our patients.