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In its long and venerable history dating back 192 years, the British Medical Association used to shy away from being called a “trades union”.

Collective bargaining was for “trades people”; the doctors were independent professionals. Their association was there to campaign for best practice and to offer advice to the politicians regulating health treatment.

That was when the reflex of most medical practitioners was to subscribe to the Hippocratic principle often paraphrased as “first do no harm”.

Much has changed. Today the BMA has no qualms about being described as the “doctors’ union”.

It has freely employed strong-arm negotiating tactics, familiar from industrial disputes, in pursuit of better pay for its members – including strikes, walkouts, deadlines and work to rules.

These have culminated in the current “unprecedented” six-day strike by junior doctors in England, which is due to end at 7am on Tuesday.

There can be no doubt that the strikes are doing harm to patient care.

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NHS England has just reported that 89,000 “appointments and procedures” had to be put off because of the three-day strike in December.

Since the industrial action started last March, 1.2 million appointments have been cancelled and rescheduled.

The BMA rejected requests from the NHS to keep working in critical areas including fast-progressing cancers, corneal transplants and emergency caesareans.

Heated recriminations broke out as the BMA accused hospital managers of “weaponising” so-called “derogation requests” permitting them to recall staff to work if patient safety is “in jeopardy”.

Meanwhile, some A&E departments declared “critical” incidents with waiting times for treatment stretching as long as 16 hours.

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Patient backs NHS despite cancellations

PM failing to fix waiting list backlog

“Cutting NHS waiting lists” was one of the prime minister’s five pledges and this aim is seriously off track. Opinion polls taken during the dispute suggest that just over half of the public back the strikes (53%).

In a survey four months ago, people were more inclined to blame the government for the dispute (45%) than the BMA (21%), although 25% said they were both responsible.

Yet 11 months into the confrontation, the junior doctors, who lose pay on strike days, must be wondering what they are getting out of it. Their demand for a massive 35.3% pay rise still seems out of reach.

Having walked out of negotiations in December, Dr Vivek Trivedi, co-chair of the BMA junior doctors’ committee, now says he might be prepared to engage in more talks, saying “all we want is a credible offer that we can put to our members and we don’t need to strike again”.

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Although discontent over pay is widespread throughout the NHS workforce, most sectors other than junior doctors in England have accepted deals or, at the least, suspended their action.

NHS consultants accepted salary rises of up to 12.8% along with some pay reforms.

The Royal College of Nursing ballot for further strike action failed and a pay rise of 5.5% was imposed.

Health management is devolved. Junior doctors in Scotland accepted a 12.4% pay rise, on top of 4.5% in 2022/23. Junior doctors in Northern Ireland are balloting on a similar offer. In Wales, there is the prospect of a three-day strike from 15-18 January.

When negotiations broke down before Christmas, the government was offering a 3.3% increase on top of the 8.8% already imposed, taking the total for the English juniors above 12%.

A NHS hospital ward
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Junior doctors in Scotland have accepted a 12.4% pay rise

Junior doctors and members of the British Medical Association (BMA) outside Royal Victoria Infirmary, Newcastle, as they take to picket lines for six days during their continuing dispute over pay. Picture date: Wednesday January 3, 2024.
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The level of doctors’ real-terms pay cut is disputed

Are the strikes really ‘saving the NHS’?

By the standards of the other disputes, a reasonable settlement should be within touching distance were it not for the sense of grievance, embodied in the claim that pay has been cut in real terms by more than a third since 2008.

Few independent analysts accept the BMA’s calculation, which relies heavily on RPI inflation fluctuations. In line with recent trends for national statistics, the independent Institute for Government says the CPIH, the consumer price index, would be a more appropriate indicator, meaning a cut of 11-16%.

This was in the post-credit crunch, austerity period when wages across the public and private sectors stagnated.

The public is sympathetic to junior doctors who help to keep them well, but should they be an exception?

Over time, pay structures change. The youngest and lowest paid of those now on strike were at primary school in 2008; is it rational to restore their pay levels to what they were then?

“Junior doctors” is an unsatisfactory catch-all term for a wide range of hospital doctors. “Doctors in training” – which some Conservative politicians attempted to popularise – hardly does them justice either.

The term covers all hospital doctors who are not consultants, ranging from those just qualified and still effectively indentured, to senior registrars.

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First-year junior doctors earn £32,398, rising to £37,303 in the second year and £43,923 in the third. Registrars’ basic pay goes up to £58,000. Full-time NHS consultants earn up to £120,000.

On the picket lines, strikers often argue their action is not about their own pay but to save the NHS because, they say, many of their peers are leaving for better terms in Australia, New Zealand and Canada.

Conversely, as recent special grade immigration figures show, there are many qualified people abroad with conflicting aspirations who are anxious to come here to work in the NHS.

Junior doctor and members of the British Medical Association (BMA) on the picket line outside Leeds General Infirmary at the start a five-day strike amid the continuing dispute over pay, the longest walkout of its kind in the history of the NHS. Picture date: Thursday July 13, 2023. PA Photo.  See PA story INDUSTRY Strikes Doctors. Photo credit should read: Danny Lawson/PA Wire

Much to ponder on how the NHS should work

The additional crisis brought on by the strikes has inevitably prompted some rethinking about how the NHS is working.

Speaking to Sarah-Jane Mee on the Sky News Daily’s How To Fix The NHS mini-podcast series, Dr Adrian Boyle, president of the Royal College of Emergency Medicine, observed “that everything flowed better” in A&E departments because senior doctors providing cover had more direct contact with patients and “there were fewer people coming into hospital for elective work and this meant more beds”.

Those statements about organisation in the NHS should provide consultants, junior doctors and potential patients with a lot to ponder.

The same goes for politicians, who the public holds primarily responsible for delivering their healthcare.

Steve Barclay took an abrasively inactive approach to the various NHS disputes when he was health secretary. In November he was moved to make way for the more emollient Victoria Atkins.

She says she wants “a fair and reasonable settlement” to end the strikes and is open to further negotiations provided the threat of more strikes is withdrawn.

 Victoria Atkins MP
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Health Secretary Victoria Atkins

Shadow health secretary Wes Streeting speaking during the Labour Party Conference in Liverpool. Picture date: Wednesday October 11, 2023.
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Shadow health secretary Wes Streeting

Is the NHS broken – and would Labour do any better?

Atkins’ position is not much different from Wes Streeting, her Labour opposite number.

He has said for months that the disputes should be sorted out by negotiations with ministers and that a Labour government would not meet the 35% pay claim.

Streeting is of the view that reform, likely to discomfort some of the NHS’s vested interests, is more needed than extra cash.

Whatever view they take of the doctors’ actions, public pessimism about the NHS is on the rise.

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Labour won’t match doctors’ demands

Much as they love the NHS, growing numbers of the public say it is “broken” or “not fit for purpose”. There is also a live debate about whether doctors should lose the right to strike, just like the police and members of the armed services.

The pollsters regularly ask the question “should doctors be allowed to strike?”

Last summer, at the height of the consultants’ dispute, 50% said yes, 42% no. By November, support for doctors’ right to strike had dropped to 47% yes, 46% no.

The asking of that question alone would have astonished the founders of the BMA’s precursor, the Provincial Medical and Surgical Association, back in 1832.

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Republicans propose 7% leaner SEC budget compared to Biden’s era

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Republicans propose 7% leaner SEC budget compared to Biden’s era

Republicans propose 7% leaner SEC budget compared to Biden’s era

House Republicans have proposed a plan to trim the SEC’s budget and cut enforcement funding for a Biden-era rule requiring public companies to quickly report cyberattacks.

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The wealth tax options Reeves could take to ease her fiscal bind

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The wealth tax options Reeves could take to ease her fiscal bind

Faced with a challenging set of numbers, the chancellor is having to make difficult choices with political consequences.

Tax rises and spending cuts are a hard sell.

Now, some in her party are calling for a different approach: target the wealthy.

Is there a way out of all of this for the chancellor?

Economic growth is disappointing and spending pressures are mounting. The government was already examining ways to raise revenue when, earlier this month, Labour backbenchers forced the government to abandon welfare cuts and reinstate winter fuel payments – blowing a £6bn hole in the budget.

The numbers are not adding up for Rachel Reeves, who is steadfastly committed to her fiscal rules. Short of more spending cuts, her only option is to raise taxes – taxes that are already at a generational high.

For some in her party – including Lord Kinnock, the former Labour leader, the solution is simple: introduce a new tax.
They say a flat wealth tax, targeting those with assets above £10m, could raise £12bn for the public purse.

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Yet, the government is reportedly reluctant to pursue such a path. It is not convinced that wealth taxes will work. The evidence base is shaky and the debate over the efficacy of these types of taxes has divided the economics community.

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Chancellor will not be drawn on wealth tax

Why are we talking about wealth?

Wealth taxes are in the headlines but calls for this type of reform have been growing for some time. Proponents of the change point to shifts in our economy that will be obvious to most people living in Britain: work does not pay in the way it used to.

At the same time wealth inequality has risen. The stock of wealth – that is the total value of everything owned – is much larger than our income, that is the total amount of money earned in a year. That disparity has been growing, especially during that era of low interest rates after 2008 that fuelled asset prices, while wages stagnated.

It means the average worker will have to work for more years to buy assets, say a house, for example.

Left-wing politicians and economists argue that instead of putting more pressure on workers – marginal income tax rates are as high as 70% for some workers – the government should instead target some of this accumulated wealth in order to balance the books.

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Lord Kinnock calls for ‘wealth tax’

The Inheritocracy

At the heart of it all is a very straightforward argument about fairness. Few will argue that there aren’t problems with the way our economy is functioning: that it is unfair that young people are struggling to buy homes and raise families.

Proponents of a wealth tax say that it would not only raise revenue but create a fairer tax system.

They argue that the wealth distortions are creating a divided society, where people’s outcomes are determined by their inheritances.

The gap is large. A typical 50-year old born to the poorest 20% of parents in the UK is already worth just a quarter of what someone born to the richest 20% of parents is worth at that age. This is before they inherit anything when their parents die.

A lot of money is passed on earlier; for example, people may have had help buying their first home. That gap widens when the inheritance is passed on. This is when inheritance tax, one of the existing wealth taxes we have in the UK, kicks in.

However, its impact in addressing that imbalance is negligible. Most people don’t meet the threshold to pay it. The government could bring more people into the tax but it is already a deeply unpopular policy.

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Former BP boss: Wealth tax would be ‘mistake’

Alternatives

So what other options could they explore?

Lord Kinnock recently suggested a new tax on the stock of wealth – one to two percent on assets over £10m. That could raise between £12bn and £24bn.

When making the case for the tax, Lord Kinnock told Sky News: “That kind of levy does two things. One is to secure resources, which is very important in revenues.

“But the second thing it does is to say to the country, ‘we are the government of equity’. This is a country which is very substantially fed up with the fact that whatever happens in the world, whatever happens in the UK, the same interests come out on top unscathed all the time while everybody else is paying more for getting services.”

However, there is a lot of scepticism about some of these numbers.

Wealthier people tend to be more mobile and adept at arranging their tax affairs. Determining the value of their assets can be a challenge.

In Downing Street, the fear is that they will simply leave, rendering the policy a failure. Policymakers are already fretting that a recent crackdown on non-doms will do the same.

Critics point to countries where wealth taxes have been tried and repealed. Proponents say we should learn from their mistakes and design something better.

Some say the government could start by improving existing taxes, such as capital gains tax – which people pay when they sell a second property or shares, for example.

The Labour government has already raised capital gains tax rates but bringing them in line with income tax could raise £12bn.

Then there is the potential for National Insurance contributions on investment income – such as rent from property or dividends. Estimates suggest that could bring in another £11bn.

This is nothing to sniff at for a chancellor who needs to find tens of billions of pounds in order to balance her books.

By the same token, she is operating on such fine margins that she can’t afford to get the calculation wrong. There is no easy way out of this fiscal bind for Rachel Reeves.

Whether wealth taxes are the solution or not, hers is a government that has promised reform and creative thinking. The tax system would be a good place to start.

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Pressure grows to leave ‘mad’ Aarhus Convention used to block UK building projects

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Pressure grows to leave 'mad' Aarhus Convention used to block UK building projects

Pressure is growing to renegotiate or leave an international convention blamed for slowing building projects and increasing costs after a judge warned campaigners they are in danger of “the misuse of judicial review”.

Under the Aarhus Convention, campaigners who challenge projects on environmental grounds but then lose in court against housing and big infrastructure have their costs above £10,000 capped and the rest met by the taxpayer.

Government figures say this situation is “mad” but ministers have not acted, despite promising to do so for months.

The Tories are today leading the call for change with a demand to reform or leave the convention.

In March, Sky News revealed how a computer scientist from Norfolk had challenged a carbon capture and storage project attached to a gas-fired power station on multiple occasions.

Andrew Boswell took his challenge all the way the appeal court, causing delays of months at a cost of over £100m to the developers.

In May, the verdict handed down by the Court of Appeal was scathing about Dr Boswell’s case.

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“Dr Boswell’s approach is, we think, a classic example of the misuse of judicial review in order to continue a campaign against a development… once a party has lost the argument on the planning merits,” wrote the judges.

They added: “Such an approach is inimical to the scheme enacted by parliament for the taking of decisions in the public interest,” adding his case “betrays a serious misunderstanding of the decision of the Supreme Court” and “the appeal must therefore be rejected”.

Another case – against a housing development in a series of fields in Cranbrook, Kent – was thrown out by judges in recent weeks.

The case was brought by CPRE Kent, the countryside challenge, to preserve a set of fields between two housing developments alongside an area of outstanding natural beauty.

John Wotton, from CPRE Kent, suggested it would have been hard to bring the challenge without the costs being capped.

“We would’ve had to think very carefully about whether we could impose that financial risk on the charity,” he told Sky News.

After his case was dismissed, Berkeley Homes said the situation was “clearly absurd and highlights how incredibly slow and uncertain our regulatory system has become”.

They added: “We welcome the government’s commitment to tackle the blockages which stop businesses from investing and frustrate the delivery of much needed homes, jobs and growth.

“We need to make the current system work properly so that homes can actually get built instead of being tied-up in bureaucracy by any individual or organisation who wants to stop them against the will of the government.”

‘Reform could breach international law’

Around 80 cases a year are brought under the Aarhus Convention, Sky News has learned.

The way Britain interprets Aarhus is unique as a result of the UK’s distinctive legal system and the loser pays principle.

Barrister Nick Grant, a planning and environment expert who has represented government and campaigns, said the convention means more legally adventurous claims.

“What you might end up doing is bringing a claim on more adventurous grounds, additional grounds, running points – feeling comfortable running points – that you might not have otherwise run.

“So it’s both people bringing claims, but also how they bring the claims, and what points they run. This cap facilitates it basically.”

However, Mr Grant said that it would be difficult to reform: “Fundamentally, the convention is doing what it was designed to do, which is to facilitate access to justice.

“And it then becomes a question for the policymakers as to what effect is this having and do we want to maintain that? It will be difficult for us to reform it internally without being in breach of our international law obligations”

In March, Sky News was told Number 10 is actively looking at the convention.

Multiple figures in government have said the situation with Britain’s participation in the Aarhus Convention is “mad” but Sky News understands nothing of significance is coming on this subject.

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Jenrick's leaked recording on 'coalition' with Reform UK
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‘The country faces a choice,’ says Robert Jenrick

The Tories, however, want action.

Robert Jenrick, shadow justice secretary and former housing minister, said the Tories would reform or leave the convention.

He told Sky News: “I think the country faces a choice. Do we want to get the economy firing on all cylinders or not?

“We’ve got to reform the planning system and we’ve got to ensure that judicial review… is not used to gum up the system and this convention is clearly one of the issues that has to be addressed.

“We either reform it, if that’s possible. I’m very sceptical because accords like this are very challenging and it takes many many years to reform them.

“If that isn’t possible, then we absolutely should think about leaving because what we’ve got to do is put the interest of the British public first.”

Mr Jenrick also attacked the lawyers who work on Aarhus cases on behalf of clients.

“A cottage industry has grown. In fact, it’s bigger than a cottage industry,” he said.

“There are activist lawyers with campaign groups who are now, frankly, profiteering from this convention. And it is costing the British taxpayer a vast amount of money. These lawyers are getting richer. The country is getting poorer.”

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