Adam Boulton: NHS pessimism creeping up as striking doctors push on with 35% pay demand

Published

1 year ago

January 7, 2024

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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.

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.

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%.

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.

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.

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.

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.

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.

Politics

Stacks Asia expands Bitcoin initiatives with Abu Dhabi partnership

Published

1 hour ago

April 28, 2025

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Stacks Asia expands Bitcoin initiatives with Abu Dhabi partnership

The Stacks Asia DLT Foundation has become the first Bitcoin-based organization to establish an official presence in the Middle East, aiming to promote institutional Bitcoin adoption through expanded educational initiatives.

Stacks Asia has partnered with the Abu Dhabi Global Market (ADGM) — one of the world’s fastest-growing financial centers — in a move that could boost the adoption of its Bitcoin (BTC) layer-2 (L2) solution in the Middle East and Asia.

The new partnership will play a “pivotal role” in shaping the future of Bitcoin’s “programmability and adoption” in these regions through educational programs and support for Bitcoin builders, according to an April 28 announcement shared with Cointelegraph.

Through the collaboration, Stacks and the ADGM aim to make it easier for institutions and investors to participate in the growing Bitcoin economy and help set “new standards for regulatory clarity and technical growth” for the rising global Bitcoin capital, according to Kyle Ellicott, executive director at Stacks Asia DLT Foundation.

“Stacks and ADGM are a powerful combination for accelerating Bitcoin adoption across the Middle East and Asia,” Ellicott told Cointelegraph, adding:

“ADGM has established itself as a world-class global financial hub at the heart of the United Arab Emirates, known as the ‘Capitol of Capital,’ where capital and innovation are brought together to shape the future financial landscape.”

“We’ll be working to enable the launch of educational programs, regional developer communities, and create opportunities for the real-world adoption of Bitcoin-powered applications,” he said.

Starting in May, the foundation will host a series of live and virtual events to “empower institutions” with the knowledge to integrate Bitcoin into their operations and learn about the “opportunity of productive Bitcoin capital,” Ellicott added.

Stacks Foundation pushing for a “progressive” regulatory environment worldwide

As the leading Bitcoin scalability solution, Stacks is also pushing for progressive global regulations that will cement Bitcoin’s role in the future of the financial landscape.

“We’re not just focused locally — our team is engaged in global conversations, advocating for frameworks that balance decentralization, security, innovation, and compliance surrounding the unlocking of Bitcoin capital,” Ellicott said.

A key part of the strategy involves knowledge sharing with local regulatory bodies to build understanding among government officials about Bitcoin’s characteristics and potential economic impact.

The foundation is also developing the Bitcoin Capital Activation Framework, described as a comprehensive policy blueprint to help regulators enable Bitcoin utility in their jurisdictions.

The Stacks Foundation will also launch the Bitcoin Policy Bridge in May, a working group uniting regulators from all key jurisdictions across the Middle East and Asia.

In February, ADGM signed a memorandum of understanding with the Solana Foundation to advance the development of distributed ledger technology.

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Politics

Crypto projects prepare to battle for privacy in Switzerland

Published

2 hours ago

April 28, 2025

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Crypto projects prepare to battle for privacy in Switzerland

Switzerland has long been seen as a beacon of privacy where companies, organizations and wealthy people put down roots in an effort to avoid the prying eyes of the rest of the world. Joining this cohort are many Web3 projects, which also appreciate the Swiss government’s generally positive stance toward blockchain and digital assets.

The country’s reputation as a privacy haven has resulted in Switzerland becoming a hub for privacy projects establishing their foundations or development entities there, including Nym, Session and Hopr — joining traditional privacy software companies such as Proton and Threema.

Now, a proposed change to a Swiss surveillance ordinance is worrying these same projects, as it would spell a marked increase in the government’s user monitoring requirements. But the decentralized nature of crypto may offer a solution for those wishing to preserve their privacy in a climate of increasing surveillance.

Switzerland is a privacy haven — or maybe not

Switzerland has long been considered by many to have some of the world’s strongest privacy protections. As Proton, the company behind the encrypted Proton Mail email service, argued in a 2014 blog post titled “Why Switzerland?”, the Central European country offers several advantages: Companies are outside of the jurisdiction of the US and EU, the country is politically neutral, there are strong constitutional privacy protections, and there is established infrastructure.

Kee Jeffries, technical co-founder of decentralized private messaging app Session, recently told Cointelegraph’s The Agenda podcast that it was important to establish the foundation “in a country which has a long history of preserving people’s personal privacy and freedom of speech.”

However, all governments must ultimately balance citizen privacy and national security concerns. In Switzerland, surveillance is governed by the Ordinance on the Surveillance of Correspondence by Post and Telecommunications (OSCPT).

In January, the Swiss Federal Council proposed a revision to the OSCPT that would increase user monitoring requirements for telecommunications service providers and widen the definition of who meets these requirements to include services such as VPNs, social networks and messaging apps.

In short, as they are currently written, the changes would require service providers that serve at least 5,000 users to identify all users and willfully decrypt all communications that are not end-to-end encrypted.

Privacy projects fight back against surveillance

The move has been met with widespread backlash from the privacy community. Proton CEO Andy Yen has threatened to fight the government in court and potentially pull the company out of the country. Decentralized VPN provider Nym issued a public call to action for Swiss citizens to contact their representatives and oppose the action.

In a statement, Nym’s chief operating officer, Alexis Roussel, said the ordinance by the Federal Council “is destroying an entire sector,” adding:

“This ordinance directly endangers the people who use these services.”

Sebastian Bürgel, vice president of technology at Gnosis and founder of decentralized mixnet Hopr, echoed the concerns of Yen and Roussel, telling Cointelegraph the move would likely backfire.

“If the intent is to limit the privacy and anonymity that services such as Proton Mail, Proton VPN and Threema are providing, that will not change much because those entities will potentially leave Switzerland if that were to happen,” he said. “But again, the consequences will be borne by everyone out there and everyone who’s actually in Switzerland.”

Meanwhile, Ronald Kogens, a legal partner at Swiss law firm MME who focuses on Web3 and fintech, told Cointelegraph that it’s unclear whether the Swiss Federal Council even has the authority to implement such changes.

“In an ordinance, you cannot include any heavy rights or obligations which have a strong impact on individuals in Switzerland,” he shared, saying that the Federal Council is essentially an executive body and that laws must pass through parliament.

“One question you could ask is, does the Federal Council have the power, based on the laws where it stated that they can enact an ordinance, the power to do this, what they’re doing now?”

Are Swiss crypto projects at risk?

The move by the Swiss Federal Council is damaging Switzerland’s privacy reputation, but decentralized technologies like blockchain networks may offer a lifeline. According to Kogens, truly decentralized projects should be exempt from the new surveillance requirements.

“In my opinion, most Web3 activities are not affected because […] the pure offering of software without running any infrastructure for the whole messaging or communication system is not covered by this,” he told Cointelegraph. “You have to have specific servers or clients that you operate that are an essential part of the communication or messaging service.”

Either way, the more decentralized a project is, the less any government can influence its operations. Take, for example, Tornado Cash, which has continued chugging along for years despite multiple developers being arrested and the US sanctioning its smart contracts at one point.

Nym CEO Harry Halpin told Cointelegraph in March that “in theory, we should be able to get run over with a car, and the network would keep operating.”

“Hopr, as an example of Web3 infrastructure, does not operate infrastructure, right?” said Bürgel. “Hopr Association is involved in software development and research and development, but we are not an operator of a network.”

The fact that the Hopr network is fully decentralized and anonymous means the Hopr Association could not actually give any information about its users to Switzerland, even if it were legally compelled.

“Individual node runners which are participating in it, or other third parties, cannot tell who is using the Hopr network to access any kind of web service. That is the explicit goal of what we are undertaking.”

The future of privacy in Switzerland

The Swiss Federal Council’s proposed changes to the OSCPT are still in the consultation phase, with the public encouraged to offer feedback on the proposal through May 6.

Kogens told Cointelegraph that the council will review the feedback, create a final report, and decide whether to adjust the proposal. “That happens quite a lot,” he said, “because in the end, it’s not in the interest of Switzerland to do something which harms the industry, as long as they still can fulfill their goal, which they have with this surveillance act.”

But even if the changes go through as written, there could be some positive knock-on effects for the crypto space. “It may be that the silver lining is that it will drive users to decentralized and privacy-facilitating solutions instead,” said Bürgel.

“It is clear to everyone that more surveillance is bad,” he added. “Every single individual understands that.”

“Taming the surveillance machinery is a goal of Web3. It’s not just about magic internet money. And yeah, I think we need more people working towards that.”

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Politics

Caitlin Long slams US Fed over stablecoin policy favoring big banks

Published

3 hours ago

April 28, 2025

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Caitlin Long slams US Fed over stablecoin policy favoring big banks

Caitlin Long, founder and CEO of Custodia Bank, has criticized the US Federal Reserve for quietly maintaining a key anti-crypto policy that favors big-bank-issued stablecoins, despite relaxing crypto partnership rules for banks.

In an April 27 thread on X, Long explained that while the Fed recently rescinded four prior crypto guidelines, it left intact a Jan. 27, 2023, statement issued in coordination with the Biden administration.

The guidance, according to Long, blocks banks from engaging directly with crypto assets and prohibits them from issuing stablecoins on permissionless blockchains.

“THE FED HAS MAINTAINED A REGULATORY PREFERENCE FOR PERMISSIONED STABLECOINS (ie, big-bank versions),” Long stated.

She warned that this move gives traditional financial institutions a “head start” in launching private stablecoins while the broader market waits for stablecoin legislation to pass through Congress.

Long urges Congress to pass stablecoin bill

Long noted that once a federal stablecoin bill becomes law, it could override the Fed’s stance. “Congress should hurry up,” she urged.

Beyond stablecoins, Long pointed out how the Fed’s policy hampers banks from participating in crypto markets as principals, preventing them from market-making in assets like Bitcoin (BTC), Ether (ETH) or Solana (SOL).

She also noted operational challenges for banks looking to offer crypto custody services, particularly around covering gas fees for onchain transactions — a standard practice for crypto custodians but restricted under current Fed rules.

Summing up her concerns, Long argued that the Fed’s decision keeps “sand in the wheels” of banks entering crypto custody, while simultaneously advancing permissioned stablecoins backed by major financial institutions.

“The Fed definitely won on PR spin–its press release listed a long list of guidance it rescindedbut omitted ANY mention of the guidance it kept. That duped *a lot* of smart people, understandably,” she wrote.

Senator Lummis calls Fed’s move as “lip service”

Senator Cynthia Lummis, a vocal supporter of digital assets, also condemned the Fed’s move as mere “lip service,” signaling potential legislative pushback in the near future.

Lummis mentioned the Fed’s policy statement in Section 9(13), which hasn’t been withdrawn, stating that Bitcoin and digital assets are considered “unsafe and unsound.”

However, other crypto executives praised the Fed’s announcement as a positive development for the industry. Strategy’s Michael Saylor said in an April 25 X post that the Fed’s move means that “banks are now free to begin supporting Bitcoin.”

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