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From militant doctors to angry lawyers, professionals are the new union barons From militant doctors to angry lawyers, professionals are the new union barons
(4 days later)
Some years back the NHS tried to kill me. I was batted back and forth between my local GP and the nearest hospital over a cancer check-up. In desperation, I finally went private. A cancer was found and removed in time. Had I stuck with the NHS I would probably have been another statistic in Britain’s dire record for late diagnosis and death.Some years back the NHS tried to kill me. I was batted back and forth between my local GP and the nearest hospital over a cancer check-up. In desperation, I finally went private. A cancer was found and removed in time. Had I stuck with the NHS I would probably have been another statistic in Britain’s dire record for late diagnosis and death.
Related: Robot doctors, online lawyers and automated architects: the future of the professions?Related: Robot doctors, online lawyers and automated architects: the future of the professions?
It was not really the NHS’s fault. The delay lay in the medical restrictive practice whereby the GP could not order an endoscopy but must “refer” me to a hospital, where consultants worked to their own schedules of convenience and remuneration. I lost any romantic attachment I once had to the NHS.It was not really the NHS’s fault. The delay lay in the medical restrictive practice whereby the GP could not order an endoscopy but must “refer” me to a hospital, where consultants worked to their own schedules of convenience and remuneration. I lost any romantic attachment I once had to the NHS.
Since the 1980s, “trade union” restrictive practices have been largely dismantled in Britain. This was a good thing. It made the economy more flexible and more efficient. It is why you can still read papers such as the Guardian. It dismantled one form of restriction, that of manual and skilled workers mostly in the private sector.Since the 1980s, “trade union” restrictive practices have been largely dismantled in Britain. This was a good thing. It made the economy more flexible and more efficient. It is why you can still read papers such as the Guardian. It dismantled one form of restriction, that of manual and skilled workers mostly in the private sector.
Yet no one, from Thatcher onwards, has confronted those middle-class unions decorously known as the professions. Now threatened by a pincer movement of technology and austerity, their practices are coming to light. They are turning to militancy in self-defence, some with tactics that would make a Scargill blush.Yet no one, from Thatcher onwards, has confronted those middle-class unions decorously known as the professions. Now threatened by a pincer movement of technology and austerity, their practices are coming to light. They are turning to militancy in self-defence, some with tactics that would make a Scargill blush.
Today, we expect to find that junior hospital doctors have voted for the first time to strike against the NHS. They are the tip of an iceberg: lawyers, scientists, generals – even those new kings of the public sector, nationalised bankers – are fighting against new regulation. The steady advance of government into professional services means that the higher salariat has come to depend ever more on state money. It is bringing out the same survival instinct as the 1980s did in the miners and steelworkers.Today, we expect to find that junior hospital doctors have voted for the first time to strike against the NHS. They are the tip of an iceberg: lawyers, scientists, generals – even those new kings of the public sector, nationalised bankers – are fighting against new regulation. The steady advance of government into professional services means that the higher salariat has come to depend ever more on state money. It is bringing out the same survival instinct as the 1980s did in the miners and steelworkers.
Professions used to get their way by relying on the public’s instinctive deference towards their mystical skills. What a doctor or a lawyer said was gospel. They were, as Shaw said, “conspiracies against the laity”, and a conspiracy that always won. When Thatcher tried to end the legal duopoly of barristers and solicitors, her lord chancellor, Lord Havers, declared it the “first moral issue on which I felt I had to defy my party whip”. It was straight log-rolling, but Thatcher capitulated.Professions used to get their way by relying on the public’s instinctive deference towards their mystical skills. What a doctor or a lawyer said was gospel. They were, as Shaw said, “conspiracies against the laity”, and a conspiracy that always won. When Thatcher tried to end the legal duopoly of barristers and solicitors, her lord chancellor, Lord Havers, declared it the “first moral issue on which I felt I had to defy my party whip”. It was straight log-rolling, but Thatcher capitulated.
Technology can analyse and resolve many of life’s troubles that used to default to human expertiseTechnology can analyse and resolve many of life’s troubles that used to default to human expertise
This deference is collapsing. Most people find it hard to see what’s so awful about the new junior doctors’ contract – it compounds a variety of exploitable practices, such as excessive overtime pay, into one salary. The key to a British profession is that its payment roots are medieval and infinitely inflatable. It depends not on the salary but on the clock. This deference is collapsing. Most people find it hard to see what’s so awful about the new junior doctors’ contract – it compounds a variety of exploitable practices, such as excessive overtime pay, into one salary. The key to a British profession is that its payment roots are medieval and infinitely inflatable. It depends not on the salary but on the clock.
For the past year criminal lawyers have campaigned furiously over cuts to legal aid, the cost of which has soared to 20 times Europe’s average. They will campaign equally strongly against giving solicitors rights of audience in court. Why use one lawyer when the state will pay for two?For the past year criminal lawyers have campaigned furiously over cuts to legal aid, the cost of which has soared to 20 times Europe’s average. They will campaign equally strongly against giving solicitors rights of audience in court. Why use one lawyer when the state will pay for two?
Others pile in after the doctors and lawyers. Big science’s lobbyists deluge the press in defence of their grants. Soldiers breach protocol to defend weapons budgets against Labour scepticism. Spies go public in their fury at having their surveillance malpractices revealed in public.Others pile in after the doctors and lawyers. Big science’s lobbyists deluge the press in defence of their grants. Soldiers breach protocol to defend weapons budgets against Labour scepticism. Spies go public in their fury at having their surveillance malpractices revealed in public.
With the decline in deference, the professions are having to shift tactics. Political lobbyists, I am told, recommend their clients not to plug their wisdom, efficiency or skill. The new buzzword is “security”. Security is the leitmotif of today’s political language. It starts at the top. David Cameron says leaving the EU would “risk Britain’s national security”. He says Jeremy Corbyn is a “threat to national security”. George Osborne’s last budget “puts security first”. Without austerity “there is no economic security, no national security”.With the decline in deference, the professions are having to shift tactics. Political lobbyists, I am told, recommend their clients not to plug their wisdom, efficiency or skill. The new buzzword is “security”. Security is the leitmotif of today’s political language. It starts at the top. David Cameron says leaving the EU would “risk Britain’s national security”. He says Jeremy Corbyn is a “threat to national security”. George Osborne’s last budget “puts security first”. Without austerity “there is no economic security, no national security”.
Theresa May’s surveillance powers are naturally essential for security – never does the word “liberty” cross her lips. Any cut to London’s bloated police budget will, says its chief Sir Bernard Hogan-Howe, “damage the fight against terrorism”. Labour adds that police cuts would “put public safety at risk”.Theresa May’s surveillance powers are naturally essential for security – never does the word “liberty” cross her lips. Any cut to London’s bloated police budget will, says its chief Sir Bernard Hogan-Howe, “damage the fight against terrorism”. Labour adds that police cuts would “put public safety at risk”.
Fracking, needless to say, is about “energy security”. The one traditional trade union to cling to its privileges is that of the firefighters. As brigades across Europe are merged with emergency services, in Britain such a merger would “endanger security”. To the fire brigades union, “They slash, you burn.”Fracking, needless to say, is about “energy security”. The one traditional trade union to cling to its privileges is that of the firefighters. As brigades across Europe are merged with emergency services, in Britain such a merger would “endanger security”. To the fire brigades union, “They slash, you burn.”
The government lacks the guts to confront these new union barons. But a real threat to the professions comes from the marketplace and its accomplice, the internet. Half of female patients admit to consulting “Dr Google” before going to a surgery, where they tend to challenge doctors over their symptoms. Medicine is becoming a conversation, not a ritual.The government lacks the guts to confront these new union barons. But a real threat to the professions comes from the marketplace and its accomplice, the internet. Half of female patients admit to consulting “Dr Google” before going to a surgery, where they tend to challenge doctors over their symptoms. Medicine is becoming a conversation, not a ritual.
Richard and Daniel Susskind’s new book, The Future of the Professions, is full of warning. “The knowledge revolution,” they say, “is doing for the professions what machines did for manual workers.” To the Susskinds most professions today are “unaffordable, disempowering, ethically challengeable, underperforming and inscrutable.” Law, accountancy, medicine and teaching are being transformed by the internet. Roll on Google, robotics and self-help.Richard and Daniel Susskind’s new book, The Future of the Professions, is full of warning. “The knowledge revolution,” they say, “is doing for the professions what machines did for manual workers.” To the Susskinds most professions today are “unaffordable, disempowering, ethically challengeable, underperforming and inscrutable.” Law, accountancy, medicine and teaching are being transformed by the internet. Roll on Google, robotics and self-help.
Related: Trade unions, the professions and rising inequality | Letters
Of some of this I am sceptical. Electronics cannot fully replace the wisdom of experience, on which most people thankfully still rely. But the Susskinds must be right in saying that technology can analyse and resolve many of life’s troubles that used to default to human expertise. There is enough information available to empower the laity to strike back at Shaw’s conspirators.Of some of this I am sceptical. Electronics cannot fully replace the wisdom of experience, on which most people thankfully still rely. But the Susskinds must be right in saying that technology can analyse and resolve many of life’s troubles that used to default to human expertise. There is enough information available to empower the laity to strike back at Shaw’s conspirators.
Meanwhile, professional restrictive practices grow ever more indefensible. I firmly believe they are to blame for Britain’s poor cancer record. Increasingly, people will simply sidestep them, seeking online drugs and alternative therapies. We will opt for mediation not law. London neighbourhoods are losing confidence in local police and hiring their own, who do not insist on walking in pairs “for reasons of security”. Universities are springing up that teach full-time, without wasting half the student year while teachers “do research” or take holidays.Meanwhile, professional restrictive practices grow ever more indefensible. I firmly believe they are to blame for Britain’s poor cancer record. Increasingly, people will simply sidestep them, seeking online drugs and alternative therapies. We will opt for mediation not law. London neighbourhoods are losing confidence in local police and hiring their own, who do not insist on walking in pairs “for reasons of security”. Universities are springing up that teach full-time, without wasting half the student year while teachers “do research” or take holidays.
Making money by making the public feel uncomfortable or afraid is a professional travesty. It is not just cynical. It will eventually fail the test of the market. The cult of security can cry wolf too often. When my government tells me every week that a terrorist attack is “likely” or “certain” or even “imminent”, I no longer fear the terrorist. I fear the government.Making money by making the public feel uncomfortable or afraid is a professional travesty. It is not just cynical. It will eventually fail the test of the market. The cult of security can cry wolf too often. When my government tells me every week that a terrorist attack is “likely” or “certain” or even “imminent”, I no longer fear the terrorist. I fear the government.