Gobsmacked by Grauniad article on equal pay

[Pruni]

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"Girls still study subjects that are in less demand than boys"

Not true. There's a shortage of midwives, yet they're still low-paid. If the rules of supply and demand applied, they'd be as highly paid as consultants, because they are so in demand and there is such a shortage of them. Same with head teachers, still overwhelmingly female even though men are disproportionately more likely to become heads, relative to the number of men in teaching.

The rules of the market just don't apply where women's wages are concerned.

"Girls still study subjects that are in less demand than boys"

Not true. There's a shortage of midwives, yet they're still low-paid.
A shortage is necessary, but exactly as you show not a sufficient criterion for more money.
There has to be market, not just one part of an organisation agreeing with another.

Same with head teachers, still overwhelmingly female even though men are disproportionately more likely to become heads, relative to the number of men in teaching.

The rules of the market just don't apply where women's wages are concerned.
Close.
All the examples you cite are for government employees. It is very close to being a monopoly consumer of this type of labour. The classic monopoly is a one of a single vendor, so simple that even journos on the BBC or eurocrats can get it. But consumer monopolies are as we see here just as bad, just not so obvious.

Your examples could be taken as evidence of a grossly sexist employer with monopoly power.

As a monopoly it can pick a point on the curve that maximises things for it's own objectives.
The midwife shortage, or that of maths teachers could be fixed in one year flat. There are ample people with the base skills, you just need to attract, train and equally importantly keep them.
I read recently that around 25% of all nurses quit in their training period.

Markets always appear in some form. The trick is to have a good one. Problem is that there is no cost function for a hospital that has too few midwives, and of course a saving to be made there.

People whings about the NHS, but if one looks at stats on voting intentions, it's like education, something Brits put well down their list of issues.
What we used to have before the tories was a high handed, badly funded NHS. Ever since the first charity hospitals appeared, people got what they were given, and for some time after the creation of the NHS you couldn't even sue them no matter how badly they behaved.
But there was well intentioned intelligent analysis of health economics. What is the "right" number of midwives ? An economist will typically say this is when you have an extra bit of spending that will produce more benefit in some other area.

Alas, the tories, and then labour got into accountancy.
An accountant will answer that question as when you have the number you are required to have at the least cost.
Thus we have a stupidly complex system of targets, and in such a system, even a decent and smart person has no alternative but to play the game. Hence we have "not-waiting" lists, etc.

This is little to do with sexism, but more to do with competence.
The harder question is why women choose careers in areas that have been badly paid for centuries.

I can't think of an answer to that which doesn't sound sexist. Can you ?

In the case of teaching, lots of women choose it because it fits in with having children (except when your children are ill of course).

As for nursing, I've always been mystified as to why anyone would ever want to do it.

I suppose in both cases, both professions have offered women a social status and job security not available with better paid jobs.

The legal profession now has more females than males and has an increasing amount of partners. This is a job that is mainly done by art graduates and is well paid. Therefore not all female dominated jobs are lower paid.

As from earlier posts, very few lawyers work for the government. Bit of a pattern here.

Yep, my wife is a lawyer, but law has a large variance in the pay scales. City lawyers earn good money, but high street solicitors do very much less well.
She did PPE, which I'm not sure is an art subject since it involves serious maths.

Law is pretty much the exception to have a majority of women and earn more than the average.

Also one sees considerably few language grads in the well paid slots.
I think one of the problems is in the structure of work that women for whatever reason choose.
You get more money by the pressure you can bring to bear upon the employer fearing to lose your services.
We started off comparing nurses and engineers, so let's see what happens if a nurse asks for more monry.
First of course, she may not be able to find the person who actually makes the decision.
Second, they simply may not care.

If an engineer leaves his role, it can cause real problems. Finding another and getting him trained up can mean expensive dislocations in the work.

The "cost" of a nurse leaving the NHS isn't in those terms at all. If the only person who knows how to drive a piece of diagnostic equipment leaves, the hospital may well simply decide not to use it. Indeed for many situations they actually "save" if the use of that equipment costs money in terms of consumables or maintenance.
Thus a nurse leaving a her job is often "good" from the point of view of an accountant.

Targets have to be awfully precise to catch this, so you either have huge bureaucracy or targets that don't actually work. Actually I'm wrong it's not "either" it's "both"

Thus we have the idea of markets. I know some very smart economists at HM Treasury, and I pity them having to try and explain them to a politico.

If a patient can take away his money if the care is poor, there is now an incentive for the NHS trust to balance cost and quality.

Problem of course is that people don't understand statistics. At all. Not even slightly. Even if they do, it's hard even for professionals to unpick whether a lower death rate is from denying marginal cases treatment, or greater competence.

Hence the shortage of midwives.
What's interesting is the mortality rate for private births. Was scary enough that we decided to go NHS.
Not because they're high, quite the contrary.
They are really really low.
Mothers almost never die in private hospitals.
They die in NHS ones.
If it goes pear shaped, they are rushed to NHS hospitals who have the depth of cover and of course makes their numbers look better.
However you look at this, it's not good for a mother who's bleeding out to be hurtled across town in an ambulance.

it's good to see a post which manages to go from equality of pay to arguments for a free market NHS.

I want to say 2 things:

a) care workers are mostly private sector, are in short supply and have rubbish wages. they are also mostly female.

b) As for "If a patient can take away his money if the care is poor, there is now an incentive for the NHS trust to balance cost and quality."...because NHS managers are so cold hearted they don't have any incentive to do that otherwise do they? I hate this argument. healthcare ain't a business and nor should it ever be. think about what successful companies do: they buy up smaller companies, or force them out of business. why the hell would we want a system where some hospitals can force others out of business? or where operations are cancelled because too many people fell ill that year for that matter. we want locally available good quality healthcare for all, thanks. targets don't work, i agree, but have we ever tried a more general system of audit/inspections instead? grrr.

>a) care workers are mostly private sector, are in >short supply and have rubbish wages. they are >also mostly female.
And mostly government employees, one way or another.

>because NHS managers are so cold hearted they don't have any incentive to do that otherwise do they? I hate this argument.
I am not impressed any more than you are, but it is often made. "Cold hearted" is a perjorative term in this context. If your boss says "you should do it this way, and the more X you do the more you get paid", then I think most people would tend to do it.

>healthcare ain't a business and nor should it ever be.
Afraid we'll have to agree to disagree I fear.
Certainly the American system is scary, and the part-privatisation of the NHS hasn't worked. But there are features of business that can viably be used. Fact is the best thinkers no longer work for governments anything like as much as they used to.

Think about what successful companies do: they buy up smaller companies, or force them out of business.
Sometimes yes, but buying up smaller companies can be a good thing. The NHS benefits hugely from it's economies of scale. None of the 3 national parties understand this.

Why the hell would we want a system where some hospitals can force others out of business?
Sadly, a major problem is that big government entities like schools and hospitals are terribly hard to shut down, no matter how badly run.

An inefficient hospital or school is a terribly immoral thing. Sometimes it would be better to just give up, and reallocate resources. By "better" I want to make clear I mean more people would get better treatment, given inevitably finite resources. Although it's done too rarely to schools, no one has worked out how to do it with hospitals at all.

>or where operations are cancelled because too many people fell ill that year for that matter.
That's what we get, indeed you could double the NHS budget and it would still happen.

>We want locally available
I get very worried when people use the word "local" as their first term in a solution. Yes of course it's horrible to make people trek across the country to get treated, but even with unlimited resources you can't have everything done best locally.

good quality healthcare for all,
Well yes, but it's hard to define that very accurately. Would you have included IVF when it was 4,000 quid a go and each shot had only about a 10% chance of success ?

But have we ever tried a more general system of audit/inspections instead? grrr.
You can't have useful audits unless there are standards. As it happens for most procedures and care regimes there are such standards. But in the case of Herceptin not yet getting through the process, that's hardly fault free.
But what's harder to audit is the balancing act.
Given that you can always do more healthcare with more money, we have to assume you only have so much.
So, how do you balance (say) better hygine in wards with training midwives ?
But it's worse than that. There are literally thousands of thing to spend more/less money on.

How do you measure good managment of staff ?
Very important, as is promoting a culture of learning, and educating patients to take better care of themselves. Loads of soft factors, you need people who can make good judgements of complex situations, and even then you need to get them to understand what it is they are supposed to be achieving, which is really hard.

Thus there aren't quick fixes. Not money, not targets, and certainly not a fixation on where the hospitals are sited.

care workers are now mostly paid by private companies. the fact that the govt ultimately foots the bill is irrelevant. if it isn't irrelevant, what's your point?

and no, I disagree entirely. If you think that even a substantial minority of doctors, nurses etc will only do what is best for the patients if they are paid more, you are wrong. If on the other hand you think that they will prioritise certain ailments over others, or give certain treatments in preference to others if paid more then you are correct, but there is not usually much point in that.

Finally, of course you can have useful audits without standards. you compare lots of things (eg death rates) to the average, and where figures are above average you attempt to find out why they were higher (eg more difficult cases). the key thing is subjective analysis. as you said, raw figures and "targets" don't work.

care workers are now mostly paid by private companies.
Be interesting to see how the pay disparity by sex works out there ?

the fact that the govt ultimately foots the bill is irrelevant.
I agree that merely being the bill pay is not very important. However no government can resist the temptation to rig the market. It's very size allows it to do things that few private firms could even attempt, and of course then pass laws to strengthen the distortion.

and no, I disagree entirely. If you think that even a substantial minority of doctors, nurses etc will only do what is best for the patients if they are paid more, you are wrong.
I'm not sure I was clear enough. In any organisation financial incentives tell people what is the "desired" action might be.
I take it you are aware of the hideious problems we've had with GPs being given incentives that lead many to give highly inappropriate care ?

Finally, of course you can have useful audits without standards.
What do you do when people don't measure up ?
Averages are poor indicators of pretty much any complex system.