Jeremy Hunt, the much maligned Health Minister, has finally announced that he’ll impose the new junior doctor contract after months of stalled negotiations. Despite attempts to bargain with the militant doctors union, the British Medical Association, the government’s negotiators have advised him that the BMA does not accept the contract and is considering ‘all options open’ to it in response.

Moving forward, the junior doctors need to think carefully about their next steps. In recent weeks, it has become abundantly clear that there is more to this than just the junior doctors’ contract, or indeed the rate of pay for Saturday daytime work. The last doctors strike went ahead with some 3,000 operations cancelled across the UK and the BMA has shown it is quite prepared to put patients on the firing line in its dispute with Hunt. Let us not have the wool pulled over our eyes; the government proposals would mean a pay-rise, not a pay cut, for 99 percent of doctors. We cannot hide from the problems the NHS is suffering from but issues around pay and overtime are never easy to fix. Hunt’s proposals do cut overtime while giving the vast majority of medics over a 10% pay increase (now averaging £53,000 for all those not in the first two years of training). Three-quarters of doctors were always going to be better off. Last November, however, the health secretary Jeremy Hunt made an improved offer, which guarantees no cuts to almost every doctor’s pay for three years. Only 1 percent of physicians will lose out — the ones who work unhealthily long hours, frankly should the NHS pay system be setup in such a way as to encourage dangerous risk-taking?

Many campaigners and their friends in the media have drawn comparisons with the miners’ strikes of the 1980s. There is no comparison. Unlike the much-in-demand NHS in 2016, Mining was on its knees in the 1980’s. The National Union of Mineworkers was fighting to save a dying industry and the communities that depended on it. In stark contrast, healthcare will continue to grow, because the NHS is one of the few areas of public spending still receiving new investment. A far better comparison is the battle that Ronald Reagan fought to liberalise the US air transport market in the 1980s. The sector had great potential, but could only realise it if the whole industry became efficient and innovative. To achieve this Reagan fired 11,000 air traffic controllers who had gone on strike over a new contract. All Jeremy Hunt has done is gradually introduce a contract after three years of negotiation, and with most of it agreed

The real tragedy with Bevan’s grand experiment is that it simply isn’t very good. Recent research in The Lancet has delivered a devasting prognosis for the National Health Service, for example, lung cancer survival rates are some of the lowest in the developed world. Here in the UK 45,000 new cases are diagnosed each year with only a 10% chance of survival for five years. We are regularly told that the NHS is the ‘envy of the world’ yet patients in Latvia, Poland, the Czech Republic, Estonia, Slovenia and Slovakia face better odds, and the US survival rate is almost twice as high as ours. But forget the US. Survival rates in Italy, the Netherlands, Norway, Australia, Iceland, Sweden, Germany, Switzerland, Belgium, Canada, Austria and South Korea are also more than five percentage points higher than in Britain. In simple terms had the patients diagnosed with lung cancer been treated in France, rather than in the NHS, there would have been almost 1,800 additional survivors. Had they been treated in the Netherlands, another 2,300 people could have survived; had they been treated in Australia, another 2,400 could have, and had they been treated in Switzerland or Germany, it would have been around 3,000.

Healthcare needs reform, and while Jeremy Hunt has made mistakes and his style is not always helpful, the direction of travel he is piloting is right. There was a manifesto commitment to a seven-day NHS and he has the public mandate to deliver it. More broadly cash pledges may sound good but mask the need for root and branch reform. He should look to Austria where world leading survival rates are provided by a mixed economy of public, private and charitable provision. State funding is combined with co-pay arrangements for those that can afford them. As the doctors strike clearly demonstrates, an unreformed NHS will always represent a risk to the government and patients alike.

Which is the biggest disgrace, 1% of junior doctors getting a pay cut or a health system so mismanaged and inefficient that it provides worse outcomes than it’s equivalent in Latvia?