> It's not that different, no. At the scale of large institutions these two things blur together significantly. They "can" fire staff for incompetence in theory

> It's not that different, no. At the scale of large institutions these two things blur together significantly. They "can" fire staff for incompetence in theory but if they actually do that more than once in a blue moon then the unions will revolt, so they develop a culture of never actually doing so because that's easier than trying to figure out if this time it won't cause a backlash. Very many people are fired for poor performance each year. This is because no hospital wants the liability of poor staff; it's also because they have a legal "duty of candour" so they have to explain to patients when something goes wrong that they knew this healthcare professional was deficient; it's also because they have legal duties to report substandard healthcare to their regulators, and also report substandard care to the regulators of the HCP. You saying "they don't fire staff" is just a fucking enormous red flag that you don't have the first clue what you're talking about, and that you're arguing in bad faith from an ideological position. You keep repeating the same thing - that the NHS is one big organisation, run by the goverment. Neither is true. Until you can break this misconception you're going to come up with stuff ("they can't fire workers because unions") that's so wrong it makes any convo impossible.