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What’s the off-ramp? When I ask one of the negotiating team close to the health secretary, the bleak answer is, “I don’t know.” Resident doctors in England are on another strike, for six days this time. Labour arrived in office bearing a 22.3% pay rise to end the strike it inherited – and it thought it was all over. But within a year, doctors were out again.
This time, negotiations over many weeks seemed to go well, but fell at the last fence: the doctors claimed there was a last-minute watering down and they returned to their fixed stand – restore their pay to its 2008 level, another 26%. “Impossible” is Wes Streeting’s line. He says resident doctors are “by a country mile the standout winners of the entire public sector workforce when it comes to pay rises”. Everything looks stuck, no pasaran on both sides. Why?
Because few involved are losing out right now. Streeting’s system now delivers 95% of treatments during a strike, so waiting times have not increased. Senior consultants step up to do juniors’ jobs at pay set by the British Medical Association (BMA) rate card, some £4,000 for a weekend. The Royal College of Emergency Medicine reported that during some of the strikes “everything works better than usual” in A&Es when specialists instead of juniors see patients.
In most industrial action, strikers suffer from loss of pay, but most of these doctors can recoup lost wages by working overtime and weekends after the strike days are over. Although fewer resident doctors turn out to vote in each successive BMA ballot, those who are reluctant are not losing out financially from strikes they didn’t vote for. In the most recent ballot in February, only 53% voted, with 93% voting to strike; but at the first ballot in 2023, 78% turned out to vote. Among high-flying doctors, this isn’t apathy or ignorance, but a signal.
The NHS is the heavy loser. Paying consultants to cover for strikers costs £50m a day, a sizeable £3bn since industrial action began in March 2023 – money that is denied for more treatments, staff and community clinics. NHS results are improving, but slowly. Public perception of the NHS is improving too, but slowly, so that £3bn is sorely missed as ever-present predators on the right are eager to prove the NHS system fails. Though treatment times have been far off target for years, most people do get treated within target. While 25.9% of people in England waited more than four hours in A&E in February, that means 74.1% of patients didn’t wait too long.
What went wrong after the latest negotiations seemed to go well? Beyond pay, the serious crisis for new medics is the lack of training posts: when Labour took over, only one in four on qualifying could progress towards their chosen specialism. Streeting increased training places to one for every two doctors, by passing an emergency law giving the British-educated priority over foreign applicants. He offered 1,000 more training places this year, and another 3,500 over the next years. As well as this year’s 3.5% pay increase, a 33% rise over the past three years, he offered to pay for medical exams (often more than £1,000 a sitting) and to propel doctors faster through higher pay bands.
Streeting’s people felt optimistic, but when BMA officers took the offer back to their committee, they rejected it out of hand, refusing to put it to members. Meanwhile, the BMA council is mid-election, its 69 seats contended by an unprecedented 247 candidates: those most likely to vote are activists, making this a bad moment for compromise.
But it was a bad time, too, for the government’s aggressively Trumpish response: “Because the BMA resident doctor committee has not agreed to call off these strikes and put an offer to members, we will now not be able to deliver the 1,000 extra training places which the BMA asked for.” Everyone knows those posts are needed. Nor was it a good time for NHS England chief executive, Jim Mackey, to threaten: “We’ll reduce our reliance on resident doctors in response to strikes.” That’s no way to get back round the table.
With the thunder clouds of Trump’s pernicious war rolling towards every aspect of the UK economy, the NHS is braced for a “huge shock” to its finances. The Treasury faces that same demand from all public services, alongside households and businesses.
When asked in the abstract about fair pay, the public frequently rates doctors and nurses as the most deserving, and FTSE 100 CEOs among the least. Yet public support for the doctors’ action, high at first, falls with each strike, now 53% opposed to 38% in support. In these stagnant growth decades, the BMA’s 26% pay demand restoring 2008 pay rates is deserved by virtually everyone else too, public and private. Resident doctors’ pay in England starts at £40,000, rising to £76,500 in their last training years. Is that a lot or not, with national median pay at £39,000? Doctors may not choose a career in medicine for money, but tend to compare themselves with equivalent high achievers who choose commercial law or the City.
A senior consultant, overseeing resident doctors in his team at a top hospital, talks to me of his easier training days: accommodation was free and student loans were nothing like the £100,000 debts weighing down new staff now. This year, only one out of eight of his residents got a training place, which shocks him. But despite his sympathy, he’s against the strike: he has had to cancel patients this week. These torn sympathies are what no off-ramp looks like. No end is yet in sight.
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