Why are junior doctors striking – and when will it end?

After the government agreed to honour the pay recommendations for other NHS workers, Sean O’Grady examines why junior doctors are continuing with their planned five-day strike

Striking NHS junior doctors on the picket line outside Leicester Royal Infirmary in April (PA)

The junior doctors have embarked on an unprecedented five-day-long strike, though it is hardly the only industrial action to have hit the NHS lately, and more will take place in the coming months. It comes just as the government agreed to honour the independent pay bodies’ various recommendations on pay across the public sector, and Rishi Sunak indicated that, as a consequence, there would be no more talks on pay.

Who’s on strike?

Doctors in the NHS who are members of the British Medical Association (BMA), British Dental Association (BDA), and Hospital Consultants and Specialists Association are going on strike from 7am on Thursday 13 July to 7am on Tuesday 18 July – 120 hours in all. Consultants who are members of the BMA and BDA will also be striking – another unprecedented move – for 48-hours, from 7am on Thursday 20 July to 7am on Saturday 22 July. This action will also have an impact on the county’s hospitals and mental health services.

The Society of Radiographers has announced 48 hours of strike action across 40 trusts from 8am on Tuesday 25 July to 8am on Thursday 27 July. Other royal colleges, such as those of anaesthetists and physiotherapists, may also withdraw their labour in the coming months. For now, the nurses are not taking action. All of these actions will only affect England.

Why such a long dispute?

Because they mean business. Since the previous Tory government abolished benefits for strikers and permitted employers to dock pay, the cost in lost wages to individuals taking action can end up exceeding any possible rise or improvement in conditions. The junior doctors are thus sacrificing the best part of a week’s pay to secure a more long-lasting benefit to themselves – and, they argue, the ability of a properly staffed NHS to do its job for patients.

They point, fairly, to doctors leaving the service and even emigrating to Australia and New Zealand after years of costly training paid for by the British taxpayer. Anyway, they’re determined.

What about my GP?

Almost all general practitioners are self-employed or form part of a partnership, so they can’t actually go on strike. They too have had major grievances, especially on the structure of their pension scheme, which sees their savings subject to a higher rate of taxation when the pot reaches a certain threshold (about £1m).

Recently the chancellor, Jeremy Hunt, made special provision for them, which should stem the outflows as a result of GPs taking early retirement. There are also reforms coming into place to make booking an appointment less of a game of 8am telephone-call roulette. Ministers hope that this will ease waiting times and make the process more rational.

It goes to show how industrial “muscle” can be applied through commercial pressure, and was in fact one of the ways in which GPs and consultants negotiated an excellent deal from Aneurin Bevan when the NHS was set up in 1948. In Bevan’s famous phrase, he “stuffed their mouths with gold” to quell their objections, and allowed them to continue in self-employment and/or private practice.

“Junior” doctors, which just means those who’ve not yet become consultants, tend to be salaried and not do so much private practice. Hence the strikes.

What do they want?

The short answer is “35 per cent”. That’s the figure – not much disputed – that would restore the real value of their salaries to 2010 levels. It sounds enormous, even under present inflationary conditions, but don’t forget that doctors’ pay, like that of the rest of the public sector (and not private business), was subject to a long period of freeze and then minimal increases during the Osborne austerity years around a decade ago.

So they want a reset, and imply that if the government concedes the principle of restoration, if not the timings, then they will talk rather than strike.

The BMA points to a similar process after the last Labour government came to power in 1997 – though the erosion of medics’ purchasing power wasn’t so great at that time, and the economy was growing healthily.

In presentational terms, however, the 35 per cent figure is a bit of a disaster. To many it simply sounds extreme and unrealistic, and in the end, retaining public support is essential to any chance of success. Meanwhile, the government is proving stubborn.

Are the public backing the doctors?

Yes. Support for junior doctors (according to Ipsos) has in fact grown from 47 per cent in January to 56 per cent in June, with only 24 per cent saying they opposed the junior doctors’ strikes.

The pollsters suggest that public opinion is guided by strong concern about the current state of the NHS and an inclination to blame the government, rather than the NHS or its staff, for problems, including the strikes.

Who will win?

Hard to judge. Even if the government wanted to settle with a handsome pay rise, it would be very difficult given the parlous state of the public finances. Although he has ramped up his tax income, the chancellor has very little room for manoeuvre, not least because rising interest rates increase the cost of servicing the national debt.

In order for Hunt to hit his fiscal targets on borrowing and debt, and for Sunak to meet his short-term “priority” aim of getting debt down, they simply cannot afford to concede. Neither side, in other words, feels that it can compromise.

What happens next?

Impasse and more strikes, probably stretching into the autumn. If they are still on during the usual NHS winter crisis, then things may turn very ugly, and maybe more so for the Sunak government than for the unions.

What does it mean for patients?

Pain and disappointment – and, common sense suggests, the risk of worse outcomes.

According to NHS England, industrial action has postponed approximately 600,000 hospital appointments across the NHS with over 365,000 staff absences during the last eight months of intermittent disputes. Previous action by junior doctors saw between 21,000 and 24,000 staff off per day due to industrial action. The most recent industrial action by junior doctors saw 106,000 hospital appointments disrupted over three days.

The NHS adds: “In advance of strike action, we work with unions to agree which members of staff can continue to work to ensure safe levels of care. These agreements are called derogations, and often mean that some health union members will continue their work in line with an agreement between employers and unions. Where derogations have not been agreed, we may have to move staff from other departments within a hospital to ensure we can continue to provide emergency care.”

Do the strikes mean Sunak will miss his waiting-list target?

It doesn’t help, but much also depends on other factors, such as whether the strikes intensify, how adept NHS trust managers are at minimising disruption, the general funds flowing into trusts, and any winter crisis or vicious new variants of Covid.

Ironically, the agreement on pay with the nurses and others will make it even more difficult to fund a large rise for the doctors, or more recruits, because ministers have told trusts to find the 6 per cent pay hike out of existing budgets, which are also being eroded by high inflation. A financial squeeze on trusts on that scale will inevitably affect waiting times and quality of service.

More broadly, continuing a year’s worth of disruption to an already struggling NHS will pile the political pressure on Sunak, and give rise to the impression that he’s not in control of events. His stance on future negotiations – ruling them out in all circumstances – may make him look stubborn and unreasonable, and then weak if he eventually has to cave in.