How damaging will this junior doctors’ strike be?

Across England, around 50,000 junior doctors are currently taking part in industrial action over a long-standing pay dispute. The doctors’ union, the British Medical Association (BMA), has calculated that junior doctors have watched their wages fall by 26 per cent in real terms since 2008. Now, they are striking for pay restoration of 35 per cent to compensate for 15 years of below-inflation wage increases. 

Predicted to be the ‘most disruptive’ strike to hit the NHS so far, the four-day walkout has been condemned by senior health service officials for the high risk of ‘real harms’ it will cause by putting patient care ‘on a knife edge’. Hospital leaders have admitted they are ‘more concerned about clinical safety than at any time during Covid surges’. As this bout of industrial action is taking place during the Easter school holidays, health bosses have raised concerns about added difficulties in finding consultants to cover, particularly for night shifts. As a result, health service officials have said that this time around there is a ‘real hike in [the] threat to patient safety’.

Emergency services have seen consultants who usually work in other departments drafted in to cover rota gaps, while the public has been urged to avoid ‘risky behaviour’ between now and 7 a.m. on Saturday. And while cover for A&E departments is a main priority, it is non-urgent hospital care that has already taken a devastating hit. Around 300,000 appointments and routine operations have been cancelled in order to ensure there is capacity to deal with emergency admissions over the four-day period. Of those cancelled appointments, many were for cancer patients. 

In a statement released yesterday, Downing Street insisted that no talks would be held with the BMA unless junior doctors ‘abandoned their starting position of a 35 per cent rise and called off the strikes’. But the government has not yet put forward a compromise of their own: the doctors’ union said before the strikes that they were after a ‘credible offer’, setting the 35 per cent figure as their starting point. Discussions held last month stagnated after negotiations broke down and with no counter-offer on the table as of yet, no progress has been made. 

Leading this second round of strike action is a recently-elected duo who chair the BMA’s Junior Doctors Committee: Robert Laurenson and Vivek Trivedi. Laurenson and Trivedi originated from a left-wing faction of the union – Doctors’ Vote – which was becoming increasingly irate about the handling of previous pay negotiations. The Doctors’ Vote group had used social media platform Reddit to ensure that their more pro-strike members were elected to the Junior Doctors Committee to influence the direction of the BMA.

Under the leadership of Laurenson and Trivedi, the BMA’s Junior Doctors Committee has been criticised by both government officials and doctors themselves as assuming a ‘political militant stance’ and for pursuing ‘impossible rises’. The Academy of Medical Royal Colleges issued a warning to junior doctors about how further strikes will impact patients. Meanwhile some BMA members have let slip that they are not entirely sure whether their leaders do possess the right attitude and skills to secure a deal. It has been reported today that Laurenson is currently on holiday.

During talks in March, the co-chairmen of the BMA’s Junior Doctors Committee sat facing health secretary Steve Barclay in complete silence. Instead of outlining their negotiation plans, delegates from the BMA exchanged WhatsApp messages and Post-it Notes so as to avoid Barclay and his team from learning too much about their strategy. Only James Steen, a BMA industrial relations officer, spoke on their behalf. All the while, the health secretary was being eyeballed by the crab badges pinned to their chests: a symbol of the BMA’s commitment to ‘move in unison like crabs do’. It’s a helpful way to demarcate those doctors on social media who are in favour of strike action: in their usernames, spot the crab.

But the picket lines have not, unfortunately, been uniform. Although the BMA has said that harm will not be caused to patients as a result of the strikes, after only a few hours of picketing on day one yesterday, junior doctors had to return to a Somerset hospital that had found itself with no emergency cover. The union announced late on Tuesday afternoon that it had agreed to a ‘derogation’ on Tuesday and Wednesday in order to cover acute and emergency medical departments at Weston General Hospital. Blaming ‘poor planning by local management’, the union explained how emergency care had been left ‘exposed’. But while yesterday the BMA announced it will let seven junior doctors cross the picket line and return to work, today it has revoked its derogation and issued a heated statement:

It has become apparent that both the BMA and NHS England were misled over the level of staffing cover. Either local management were unaware they had sufficient senior cover, or they deliberately misled us. We granted a derogation in good faith and it is incredibly disappointing to see this abused in this way.

Junior doctors have left their wards to stand in protest outside of hospitals, some – though not all – arriving as early as 7.a.m. On London’s picket lines this morning, the atmosphere is buoyant and the medics are cheerful. Despite the sunlight it is cold, and a couple told me they had planned to protest for a few hours each morning before leaving around midday. The first day of industrial action in London saw a march take place in Trafalgar Square; on day two, picket lines are not quite so populated. Most passersby are mildly curious if not supportive, though one group of medics told me how one man had verbally abused them. ‘He told us we were part of a religious cult,’ one laughed. Consultants, senior doctors who are not striking, have joined picket lines briefly on their breaks to show solidarity — when they’re not having to provide cover in A&E.

And there are many different types of doctors on the picket line this week. The term ‘junior doctor’ is a broad one, used to describe any medic from their first year of work to their last year as a registrar, before they become a consultant or a GP partner – a specialist or a generalist respectively at the top of their career. Annual salaries increase with experience, but can start at approximately £29,000 which, according to the BMA, can work out at roughly £14 an hour.

When Pret-a-Manger announced that their staff were being paid up to an hourly rate of £14 there was then widespread outrage amongst many – though not all – junior doctors. ‘Thanks to this government,’ block capitals on a BMA poster screamed, ‘you can make more serving coffee than saving patients.’ It continued: ‘This week junior doctors will take strike action so they are paid what they are worth.’ 

The message was a controversial one, receiving immediate backlash from the government, the public and from other junior doctors. While the government labelled the figures ‘misleading’ as they did ‘not take account of the additional earning capacity and pay progression available to junior doctors’, many on Twitter complained about the ‘classism’, ‘wrong tone’ and ‘harmful narrative’ of the message. It looked, in some spaces, like the BMA might have severely misjudged their campaigning technique.

But with a new Ipsos poll showing that an estimated 54 per cent of the public support the junior doctor strikes, it seems the BMA’s tactics have so far paid off. The public remain on side even as medics embark on their longest – and potentially most dangerous – strike yet. And with the polls confirming public support, junior doctors’ momentum has been bolstered as the second round of strikes ramps up.

Will this support last? It’s hard to tell, given the gloomy predictions for how hospitals will fare during the walkouts. It’s clear that public support is driving the junior doctors’ own momentum: if it remains high, the government will need to shift on their own hardline position or risk dropping lower in public approval ratings. If Steve Barclay wants to be seen as the adult in the room, he will have to start talking — even if his opponents won’t.