Junior doctors have begun their 72-hour strike today, with tens of thousands of NHS appointments cancelled. NHS chiefs are more worried about the impact of this industrial action than they were about strikes by nurses or ambulance workers. This is not least because doctors who are members of the British Medical Association (BMA) and the Hospital Consultants and Specialists Association are walking out from emergency care as well as elective treatment.
The political dynamic between ministers and the BMA in particular is very different to that with the Royal College of Nursing (RCN). The BMA has been at loggerheads with successive governments throughout the 75 years of the health service’s existence. The RCN, on the other hand, has been a more moderate force – with just the odd spell of booing health secretaries at conferences from time to time. The current stand-off, over whether junior doctors should get a 35 per cent pay rise to compensate for a real-terms loss of income of 26 per cent since 2008/09, failed to reach a resolution before this strike because both sides claim the other is refusing to engage.
Even if and when the pay dispute is resolved, the short-staffing and crumbling hospitals won’t be
On the side of the government, Rishi Sunak told journalists travelling with him to San Diego that it is ‘very disappointing that the junior doctors’ union are not engaging with the government’ and that ‘we are actually having constructive dialogue with other unions who have accepted our offer to come in and talk’. That last line is a reference to the nursing strikes, which are currently on pause after the two sides agreed to discuss pay.
It isn’t accurate to say that the unions ‘accepted our offer to come in and talk’, though. In the case of the RCN, the breakthrough came when Steve Barclay offered to discuss pay for 2022/23, rather than for 2023/24. The nursing union also agreed to discuss increasing productivity, which was one of the the Department of Health and Social Care’s demands. They also indicated that their initial demand of 5 per cent plus inflation was something they could meet the government halfway on.
Late on Friday night, the government offered junior doctors formal talks on pay for 2022/23 and 2023/24 to stop the strike, on the condition that the BMA cancel the walkout. The BMA refused, saying it could not accept the pre-conditions. The talk on the picket lines is as much about the conditions in the NHS more widely as it is about pay.
After talking privately to hospital chiefs about the action, I was struck by the combination of anxiety that they had about the impact of the strikes on patient safety and sympathy for doctors who they know are stretched beyond their capacity on a regular basis. Many feel the suggestion that consultant cover for striking workers will actually raise the quality of care overlooks the fact there aren’t enough consultants to cover the wards in the first place, with junior doctors making up some 45 per cent of the medical workforce.
At a recent conference organised by the Nuffield Trust, one specialist explained that, at the moment, the levels of post-traumatic stress disorder and mental illness in the health workforce are worse than in military veterans returning from Afghanistan. Other speakers in the same session complained of NHS staff being sent on ‘resilience training’ if they complained about unsafe staffing levels – as if the concerned worker was the real problem, not the lack of colleagues to treat patients effectively. There was a general agreement among the panellists in this session that a significant aggravating factor in the strikes going ahead was the level of moral injury that NHS workers have been suffering recently (I wrote more about this here).
Away from the talks themselves, something that will aggravate the situation still further is the possibility that the Treasury could be removing or editing the numbers of doctors and nurses from forecasts of how many workers the NHS will need. The fear in the Treasury has always been that such forecasts unnecessarily tie the hands of future governments. They can also provide a convenient political stick with which the opposition can beat ministers when they fail to meet the forecast numbers. That was perhaps more understandable in previous incarnations of Whitehall’s beancounting department. But given the current Chancellor is the man who campaigned for these forecasts in the first place – and then complained when they weren’t introduced – there had been some hope across the health service that something might actually happen.
Even if and when the pay dispute is resolved, the short-staffing and crumbling hospitals won’t be. As such, relations between doctors and ministers aren’t going to improve any time soon.
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