There were no pickets when I set out at the weekend to talk to striking doctors. Not even at St Thomas’ hospital, a prime site opposite the Houses of Parliament, or at Guy’s at London Bridge. “It’s a bit sparse,” said the duty officer from the British Medical Association, the doctors’ union. The British Medical Journal (owned by the BMA but with editorial freedom) ran the headline: “Striking resident doctors face heckling and support on picket line, amid mixed public response.” Public support has fallen, with 52% of people “somewhat” or “strongly” opposing the strikes and only 34% backing them.
Alastair McLellan, the editor of the Health Service Journal, after ringing around hospitals told me fewer doctors were striking than last time, which isn’t surprising given that only 55% voted in the BMA ballot. Managers told him strikes were less disruptive than the last ones. But even a weaker strike harms patients and pains a government relying on falling waiting lists.
“When you’re operating on the margins, it takes very little disruption to send waiting lists up again,” McLellan said. Strikes are costly, since consultants have to be paid to fill shifts, which is typically more expensive. One hospital manager asked me wryly: “Have you tried paying for an out-of-hours emergency plumber or electrician?” This time Jim Mackey, the head of NHS England, is playing it tough. He told medical directors on Monday to warn doctors that anyone striking on one of their 12 compulsory training days would forfeit their qualification, and not to let strikers take up locum shifts on non-strike days to make up for the money they’ve lost. No more Mr Nice Guy.
Everyone employed by the NHS will get an above-inflation pay rise this year, which is less than the 5.4% (comprising a 4% rise and a consolidated £750 payment) that resident doctors will receive. Nurses and ambulance crews have just voted overwhelmingly against a pay award of 3.6%. That was just a consultative ballot, leaving plenty of time for negotiations that might avoid holding a full strike ballot. Consultants are now balloting too. These looming demands make it vanishingly unlikely Wes Streeting will give even more money to striking resident doctors, who have already received the top NHS offer.
Mackey plays the hard man, but Streeting’s emollience is over. He seems indignant and offended by the BMA. His first act as health secretary was to end the resident doctors’ 44 days of strikes between March 2023 and July 2024 with a generous 22% pay rise, even while the rightwing press accused him of bowing to “union paymasters”. Making peace was his welcome political signal that the party of the NHS was setting about repairing Tory damage.
There was hope for goodwill and patience from healthcare workers. So the BMA coming back for more within a year was a shock, and a slap in the face for Streeting. The BMA is kicking a government that had been well-disposed towards it. With Tory and Liberal Democrat peers attempting to block the government’s radical employment rights bill, Labour’s enemies will relish this timely assistance from the strike. A piece on CapX, a comment site owned and produced by the Centre for Policy Studies, called the striking doctors “Scargills in white coats” with “blood on their hands”, which is of course the literal truth, given what they do at work (Tom Dolphin, the new BMA chair, is a consultant anaesthetist who works in trauma surgery; his job involves “a fair amount of stabbings, occasional shootings, assaults [and] falls from height”).
Keir Starmer has warned that the strikes “play into the hands” of those who do not want the NHS to “succeed in its current form”. Vultures are circling: Nigel Farage talks of private insurance; the International Monetary Fund, in its great unwisdom, recently suggested the better-off should pay for NHS services; while the piece on CapX echoed the right’s glee at the strike: “The problem here isn’t just that the BMA is populated by socialist thugs, it’s that the NHS is a socialist system.”
The NHS is ever ready to rescue us all, regardless of status – that is why doctors and nurses top public respect charts, and why they have much to lose as the public turns against them. “When the BMA asks, ‘What’s the difference between a Labour government and a Conservative government?’, I would say a 28.9% pay rise and a willingness to work together to improve the working conditions and lives of doctors,” Streeting said in vain last week. In a timely contrast, Kemi Badenoch has declared that the Tories would ban doctors’ strikes, putting them under the same restrictions that apply to police officers and soldiers.
Both sides in this strike are obdurate. “This could be a marathon. We could be doing this until Christmas or maybe beyond,” the deputy chief executive of NHS England has glumly warned. Streeting says the negotiation door is always open, but the BMA says there’s no point without cash on the table. Bad blood between them springs from the negotiations: talks were going well until the BMA resident doctors’ committee told its co-chairs that it could not approve the government’s deal because it did not address the BMA’s demand that resident doctors receive a 29% pay rise over the next few years.
Yet Streeting’s offer tackled serious grievances: years of bad planning left 20,000 resident doctors without specialist training places, stuck in a bottleneck that he promised to resolve. The BMA damaged people’s sympathy for the doctors by absurdly comparing their pay to that of a coffee barista. Resident doctors can expect to be on a steep annual trajectory, averaging £43,400 in year one and £51,600 in year two; as new consultants they will get £105,000, while GP partners earn as much as £160,000.
The word in the corridors is that the BMA is losing support across the NHS, as well as among its own members, Nick Hulme, the CEO of the East Suffolk and North Essex NHS foundation trust, told me. He said some of his consultants had this week resigned from the BMA. So has the fertility pioneer Robert Winston. History may reassure the BMA that the public will always trust doctors over politicians. This time, the public backs those trying to cut waiting lists more than the strikers who are adding to them.