16.03.2023

Striking for pay restoration

Richard Galen welcomes the growing influence of the left amongst junior doctors and how this had led to a surge in BMA membership

Junior doctors across England struck for 72 hours over March 13-15. Coinciding with Jeremy Hunt’s spring budget, they were joined by teachers, university lecturers, London Underground drivers, civil servants, and BBC journalists. This was the biggest walkout since the start of the current wave of industrial action.

Junior doctors are overworked, often deep in debt and furious. The ballot for strike action saw an unprecedented mandate of 98% in favour, with a turnout of 77% - easily clearing the draconian threshold imposed by the 2016 Trade Union Act.

The strength of feeling was such that the unions involved - the British Medical Association and the much smaller Hospital Consultants and Specialists Association, which held an independent ballot of its own eligible members with a similar mandate - decided to commence the strike action with a full withdrawal of labour, leaving consultant colleagues to cover all patient care.

This represents a marked escalation, compared to the previous strikes in 2016, which were over 48-hour periods and initially did not involve a full withdrawal of labour. The grievance, too, has changed, with the previous walkouts relating to the imposition of a new contract, universally felt to be a backward step in terms of pay and conditions. However, this time the message is clear and concise: the unions want what is termed ‘full pay restoration’ - a return to the pay levels seen in 2008 (inflation-adjusted).

As with almost all public-sector workers, junior doctors have seen their pay cut by both inflation and years of pay freezes. The BMA estimates that, compared to 2008, basic pay has declined by more than a quarter (26.1%) in real terms, thus requiring an increase of 35.3% to reach parity. First-year doctors, after racking up huge debts at university, often north of £100,000, can be paid as little as £14.09 per hour.

This is adding to the problem of doctors leaving the NHS in droves. As of today there is a 9,000 shortfall in doctors. Gaps in rotas have to be filled by locums (with medical agencies creaming off profits) or by already overworked doctors in the department, contributing to high rates of burnout. Emigration to the Middle East, US, Canada or Australia is seen as an attractive option, where it is said posts offer much better pay and less stressful job plans.

At the root of these problems lies the chronic underfunding of the NHS by the Conservatives, leaving over seven million people now on waiting lists for treatment and an overall staff vacancy total of over 133,000. A&E departments are struggling to cope, with three in 10 patients waiting more than four hours to be seen and several records set in the last few months regarding the number of patients waiting more than 12 hours for a hospital bed. Even the hospitals themselves are quite literally falling apart, with the overdue repair backlog for the NHS estimated to have reached £13.8 billion - all while the government is laughably claiming that soon there will be “40 new hospitals”.

The road to strike action began with a grassroots campaign to reform the BMA that started on the Junior Doctors UK forum of the news aggregation site, Reddit. There was widespread dissatisfaction with the outcome of the last set of strikes. Many put the poor settlement down to the BMA, whose leadership capitulated to government demands and failed to take advantage of the appetite for change amongst members. It was also felt that both the leadership of the union and the formal meetings of its various committees lacked transparency.

A group of like-minded doctors was brought together under the name, ‘Doctors Vote’, and it has campaigned for democratic changes in the BMA, better conditions, ending privatisation and pay restoration. Together with the Broad Left - a self-described leftwing group of doctors and medical students - they ran a coordinated online campaign, which led to a good number of its candidates being elected to the BMA council. This allowed the group to pass motions that formalised the policy of the union to aim for pay restoration, making union activities more transparent to members, providing funding for union reps and activists to become trained in labour negotiation and media appearances.

No doubt this has contributed to the BMA’s recent surge in membership, with the ballot result for industrial action coinciding with the announcement by the union of a record 184,000 members, of which 17,000 have joined since the start of 2023.

Meanwhile, the Tory government seems to be sticking with the same strategy it has employed with other health unions, such as the Royal College of Nursing - trying to wait out the dispute in the hope that public support wanes and the unions accept the first inadequate deal they are offered. After stonewalling the BMA for months (despite knowing that strike action was on the cards), a meeting with civil servants from the department of health in mid-February yielded no progress - health secretary Steve Barclay refused to even attend. He later did meet with the BMA junior doctors committee (JDC), but admitted that he had no mandate from the prime minister to start negotiations, and in any case was unwilling to negotiate while strike action was pending.

A last-minute request on March 10 by the government to call off the strikes during a meeting with department representatives - yet again, Barclay did not show up - was rejected, after officials could not even describe how negotiations might progress. A letter from Barclay did reach the BMA later that evening, offering to begin formal discussions on pay, but set a number of preconditions - including an immediate halt to all proposed industrial action and the discussion of future pay levels only - rightly seen as unacceptable by the JDC leadership, which refused to call off the action.

The impact of the strike has been significant, with NHS trusts having to cancel tens of thousands of outpatient appointments and elective surgical procedures, while further action is planned if reasonable negotiations are not forthcoming. Consultants are likely to be next in line for an official ballot on industrial action, with a consultative ballot this month easily meeting the threshold to proceed.

The government still claims that the pay demands made by the BMA are “unaffordable”, yet net costs have been calculated by the union to be approximately £1 billion - a quarter of the amount that the Tories were willing to waste during the pandemic on personal protective equipment that could not even be used.