29.06.2023

Back on the picket line

The pay battle in the NHS is a mixed picture, but, when it comes to doctors, there can be no denying the determination to fight, writes Richard Galen

Strikes by junior doctors are due to reach a new high, with the British Medical Association announcing a five-day walkout starting on July 13 - the longest industrial action ever taken by medical professionals in England. This, of course, stands in stark contrast to the Royal College of Nursing ballot.

While an overwhelming 84% of RCN members voted for action, the anti-union laws took their toll once again. Less than 50% of the membership voted - there was a 43.4% turnout. Therefore, the result is deemed ‘invalid’. A further, more dynamic campaign within the RCN will be needed before another ballot is called.

The BMA dispute has so far seen three separate strikes since March and the union is currently conducting a ballot to ensure industrial action can continue past the current mandate in August. At the heart of the dispute is the push for “full pay restoration”, bringing junior doctors’ back to 2008 levels. Adjusted for inflation, that means a 35% increase will take us back to where we were 15 years ago!

Current grievances have seen a sea change in the operations and tactics of the BMA - initiated by grassroots action on social media, led by a left coalition of doctors and medical students, including the Doctors Vote and Broad Left groups. A stark contrast with the leadership back in 2016 - the last time that junior doctors took industrial action. The outcome then was the imposition of a new working contract, widely seen as discriminatory against women and single parents and resulting in further pay erosion.

At the time, many of those on the BMA’s junior doctors committee (JDC) were careerist and self-serving. They certainly had no experience of negotiating in the context of strikes. This was evident in the course of action seen towards the latter part of the dispute. There was a dearth of communication to members about the state of affairs. The cancellation of further planned strikes, followed by the invitation to health minister, Jeremy Hunt, to discuss his plans, left them no more cards to play.

Thankfully, it is clear that lessons have been learned since then. Interaction with the media has been handled more skilfully, with BMA reps undergoing media training and strict messaging to members that press enquiries should be handled exclusively by the union. This has produced the desired effect, with no mixed messages seen in interviews with JDC members. The rightwing press has struggled to find dissenting voices. Not the case back in 2016.

Hence the media seems to have tried to ignore the dispute. Even when the strikes happen there has only been minimal coverage. This has been viewed positively by the junior-doctor community - no publicity supposedly being better than bad publicity.

There has been a shift away from focusing on public opinion and garnering sympathy. Partly this is due to the new BMA staff (hired specifically for their previous experience working in the trade union movement). The priority given to public opinion is widely thought to have contributed to the failure of the 2016 action, through strike fatigue and concern about destroying the reputation of doctors.

Formidable

In this respect, the BMA has been clear - its dispute is solely with the Tory government and the Department of Health, which bear full responsibility for the current situation. That the union has had to resort to industrial action is down to them. The BMA seems to believe that having the public onside carries little weight in negotiations. Clearly the DoH simply wishes to drag out the dispute for as long as possible, hoping lost pay and a lack of commitment from the membership will eventually lead to capitulation.

Either way, a recent BMA survey shows that 83% of junior doctors have found their patients to be fully supportive of the strikes. So we are winning the war of public opinion.

Government tactics are further evidenced by the initial offer presented to the JDC by health secretary Steve Barclay - a paltry 5%. This would fall well short of current inflation figures and represents yet another real-terms pay cut. Interestingly, the Doctors’ and Dentists’ Remuneration pay review body has recently been reported recommending 6%, coupled with a ‘consolidated payment’ of £1,000. This has, though, yet to get the green light, and, of course, the government has routinely ignored pay recommendations in the past. Indeed, health and social care minister, Helen Whately, has refused to say whether or not the DDRB’s advice will be followed - that despite the fact that its chair is government-appointed, as is the whole caboodle.

The pressure is mounting on Barclay, however. The Scottish government, which has devolved powers for health, has already made a 14.5% offer over two years. This is a starting point, but, quite rightly, BMA members have stood firm, the offer has been rejected by a 71% majority. BMA Scotland has made it clear that only full restoration of pay will be accepted.

Also, this week, we have the strike ballot by BMA consultants - 87% voted in favour. They will go on strike on July 20 and 21. The margin was very much like that for the RCN - except, of course, that there was a 71% turnout. It should be noted that many of the grievances over the consultant contract are to do with the lifetime allowance on pensions, which the government abolished shortly after the ballot closed. Nevertheless, the vote represents a significant challenge to the DoH - with costs due to lost elective work now running into hundreds of millions. With more strike action, that can only but increase.

Further adding to Barclay’s woes are GPs, who in April balloted in favour of industrial action if their working contract is not reviewed in the next few months.

If the Tory government thought they were facing the same disorganised and timid union as in 2016, they have been proven wrong - and the change has wholly come from rank-and-file members, who, when properly galvanised, represent a formidable challenge.