27.06.2024

Upping the fight

Neither the Tories nor Labour will commit to full pay restoration, writes Richard Galen - that despite the huge popular support for doctors

Just seven days following Rishi Sunak’s announcement that the much-anticipated general election had been called, the Junior Doctors Committee of the British Medical Association for England made a bold move. It announced a five-day walkout (June 27-July 2). That means we finish our latest strike action just 48 hours before polling stations open. Despite the latest round of negotiations running for three months and employing the services of an external mediator, no credible offer had been made by the government.

The decision for further industrial action so close to the general election did initially draw some criticism from doctors on social media. There are those who felt a strike while parliament was dissolved would be pointless, especially given it is likely that the Tory government, with whom we have been negotiating for more than 18 months, will be booted from office. However, others saw it as a positive, correctly predicting huge amounts of scrutiny over healthcare policy during the election campaign and the chance for parties to make a manifesto commitment to resolve the dispute.

The response from the political establishment was predictable, with Sunak calling the strike “politically motivated” and insinuating the timing was planned to benefit Labour. Tory health secretary Victoria Atkins called on Labour to “finally condemn junior doctor strikes” and called the decision a “highly cynical tactic”. The ongoing industrial action - 39 days in total over the last 17 months - has become a significant thorn in the side of the government, with Sunak repeatedly trying to lay the blame for soaring waiting lists (currently at 7.57 million cases, a near-record level) at the feet of striking workers. This claim is cast into significant doubt (to put it mildly) by the fact that waiting lists have continued to rise even when no strikes have been taking place!

At this point, the financial cost to the NHS of industrial action has been estimated to be as high as £3 billion, dwarfing the likely £1 billion net cost of meeting the BMA’s demands for full pay restoration (FPR) to 2008 levels (in practice a 35% pay rise). The union has repeatedly stated that all that is needed to avert more walkouts is a credible path towards FPR, which does not have to be achieved in a single pay uplift. Why on earth should we doctors accept such greatly decreased pay in real terms?

Interestingly, Labour leader Sir Keir Starmer refrained from directly condemning the strike, but did take the opportunity to criticise the “shocking” lack of resolution from the Tory government. Shadow health secretary Wes Streeting has indicated that finding a solution to the dispute would be a priority if a Labour government is elected, stating that he would be “phoning [the BMA] on day one” to restart negotiations. However, he has refused to back down from his longstanding stance that the BMA’s FPR demand is “unaffordable”!

In fact, out of all of the major political parties standing in England, only the Greens have made a commitment in their manifesto to support the call for pay restoration, with the Liberal Democrats making passing references to an independent pay review system and Reform UK’s “contract” not mentioning the dispute at all.

Of course, the dispute rumbles on in the other devolved health services as well, albeit not as well covered in the media. Junior doctors in Northern Ireland recently staged a third 48‑hour strike at the beginning of June, and their consultant colleagues are also set to walk out (though providing a ‘Christmas Day’ service) on June 26, following a successful ballot, with no less than 92% in favour of industrial action. This is aimed at putting pressure on the new health minister, Mike Nesbitt (Ulster Unionist Party), who has yet to put forward a pay offer.

After a series of strikes, BMA Cymru/Wales has secured new pay offers for both junior doctors and consultants working in the country, with members being balloted on whether to accept this month. The new deal offers junior doctors a 12.4% rise backdated to 2023 - a marked improvement from the original offer of just 5%. The union has advised its members to accept, stating that “this offer puts us well on the path to pay restoration”.

Although GPs in England, on separate contracts to their hospital-based colleagues, have not yet begun any form of industrial action, the recent ballot on the government’s proposed 2024-25 contract changes resulted in over 99% of members rejecting the plan. There is currently a ballot running for so-called “collective action” - not a true strike, but a commitment amongst members to push back against NHS management targets and strategies and consider “work to rule” approaches to the current contract - but understandably this has resulted in a backlash from members, who feel that this does not go nearly far enough.

Ultimately though, it does seem like lessons have been learned from the disastrous days of the 2016 contract disputes, where the BMA leadership of the time capitulated to government demands, and utterly failed to capitalise on member support. The current underlying strategy of full walkouts with consultant cover, gradually ramping up in terms of length, still manages to retain support from both the membership and the wider public, as evidenced by Sunak’s recent appearance on the Sky News leadership debate, where loud boos from the audience came when he blamed the waiting list figures on the strikes.

Detractors from within the BMA have consistently not seen their fears play out, whether that be the loss of public support from repeated walkouts, patients coming to harm as a result of strikes, or apathy from the wider media, given the length of the dispute. Most members are confident that this will remain the case with the current action.

The decision to call a strike so close to the election will force the issue back into the public eye, and set a challenge to any incoming government - get back around the negotiating table and thrash out an improved pay deal for doctors.