Doctors strike – what's different this time?

0:00Hey man, you hungry? Let's order delivery. Yeah, I was thinking... Italian. Burgers? Oh. Game night, just got tense. Two bros on different sides of the fence. Burgers or pasta tonight. Why can't we have food without the fight? With Wonder, you can combine 20 restaurants in one delivery, so no one has to settle. Download the app today. Wonder. Food without the fight. Coming up on The Daily with me, Neil Patterson. Junior doctors are heading out on strike for five days, demanding a significant pay rise. But didn't they get one last year? That's next. Okay, last meeting wrapped. It's too late to cook.

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1:15Brace yourselves for another set of NHS strikes. Junior doctors, now known as resident doctors, well, they won't be going to work for the next five days. appointments and services will be affected. So why strike? The British Medical Association says, thanks to inflation, its members are in real terms earning less than they were more than a decade ago. Which was the argument they were making last year. An argument that led the Health Secretary to offer, and the BMA accept, an average 22 % increase across two years. Now that clearly hasn't stopped them from demanding even more. But for now, the government giving no sign that it's willing to back down.

1:57We will be speaking to one resident doctor just a little later to get the perspective of someone who knows just how hard the job can be. It has a huge toll on your body. I've lost hair in the process of the stress that I've had to go through. But let's get started with our health correspondent, Ashish Joshi. Ashish, walk us through why the junior doctors, now obviously residents, why they're off out on strike again. They're striking about the same thing they were striking about last time. They want more money. They want more money because they say that they have been undervalued and underpaid for so many years that even with the 5.4 % they had in this financial year on top of the 22 % they've already had still means that they are way behind where they should be because they're not earning as much as they should have been earning 10 years ago.

2:47Pay restoration, Neil, it's called. When you say it should be, What do you mean? What I mean is if their pay had kept in line with inflation, with everything else, the cost of living, then they should have been paid more money. But their pay has actually fallen behind in real terms. So a junior doctor right now is earning£18 an hour. And they say that they should be earning at least£22 an hour. So is the government just point blank refusing to negotiate? No, no, it can't. It can't point blank refuse to negotiate. What it can do is it can come to the table and say, we're not going to talk about money because I don't have any more money.

3:28All the money I have, this is where Streeting speaking, has already been earmarked for the NHS, the 10 year plan to get the NHS back up on its feet. We've given you all pay rises. This was one of the first things he resolved when he came into office. And he made a big deal of this. He said, two years of strikes under the Conservatives. I've come in. I've sat around the negotiating table. I've told doctors I value them. And this is the pay deal. And they accepted it at the time. But the resident doctors went back to their membership, balloted again. And they said, no, we're still way behind everyone else.

4:05Couldn't they have made that point when they negotiated the last settlement? Well, they have a different union leadership in the BMA now. and there was some discontent that the margin was very small, which got it over the line to accept the government's offer. And even the backing for this strike isn't as big as the BMA would have liked. Let's be specific. What is it? Percentage terms. How much more do resident doctors want on top of what they've already had? They want to see pay restoration, which would bring them up to current levels. And that means a uplift in their terms of 26%. Dear Lord.

4:42And I think there's a general acceptance, Neil, that resident doctors' pay is below where it should be. 100%. And they want to see this 26 % as a restoration to bring them up to current staffing terms. OK, so what does the health service look like for the five days of this strike? It depends on what part of the country you're in. NHS England is very keen to make sure that there is as little disruption as possible. ED, the doors will remain open. They have to stay open all the time. ED is primarily run. Emergency department. Yeah, the former A &D, not only are the junior doctors now resident doctors, but accident and emergency is now rebranded as the emergency department.

5:26So that relies heavily on resident doctors. No resident doctors in ED means it has to have more senior staff drafted in. And what about appointments? I mean, people have got appointments over the next five days. Are they happening? Are they not happening? What's the deal? This is very, very important. This is the new battleground between the government and the BMA. NHS England has gone back and told all of its trusts, you decide you're in charge, it's your hospital, you understand the patients, you understand the demands and needs, and you also understand what your staffing levels are. We do not want you to cancel electives, diagnosis, all of the routine appointments unless you absolutely have to.

6:10So the language has changed now, right? NHS England has told trust leaders that you can look at somebody who's coming through a cancer pathway, for example, somebody who's got cancer, they need to have a scan, they need to have some sort of treatment for their cancer. Is that life threatening? No. But could there be a serious deterioration in that person's health if they don't have that appointment? Yes. So that person can then be brought in and seen under striking conditions. Right. That didn't happen during the previous two years. So almost routinely, all appointments were cancelled. This time around, the battleground has changed because the language has changed.

6:55And this is what the BMA, they're really concerned about this. and they're pointing this out and saying, you can't change the parameters around the safekeeping of patients. Well, the BMA basically just wants hospitals, whilst they're on strike, to be providing emergency care and nothing else, don't they? They want to go on strike and they want to cause maximum disruption because otherwise, what is the point in being on strike? That's what they would tell you. But they would say safety and patient safety is a priority. They do not want to undermine patient safety. But there's an argument being had very openly between NHS England, the government on one side and the BMA on the other saying, what are safe staffing levels?

7:36If the NHS raises that bar, then it can see more patients. There's less disruption. If the BMA keeps the bar as it is, then those appointments aren't taken. They're not made. And patients have to wait longer. And what happens then, Neil? The waiting list grows, which is one thing where Street Team does not want to see, is the waiting list growing again. Are patient lives at risk? I mean, I've heard some very prominent people resigning from the BMA, suggesting that the doctors are once again, essentially, putting people's lives on the way. Of course, industrial action puts patients' lives at risk, because you don't have the number of doctors that you would ordinarily have attending to patients.

8:17and this happens on so many different levels. We've had five names, I think, in the public domain of patients who have very sadly lost their lives over the last few years because it came through the coroner pathway. Coroners picked up these deaths and said, this person had a certain condition. Had they been seen, it's very likely that they would still be alive. So they haven't absolutely said, because of the strike, this person died. But if you have patients who need to be seen, And this is the problem, right? It's not just the staffing levels. If you make it to a hospital and you are very, very, very sick, the chances are you will survive.

8:57You will be seen by a trained doctor in a timely fashion. They will make that intervention. You will be seen. It's the people who don't present at hospital. Oh, there's a strike on. There are no doctors. I better not go in. This pain I've got in my chest, I'm sure that will go away. Ashish, if resident doctors are on strike, that to me implies that the people who will be backfilling them will be more senior than them. They have to be. And if they are more senior than them, they will cost an awful lot more than them. I mean, I saw a figure quoted of£3 ,000 for a consultant doing an overnight shift.

9:31I mean, is that the ballpark? That's the ballpark figure. Consultants earn a lot of money, and if they're not working their NHS shift, there will be many consultants who will earn twice as much in the private sector. But what they do is they come in, they have to backfill. Over the last couple of years, we saw figures in there, tens of millions of pounds. It was costing a lot of money to bring in trained staff to support these doctors in the hospitals. Strikes cost a lot, full stop. Isn't it more than that? I mean, yeah, we've already identified that both the NHS and the government are speaking in a bolshier tone on this particular topic.

10:05But the argument coming from the NHS is a really striking one. They are saying that actually periods of strike action are a net benefit for the resident doctors. They're actually, yeah, they lose money when they are on strike. The waiting lists have increased. They want to get in there and clear that backlog. Who clears the backlog? The resident doctors who are on strike. So they got overtime and their pays back to where it was or even higher than it should have been. No, but they're still earning the same amount, but they're earning that money, which they say they're being underpaid for, for doing overtime.

10:34But they're all, they would say to you, and you're going to be speaking to resident doctors and I'll let them put their own argument forward. But I spoke to one yesterday who's going out on strike over the next five days. And he said, we don't want to be striking. Right. He said, we don't need the extra work. We don't need the pressure. We'll return to Ashish in just a second. But time to hear from someone actually doing the job. Hi, I'm Dr. Pasha Mukherjee. I'm a GP trainee. I've got about two weeks left of my training before I qualify as a GP. and I work in North London in a GP practice and I have voted to strike.

11:13And explain that. Explain your reasoning behind the vote to, again, strike. To me, West Streeting was going back on his own claims. A year ago, he had claimed that when Labour would be coming into government, he would do anything in his power to put the strikes to an end. And the deal that he's given us this time round, which is 0.9 % above inflation, which is going to take us 20 years to get to full pay restoration, that to me doesn't seem like he's keeping up his end of the promise. Pasha, just give us a flavour of what your day-to-day job is like. I mean, it's often said that resident doctors, without them, the NHS would collapse.

11:52Give us an insight into that. I can speak for what my current workday looks like right now. I'm working five days a week. I usually will see 10 minute appointments, patients literally on edge trying to get through as many patients as I can, because we don't have enough GPs. So all the patients get squeezed in. And we're having to essentially document, document, document after each patient. And any time that I have left during the day, I'm usually updating my own knowledge, you know, doing preparing for exams, studying, I've just passed my exams, actually. I was actually doing two, three hours every single day on top of a work day studying for an exam, which obviously you don't get paid for those extra hours.

12:36I definitely empathize with, you know, the junior doctors that are working in hospitals as well. Back then, I used to be working some weeks, seven days a week. It has a huge toll on your body. I've lost hair in the process of the stress that I've had to go through through COVID. I've had real health problems. I've developed high cholesterol from the high levels of stress I was working in. So it has real world implications on us working in those circumstances, eating the trashy food that you get in the shops and hospital because you're so busy, you're not getting a chance to make food for yourself or do some of these things like shopping, cooking, et cetera.

13:17It has real world implications in our lives. But doctor, with respect, What does a 26 % pay rise do for the quality of care provided to patients or indeed the negative health outcomes you've experienced because of working long hours? What that 26 % will ensure that is going to be more incentivised for doctors to stay in the system so that we're not constantly having to rely on foreign doctors and doctors that are working locum shifts who don't provide that same continuity of care. and we can at least feel minimum staffing levels in hospitals and GP practices. But do you not concede that for the average member of the public looking at the situation right now, a 23 % pay rise given over two years admittedly and now the BMA asking for an additional 26%, it is in the eyes of people who are on short-term contracts, minimum wage, zero hours, it is surely unjustifiable to them that a profession which is not badly paid, not paid what they should be getting paid perhaps, asking yet again for not just a double digits, but a more than 25 % increase in their salary.

14:26I think we need to think bigger than just this pay conversation. It's a conversation also about, and by all means, I think that all healthcare workers should be asking for fair pay. I think the NHS overall needs to be reprioritised, and I don't think that's happening. For every pound that's put into the healthcare system, it actually puts four pounds back into the economy. There is definitely a narrative that the blame of everything that's wrong with the NHS to scapegoat that onto resident doctors. The NHS, as it stands, is horrendous. I've had to resort to private healthcare, even at very high cost to myself.

15:07I have lost faith in the healthcare system myself. But if we don't protect what stands at the moment, which is the staff, which is the resident doctors, then it is going to keep crumbling. Thanks, Pasha. Let's just bring our health correspondent, Ashish Joshi, back in. Ashish, look, Pasha made the case, made the case pretty strongly, I would say. But let me counter with a simple point. Since March 2023, we have had, including this one, 12 strikes by junior doctors, 49 days of disruption. that's almost 10 weeks 10 working weeks within the NHS that have been lost or affected The only thing that's going to bring this to an end is the government and the BMA agreeing on a sum which is acceptable to both parties that's the only thing the BMA aren't going to back down I was on Sophie Ridge's show last week and quite embarrassingly I stuck my neck out I shouldn't have done as a professional journalist but I was put on the spot and they said to me Ashish, what do you think is going to happen next week?

16:07And I said, well, I'm telling you right now, the strikes will not go ahead. Because I was absolutely convinced. If you look at the dynamics of this, this is a Labour government, a Labour government which has gone in with two feet and looked at the root causes of all the problems in the NHS. It resolved the doctor's strikes as soon as it came in. We have the 10-year plan. We have the DASI report. So it's absolutely clear to anyone, even the most cynical outsiders, that the NHS is the Labour government's number one priority. It wants to fix the NHS, right? So I thought, if you have a Labour government which is absolutely sure that it knows what to do with the NHS, it needs the resident doctors on board, otherwise it can't do this.

16:55And you have the resident doctors who must see that the government is doing everything it can to improve the NHS. Yes, your working conditions. So I thought in my head when I was speaking to Sophie, I thought, I just can't see this strike happening. Two days later, the BMA says the strikes are going ahead. So it just shows, one, I'm not a very good pundit. Two, there are deeply entrenched positions. Deeply entrenched. I mean, we've had so many strikes. There's been so much disruption. And increasingly, people just do not like it. Public opinion is turning against resident doctors. And they accept that.

17:28I put that to the resident doctor I saw yesterday. Dr Shivam Sharma and I said you don't have public opinion on your side anymore he said yeah I know we're losing it but hey that's a price we're willing to pay Given your powers of foretelling on Sophie Ridgis programme I'm loathe to do this to you Ashish but where does this go? What happens next? Do we see five days of strikes? Do we see West Street going back into the negotiating room? What happens? I don't know I really don't know and I'm not I'm not actually trying to avoid the question. I'm really trying to wrap my head around this, right?

18:03We have a health secretary who has done everything he can to shake up the NHS, but he's also a health secretary who will now be furious with the resident doctors. What does that do? Does that push West Streeting further away and say, right, this is it. I'm going to do this my way. We're going to bring them back to the negotiating table and we're going to get them to call off the strikes, but without giving them any more money because we know we've got to end this dispute. We also have a new leadership at the BMA who are, let's just say... As bolshy as the government? Yes, definitely, who are not taking anything that the government gives to them without putting it to their membership and the membership themselves.

18:51Younger, more organised and clearly from speaking to a lot over the last few years, they are not willing to back down. That's the difference. Neither side in this is willing to back down, but something's got to give. Certainly does. Ashley, thank you. That's a lot for this edition of The Daily. To read more about the doctor strikes, just head to skynews.com or see you again tomorrow.