Why doctors are striking again

0:00This is The Guardian.

0:07Today, junior doctors are striking again. And this time, they want a 29 % pay rise.

0:21My name's Dr Becky Lavelle. I'm a registrar in obstetrics and gynaecology. And I work as a resident doctor based in Yorkshire. I'm 35 years old, I'm from a working class background and the first and only doctor in my family. I support the resident doctor strikes because all we're asking for is for a fully qualified doctor to start on£23 an hour. Doctors have had the worst pay erosion of any profession since 2008, being paid less than our assistants. And this despite skyrocketing tuition fees and debt, working through a pandemic and competition for training jobs. Britain's junior doctors, resident doctors to give them their proper title, are set to walk out for five days later this month.

1:05The British Medical Association has announced a five-day walkout. Resident doctors, who used to be called junior doctors, will go on strike from 7am on July 25th across the NHS in England. Their union, the British Medical Association, or BMA, is demanding a whopping 29 % increase on top of their starting salaries of almost£39 ,000. It is a huge ask, and one which is dividing the medical profession as well as the public. I'm a GP trainee and began my training in 2011. I don't support the proposed resident doctor strikes because I just don't understand how another generous pay rise is going to change how valued doctors feel if it hasn't done already.

1:46My name is Maz and I'll be starting as a new F1 doctor in two weeks time. I do support the proposed resident doctor strike. When I start in a couple of weeks as a fully qualified foundation doctor I will have nearly£100 ,000 of student debt because I've paid for five years of university. Trust is at the heart of the doctor-patient relationship and I'm worried about how this might be eroded by the current strikes. I will be working on call from day one so that means that when it's out of hours, I might be the only doctor responsible for patients on four wards at once. I will be responsible for prescribing medication.

2:21I'm a senior partner in general practice. I do not support the proposed resident doctor's strike because I feel it is morally wrong to withhold patient care for any reason. Today, the Health Secretary, Wes Streeting, will meet with BMA officials to try to prevent the strikes. But with the two sides poles apart, what chance is there of a deal? And could it scupper Labour's 10-year plan to sort out the NHS? From The Guardian, I'm Helen Pidd. Today in Focus. Everything you need to know about the resident doctor's strike.

3:05Dennis Campbell, you're The Guardian's health policy editor. Welcome back to Today in Focus. Glad to be here. So let's cast our minds back just a couple of years. Between 2022 and 2024, there were 11 separate walkouts in the NHS. And as a result, 1.3 million appointments were lost at a cost of£1.5 billion. I was on the list, on the NHS, supposed to have my colonoscopy. It got cancelled, first time, because of the strikes. And after that, I didn't hear from them. And that, of course, was under the old Tory government. And call me naive, I thought things might be a little bit different under a Labour government.

3:46And one of the first things that West Streeting did after becoming health secretary last July was sitting down with the junior doctors, the resident doctors, as we should call them now, and agreeing to this fairly big 22 % pay rise. Just one year later, why on earth are they striking again? The British Medical Association have in effect said to West Streeting, thanks very much for the 22%, which was for two years, the last two years effectively of the previous government. We'd actually like another 29%, albeit spread over a few years, to restore the full value of our salaries going back to 2008.

4:22because a combination of inflation and serial low pay rise in that time have, they say, diminished the real terms value of their pay by what remains in their mind to be 29%. Right, 29%. There's a lot of people listening to this who might think, I would like a 29 % pay rise. And had my pay kept level with inflation since 2008, you know, that would be very nice for me. How is the British Medical Association, the BMA, justifying this demand? So they say doctors are very important people in society through the role in the NHS and we respect and sometimes venerate them for that. We appreciate them very much.

5:02And they're saying basically workers as a principal shouldn't have to accept real terms erosion of the value of the pay, which is, you know, sounds quite reasonable on the surface of it. all the evidence is that there's almost no worker in Britain doing anything from a low-pay job to a top-pay job whose salary has kept up with inflation over the last, you know, 15 to 20 years. And therefore, against that backdrop, clearly, I think to the public, the BMA's claim of 29 % on top of 22 % looks entitled, out of reach, and definitely failing to read the room of what other workers can realistically expect whenever inflation's sort of roughly 3.5%.

5:41We're talking about a training salary here, so very much not a final salary for many doctors. Can you just walk us through at what stage a medical student becomes a resident doctor? What does it involve? How long are they at this stage before they move to the next level? So when a doctor starts off their training in the NHS in England, having just done four or five years at med school, their starting basic salary as a foundation year one doctor, this year is£38 ,831. That goes up in the second year of their training to 44 ,439. And by the end of their period as a resident doctor, before they become a consultant, their basic salary this year will be just under 74 ,000 pounds.

6:26And you factor in sort of up to 15 % extra on top of the figures I've just given you, Helen, for working overnights and weekends. Then when they reach consultant, the starting salary for a consultant in England this year is just under 110 ,000 pounds. but some consultants basic salary depending on length of time and experience and so on is 145 ,478 so that is obviously a lot of money the BMA would point out perhaps that doctors in other countries are paid more and that is a matter of fact a matter of record but if our main comparison is doctors in England compared to most other workers and definitely pretty much all public sector workers in England they are well paid.

7:05And in terms of resident doctors themselves how united are they? Are they sort of across the board comfortable with the demands that their union are making? So it was interesting that when the result of the BMA's latest resident doctor ballot came out last week, the turnout was significantly down. Just under half of one who was eligible to vote actually voted to strike. I think it's reasonable to assume that quite a lot of them think 22 % was pretty good and that 29 % may be a bit OTT. And the strike, if it goes ahead, is set to run from 7am on Friday the 25th of July and run right until 7am the following Wednesday.

7:44How much disruption do you think that it's going to cause and how much disruption can patients expect? First of all, the fact that the BMA have opened their innings, if you like, the start of this fresh campaign of industry action with a five-day strike. Not a 24-hour strike, not a 48-hour strike, but a five-day strike is a real two-fingers to the government. We're going to show you right from the off the amount of disruption we can cause. Yeah, and over the weekend, I guess, when resident doctors are more likely to be working maybe than consultants. Indeed, which means you'll have a lot of consultants who have to give up their weekend plans and come in and work, including overnight shifts for particularly over that weekend, but generally over that five day period.

8:20So the disruption for the NHS will be huge. And given that the consultants are the ones who, as you say, will have to step in and cover these five days of strike, how supportive are they of their more junior colleagues? I don't want to exaggerate this, but I think there is definitely something akin to sort of almost a climate of fear now. Senior doctors and hospital bosses don't want to speak out publicly on social media, anywhere at all, to take issue with the junior doctors, their pay demand and the action they're planning to take. Because if they do, they get vilified. It causes problems for them individually.

8:59They get pylons on social media. and there have been a small number of very senior long established doctors have spoken out in the last few days people like uh professor sir steve powys the uh the about to retire medical director of nhs england professor sir robert winston the ivf pioneer who resigned his membership from the the other day it's damaging to the doctors it's damaging to the profession most importantly it's damaging to patients and the risk of taking one's workout means inevitably that somebody at least somebody will die, even if it's only a matter of one But in terms of bosses who run hospitals and the senior doctors who perhaps are leaders of the medical colleges representing the different medical specialties you can't get anybody really to say boo to a goose now because they do not want to come up against the anger and the vehement opposition of their more junior colleagues.

9:49There's not much of a public debate. It's interesting that those doctors are warning the BMA in effect that the public's great staunch support for and trust in doctors generally the medical profession that that's now in peril because for so many people this action looks unreasonable and unjustifiable yeah and what do we know about public feeling ahead of this potential strike so public opinion has shifted massively against the resident doctors when they were junior doctors feels like that every conversation i have with people guardian readers who's instinctively would side with the unions are basically like they're taking the mick.

10:28People think they're taking the mick. People do not really understand what planet they're on. 22 % followed by 29%. I mean, there's probably no worker in the country has ever had anything like that at all. Wes Streeting points out that no trade union in British history has ever, you know, submitted claims for such large ones money. But the thing to bear in mind and the difficulty for Wes Streeting and the NHS and the wider public will be affected by this, is that getting that 29 % for the BMA, for the resident doctors, is an absolute article of faith. They think they deserve it. So in the old days of trade union government resolutions, the trade union would put in for 10%, really wanting 5 % or 6%, and they were compromised.

11:13I sat down last week with Dr. Tom Dolphin, the newly elected new leader, chair of council at the BMA. I'm an anaesthetist. I work in West London. and he made clear that the 29 % is reasonable, his word. It is reasonable because it's based on the loss of value that we've had and it's restoring that value. Affordable. I'm saying it's a small proportion of, a very small proportion of the budget because it sounds like a large number, but actually put into the context of the whole NHS, it's not a huge sum. A non-negotiable. So if we picked a different number, that wouldn't achieve pay restoration. So that's why it looks inflexible.

11:53It's because it's based around a principle. And I think the word non-negotiable will probably cause West Streeting's stomach to churn. So you have the absolutism of that mindset coming up against West Streeting saying, well, listen, the public finances are knackered. We're not reopening the discussion. And so here we are with the threat of five days of strike action at the end of this month. and what I cannot understand and I think other NHS staff let alone the country can't understand is how having had a 28.9 % pay increase from this government resident doctors are now saying we're going out on strike there isn't a precedent for this in the history of British trade unions and just to clarify the figure that Wes Streeting has been quoting is based on a government calculation that resident doctors have received a pay rise of 28.9 % over three years.

12:47So not simply the 22 % that they agreed a year ago. And so as you said, you sat down with Dr. Tom Dolphin. Can you just paint us a little picture of him? Is he a bruiser in the Mick Lynch mould? When I met Tom Dolphin last week, he was, I think, a little nervous because it was his first media interview as the new head of the British Doctors' Union. He was actually very articulate in the way he argued the case that no group of workers should lose 30 % of the value of their pay. Nurses deserve the same. Everyone else who suffered pay erosion deserves the same. Kind of hard on the surface to disagree with that as a principle.

13:19But he was, I wouldn't say hard line, but he was certainly 101 % determined that the BMA will get the 29 % and that they will do whatever it takes to get it, regardless of the court of public opinion and the impact on the NHS. But is he really not worried what the public think? You had an exclusive story just a few days ago about polling for the Guardian, which showed that approval, support by voters for the strikes has halved from 52 % a year ago to 26 % now. Does that not give him any pause for thought? I put this point to him and he said, well, first of all, he referenced the fact that a lot of the media is against doctors and it's going to set one group of works against another, sort of a classic trade union argument.

14:03There's a strong narrative in a lot of media commentary that encourages people to be jealous of each other, jealous of success and jealous of success in terms of pay awards, I mean. And what that should inspire is envy. So jealousy is where you see somebody having something that you would like and you want to take it from them and have it for yourself and not them. Whereas envy is like, I see he's got that cool thing. I'd like to have that cool thing too. He seemed unperturbed by the obvious loss of public support for doctors and their action. In their mind, the 22 % last year was basically a down payment on the full amount they feel they are owed.

14:43Do they not think though that West Street is going to be looking at this exclusive polling that was in The Guardian about public support halving and thinking, well, no way am I going to cave. The public are not behind the doctors this time and therefore I'm going to dig my heels in. Again, I said to Tom Dolphin, do you not think people will think that at least some people think that doctors are out of touch, arrogant, greedy. And he said, well, if people hear the arguments, we put this to people particularly individually, they will kind of get that no one should really, you know, see the value of the pay fall over time.

15:17And how surprised do you think West Streeting has been by the demands and how quickly they've been made? I mean, for me, who doesn't keep a very close eye on the NHS, unlike you, I was like, What? They're striking again? After only a year? I think West Street is gobsmacked by this. I don't know this for a fact, but I do wonder if some of the senior people at the BMA think that if actually, if you push hard enough, you get what you want, because they did 44 days of strikes under the previous government and they got 22%. I think if that calculation hadn't crossed their minds, I'd be surprised.

15:58And just last week, Wes Streeting unveiled the government's 10-year plan for the NHS, which I think has received significantly fewer column inches, actually, than this proposed industrial dispute. And now it falls to our generation to make the same choice, to rebuild our national health service, to protect in this century what Atlee's government built for the last. High quality health care, not according to wealth, but according to need. That is the driving mission of our 10-year plan. For those who did miss what this plan is, can you just briefly outline what it is and how transformational do you think it could be?

16:35The government's sort of main domestic pledge to voters is we will restore the broken NHS, we will get the NHS back on its feet. It's taken them a year to get this plan together. It's a long 150-page document, very, very detailed. It envisages them getting the NHS into the 21st century by undertaking what they call three big shifts, changing the NHS from its reliance on analogue technology and paper to being very digitally empowered. Crucially, making a big push on prevention of illness rather than just treatment of it. And thirdly and importantly, that an awful lot of NHS activity services currently provided in hospitals are moved into community settings, particularly a network of planned new neighbourhood health centres, which would have GPs, mental health therapists, physios, a whole range of services all under one roof saying that the NHS will work completely differently in 10 years time.

17:28And obviously the NHS is far more than just the resident, the junior doctors. But do you think that their strike action, if it goes ahead, could threaten, kind of imperil this 10-year plan? The main way the government have asserted their determination to sort out the NHS to the public is by saying we will get back to 92 % of people getting hospital treatment within 18 weeks, which is a standard that the previous Blair-Brown government brought in and which was still being met whenever Labour left office in 2010. It was met until about 2015 and then it's gone down the tubes and we've had a decade now of terrible headlines, understandably, about that no longer being the case.

18:07the real risk of this coming resident doctor strike in england is that you will be back to the days of tens of thousands of outpatient appointments and operations at a time being cancelled every time that the doctors go on strike and therefore the waiting list which has been showing some modest signs of progress over the last year or so will start to go into reverse again therefore west streetings politically hugely important pledge to the public we will get waiting times back on track will look even more precarious than already does. And if you listen to anybody working in the NHS at the moment, and I'm sure you do that on a daily basis, it does feel like everybody is stretched to capacity and kind of beyond capacity.

18:47The stress levels are off the scale. The system is so fragile. Are there other immediate challenges beyond simply their own pay that resident doctors are facing that maybe doctors didn't face 20 years ago when Tony Blair was in power and had got the waiting list down and so forth. Resident doctors are to a large degree kind of the workhorses of the NHS. They do a lot of the work. They are doctors in training therefore they do a lot of stuff that more senior doctors who've served their time don't have to do. They do a lot of the antisocial shifts, the weekend work etc. So it's not great being a resident doctor whatever they're paid.

19:21It's not great. But it was ever thus wasn't it? My mum was a junior doctor. She always talks about I used to do 24 hours then another 24 hours. You're right it was ever thus. I think many resident doctors, younger doctors in training, see the NHS as in great difficulty. Doctors, like most NHS staff, have generally very pressurised, stressful working lives, work a lot of overtime, sometimes paid, sometimes not. They pour their heart and soul into what they do, but things aren't improving. And I think there's a degree to which Wes treating a Labour health secretary, they're not really distinguishing between him and his many Conservative predecessors.

19:58And I think there's a big reservoir of pent-up anger and frustration amongst resident doctors, and they want to give somebody a kick. And I think Wes Streeting has tried to say, listen, I'm the new guy. We gave you 22%. I'm on your side. I'm the most resident doctor-friendly health secretary you will ever come across. And he's getting no credit for it. Perhaps the talks they're having might see some common ground, fine. But at the moment, he's getting no kudos at all for what he's already done.

20:29I just wonder if there's a kind of generational divide at play here. I mean, these are essentially Gen Z doctors, aren't they? Often, unless they were mature students in the first place. And we know that their prospects, even on good salaries of buying a house, of just having the same kind of comfortable lives that maybe their consultants have enjoyed, just feel out of reach now. And their tuition fees are more than£9 ,000 a year now, where the consultants were probably on£1 ,000 a year or no tuition fees at all. Do you think that it's sort of wider than the NHS, just a sort of feeling of generational iniquity?

21:03For generations, the NHS has been sustained by people breaking their backs, like your mum. Not sleeping for days. And literally millions of other people over the years. You've got a lot of younger people now across the healthcare profession, but particularly the doctors who are basically saying, we didn't sign up for that, we don't want to do that. But actually, if you've got a run of weekend shifts, and maybe you're missing your best friend's wedding or something. It thinks that nothing is really changing. They keep being told by successive governments, we're making life better for resident junior doctors.

21:33We understand the stress you're under. And not huge amounts actually change. One particular issue at the moment is that there is a big mismatch between the number of posts to move on from being a foundation year, early training year doctor to a specialist doctor. Is that what we used to call a registrar? A registrar, yes. To become a specialist in whatever area you've chosen, whether it's psychiatry or surgery or emergency medicine, whatever it might be, there is a big mismatch. Basically, there are thousands and thousands of younger doctors who cannot get a place to start training as the specialist of their choice just because there is a big bottleneck in the NHS and that is also a real big issue for them as well.

22:13And is that why we're seeing, I think, an increasing number of young doctors looking abroad and moving? The General Medical Council, which regulates doctors, have noted for the last couple of years more doctors working in the UK for only a small amount of time and then heading to, classically, Australia, New Zealand, Canada, America, English-speaking countries where generally doctors are paid more. And I think Australia has something like double the number of doctors per head of population that we do. Therefore, working conditions, working lives are easier and it's not just more time to go to Bondi Beach.

22:44It's just generally an easier life. How many of them come back, of course? That's the interesting question.

22:52Coming up, how damaging could this be for Labour?

23:05Let's look ahead now to possible resolution on this issue. So as you said, the BMA have insisted that pay restoration is non-negotiable, that they're not moving. from what you're saying it seems highly unlikely that West Street Singh is going to be able to meet this demand anywhere near this demand actually given the current strain on the public purse and how it looks politically as well um what do you think is going to happen next I worry that basically this is just going to be an episode of Groundhog Day we're just going to have more strikes more disruption more public spats more picket lines and it'll just go on and on and on It went on for an awful long time under the last government.

23:43There's no reason at the moment to think that pragmatism is going to break out, that the BMA is going to come down from its 29 % demand, or that Wes Streeting is suddenly going to say, oh yes, actually Rachel Reeves has found me a billion quid on the back of the Treasury sofa. Let's sort this out. But have they actually sat around the table yet? Wes Streeting and the co-chairs of the BMA's Residence Doctors Committee had an initial meeting last week, and they're meeting later to try and see if any compromise can be reached, if these strikes can be averted somehow. I think there is not a lot of optimism.