The real reason junior doctors are striking

Any remaining question about who NHS strikes are supposed to benefit has been put to rest this week. Industrial action is needed, the British Medical Association’s website reads, ‘For the benefit of all junior doctors and for the benefit of all patients’ – and also, of course, to ‘protect the NHS’. Yet the union has selected the most dangerous time of the year to start its six-day junior doctor walk-out – the longest ever in the health service’s history.

That up to 200,000 more appointments are estimated to be cancelled for patients – piled on top of the 1.2 million that have already been cancelled from previous industrial action – is tragically not the most pressing issue in this round of strikes. With the NHS already at breaking point every year in January and February – due to a surge in viruses and the cold weather – these strikes are putting even more lives at risk. 

NHS trusts up and down England are issuing advice to patients. Some are once again asking people to stay at home to protect the health service. Patients in the North East and Cumbria are being asked to ‘use services wisely’; friends and family in Frimley are being asked to get patients out of hospital as quickly as possible after they are discharged. The narrative that emerged during the pandemic – insisting people change their behaviour to protect the health service, rather than the other way around – is now repeatedly relied upon by the doctor’s union to keep these strikes afloat.

Meanwhile, health bosses are telling older people to ‘keep warm’ in the next week, as there are growing fears it may be more difficult than normal to treat those who fall sick, or indeed that they will be less likely to be sent to hospital due to the strikes. All this, we are supposed to believe, is being done in the name of patient safety. 

‘Excess deaths’ in 2023 were at a record high in a non-pandemic year, as revealed by the Telegraph earlier this week, and waiting lists are surging. Both of these things are linked to people not seeking care when they are plainly in need of it. We know from experience, now, that discouraging people from using the health service costs lives. There are almost ten million ‘missing patients’ since the pandemic:

Some people are speaking honestly and bluntly about what is really going to happen to patients. The boss of East Suffolk and North Essex NHS Foundation Trust, Nick Hulme, told LBC yesterday that the ‘impact on patients is absolutely huge’, noting that the strikes have ‘decimated’ hospital plans to get the waiting list – which stands nationally at 7.7 million – under control. 

The truth is being revealed in more private circles, too. WhatsApp messages sent this week by the BMA to junior doctors make crystal clear what the real intentions of these strikes are. The ‘strike FAQs’ list pays lip service to patient safety, insisting that ‘our strikes are safe’ because ‘consultant, GP, and SAS colleagues are covering our strikes (and) the BMA meets with NHS England several times on each strike day to ensure patient safety.’ In reality, there’s plenty that won’t be covered over the next six days: not only are tens of thousands of appointments being cancelled, but the strain on emergency services is all but certain to reduce capacity (during the strike last month, an A&E department in Cheltenham had to close).

It’s the rest of the FAQ that seems to reveal the true motivation of the strikes: pay. The memo notes that each doctor will only lose ‘1/365th of your annual salary or 5.69 hours per strike day, regardless of shift type or length.’ In other words, many doctors are getting partial pay for the days they are not treating patients, and they ‘won’t lose pay if you’re on a zero day, annual/study leave, or sick’. The memo goes on to note just how much the government has moved on its pay position so far – ‘Your action has moved the government from 0 per cent to ~12 per cent, and they’ve admitted this isn’t even their final offer’ – citing the government’s well-above inflation pay offer as reason to further continue strike action.

None of this is surprising: money has always been the main motivation of the strikes. In some ways, it’s understandable. Doctors in the UK are paid less (and certainly suffer from worse working conditions) compared to countries like Australia. But it is the doctor’s union that also remains wedded to the NHS system, which now stands out in the developed world as a notoriously expensive system for the outcomes it gets for both patients and doctors. 

It’s telling that the BMA demands salaries closer to mixed health systems (which tend to combine public and private measures, while still ensuring universal access to healthcare) while also demanding the NHS stick to its socialist structure. Despite being a state-run monopoly that relies almost solely on tax receipts, the average salary junior doctors receive now, even in their first year, is still above the median average for workers – and their future earnings put them well above most professions. Get through those first few years and, while still being categorised as a junior doctor, you can earn something closer to double the average wage (and that’s before you even factor in the 20 per cent pension contribution scheme, one of the most generous in the UK). 

For the union, this is an ideological battle, with one of its co-chairs admitting last summer that the 12.4 per cent pay boost accepted in Scotland would be rejected at the Westminster level, because the ‘governments are very different.’ Indeed the WhatsApp messages acknowledge that Rishi Sunak’s government is offering a pay raise roughly in line with the offer from the SNP – but the BMA still plans to continue to reject it.

So there’s a host of reasons these strikes continue – but improving patient outcomes does not seem to be one of them.