U.K. junior doctors’ ‘historic’ strike for better pay | Explained

Junior doctors recently staged the longest-ever uninterrupted walkout in the U.K.’s National Health Services history. 

Updated - January 11, 2024 01:49 pm IST

Published - January 10, 2024 02:58 pm IST

People hold placards calling for better pay, as they stand outside St Thomas’ Hospital in central London on January 3, 2024, on the first day of six days of strike action.

People hold placards calling for better pay, as they stand outside St Thomas’ Hospital in central London on January 3, 2024, on the first day of six days of strike action. | Photo Credit: AFP

The story so far: Drawing picket lines around London hospitals, junior doctors in the U.K. staged the longest walkout in the 75-year-long history of the state-funded National Health Service (NHS). On January 3, they began a six-day strike to protest poor work conditions and the “steep decline in pay” over the last 16 years, cuts that pierce deeply amid soaring inflation rates. The strike, which is expected to disrupt critical health services, comes after talks last year between the British Medical Association (BMA) and the government failed to materialise.

“A crippling cost-of-living crisis, burnout and well below inflation pay rises risk driving hard-working doctors out of their profession at a time when we need them more than ever,” the BMA said, highlighting that this would have a cascading effect on the U.K.’s health services.

Why are the junior doctors protesting?

The BMA has demanded a “full pay restoration” to reverse the pay cuts triggered by the 2008 global financial crisis, which propelled the U.K. into its deepest recession since World War II. The government should put in guardrails to “prevent any future declines against the cost of living” and reform the institutional process around pay increases “to safeguard the recruitment and retention of junior doctors,” the Association has stated.

The pay dispute between the government and health providers goes back to late 2022. Nurses, consultants, radiographers and junior doctors have staged 16 strikes over the last 14 months, according to NHS England data. Junior doctors are medics undergoing official training to become specialists, a level below consultants. The latest NHS England data shows there are about 75,000 junior doctors in the workforce. Their average annual NHS earnings are between £55,420 and £57,118 — a figure which Nuffield Trust, a local NGO, predicts will fall to around 14% below levels in 2010-11 in the latest financial year. Junior doctors are earning less while working more and facing high levels of burnout, the BMA contends.

This is the ninth walkout staged by junior doctors; with previous strikes stopping work for three to six days. Initial talks last summer led to the government ceding to an average increase of 8.8%, deemed insufficient by the doctors. Pay has been reduced by more than a quarter since 2008, and the BMA has asked for a 35% pay increase. Health Secretary Victoria Atkins on January 9 said this is “simply unaffordable.”

The latest series of negotiations in November last year ended unsuccessfully five weeks later. “No doctor wants to go on strike, and we are asking the government to get back around the table and make a credible offer that we can put to our members and stop more strike action,” co-chair of the BMA Dr. Rob Laurenson told The Guardian. “But if there is not enough progress, we will have to consider further industrial action, and beyond that, our mandate.”

The six-day strike ended on January 9 at 7 a.m. GMT. If more junior doctors express support for industrial action, the Association is expected to hold another round, which could extend protests till September, according to a Guardian report.

Are health services disrupted?

Public sentiment has been divided over the protests. The NHS and Rishi Sunak-led government have chastised the unions for timing the strike to coincide with the busiest time of the year. Reports suggest a third of NHS’s work is likely to be cancelled as a result of the strikes. Rising rates of respiratory illness — including COVID-19 and flu rates — made this particular walkout “very challenging,” said NHS medical director Prof. Sir Stephen Powis to the BBC.

Cancer, maternity and emergency care are similarly disrupted; some hospitals across England said they are under “extreme pressure” and facing “high waiting time.” Dr. Vivek Tripathi of the BMA on January 4 reiterated they would end the strike if the government makes a credible offer.

The BMA has also alleged foul play on NHS’s part, saying that the state-run organisation is overstating the disruption’s impact to weaken public support. The two bodies earlier agreed to a system for “derogations” — protesting doctors would return to work if emergency care is under threat, as long as the NHS shows credible evidence of having “exhausted” other sources of staffing. BMA chairman Professor Philip Banfield said last week that the NHS is not providing “requisite information” which would allow junior doctors to return to work and exempt their right to strike. The NHS will also reportedly start documenting “harm caused to patients” in cases where BMA doctors have refused to provide care, according to an HSJ report. This puts them in an “impossible situation,” wrote Prof. Banfield in a letter to NHS head Amanda Pritchard.

“NHS England’s change in attitude towards the process is not due to concerns around patient safety but due to political pressure to maintain a higher level of service...,” Prof. Banfield said.

U.K. Prime Minister Rishi Sunak last year made five promises to voters; one was to cut down on NHS waiting periods and deliver care more quickly. Mr. Sunak targeted eliminating waits of longer than 65 weeks for elective procedures by March 2024. The target is most likely to be missed. In an interview with the BBC on January 7, Mr. Sunak said he’ll meet his pledge only when the strikes cease.

At the time of pledging last year, 7.21 million people waited for consultant-led treatments; this waiting list would peak at 8 million by August 2024 if industrial action ends, according to an analysis by the Health Foundation. If strikes continue, the waiting list could spill beyond 9 million.

However, the protests have made a small dent in the size of the overall waiting list, according to Charles Tallack, Director of Data Analytics at the Foundation. Officials are “quick to blame industrial action for the lack of progress...but the roots of this crisis lie in a decade of underinvestment in the NHS, a failure to address chronic staff shortages and the longstanding neglect of social care,” Mr. Tallack added.

What has the government said?

According to a BBC report, Health Secretary Victoria Atkins has refused to engage in further negotiation until the junior doctors call off their strike.

Mr. Sunak in a recent BBC interview claimed the “government has now reached (a) resolution with every other part of the NHS, nurses, midwives, paramedics, consultant doctors, speciality doctors most recently,” and the “only people that haven’t [reached a reasonable pay resolution] are the junior doctors.” Royal College of Nursing (RCN) chief executive Pat Cullen objected to this claim, saying the union has rejected the pay offers and “remains in dispute.” s

The BMA added that Mr. Sunak’s narrative is “incorrect,” saying they were “deeply disappointed the Government hasn’t made a credible offer we can also put to junior doctors.”

Dr. Laurenson said the junior doctors will persist with their demand, adding, “It is up to the government to stop the strikes, to stop wasting more time, money and risking further disruption to patient care.”

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