Friday briefing: ​Can the NHS and Labour survive another strike by resident doctors?

The Guardian

4 days ago

Good morning. Resident doctors, formerly known as junior doctors, working in the NHS have begun their five-day strike.
At the heart of this dispute is the government's offer of a 5.4% pay increase this year, after a 22% rise over the previous two years. Ministers say this amounts to a total uplift of 28.9% over three years.
But the offer has been met with anger from doctors, who argue that nearly two decades of pay restraint have eroded their salaries significantly in real terms. They are striking as part of their campaign for a 29% pay rise, to be delivered over several years.
But Wes Streeting, the health secretary, denounced the move as 'completely unreasonable', stating that 'no trade union in British history has seen its members receive a 28.9% pay rise only to immediately respond with strikes'. He argued that a strike by resident doctors 'enormously undermines the entire trade union movement', urging them not to join industrial action this morning.
The two sides have become deeply entrenched in their positions and are further apart than ever. To understand the ins and outs of this dispute, the political consequences it could have, and whether there is an off-ramp, I spoke to Denis Campbell, the Guardian's health policy editor. That's after the headlines.
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When Labour entered government there was a brief period of calm after years of turbulence between NHS doctors and the Conservatives.
'When Wes Streeting became the health secretary in July of last year he inherited a really long-running, messy, difficult, protracted dispute involving resident doctors,' Denis Campbell told me.
'In simple terms, resident doctors in England who belonged to the British Medical Association (BMA) had been seeking for some time a pay rise of 35%. They wanted that sum over a number of years to make up for the significant erosion in the real-terms value of their pay that they had seen since 2008-2009. In pursuit of that goal, they had gone on strike 11 different times, totalling 44 days, under the previous Conservative governments.'
Combined with action by other NHS staff, these walkouts forced the cancellation of about 1.5m appointments and cost the health service an estimated £1.5bn.
'Streeting said resolving the dispute was going to be his first priority as health secretary, and he was as good as his word. He met the junior doctors' committee of the BMA right away after stepping into office, and a few weeks later they seemed to have resolved things by giving them a pay rise of about 22% spread over two years,' Denis.
That pay rise was backed by a large majority of resident doctors, and for a time it seemed the dispute was over. Until now.
What's at the heart of this dispute?
According to the BMA, resident doctors have seen the real value of their pay fall by nearly 21% over the past 17 years. This is the equivalent, they say, of working one day in every five for free (there is some dispute over these calculations). The resident doctors' committee of the BMA is now seeking a further 29% pay rise over several years.
Supporters of the strike argue that resident doctors are not just asking for more money but highlighting a system on the brink. Many say they are overworked, underpaid, and increasingly unable to deliver the level of care patients need. For them, this dispute is about valuing the people who hold the NHS together day in, day out, often under immense pressure
Dr Ross Nieuwoudt, co-chair of the BMA resident doctors' committee, tweeted that a new doctor starts on £17.60 an hour: 'Name one other profession that gets paid less than their assistants. That is how far doctor pay has eroded.'
While these figures are contested, Denis points out that the basic starting salary for a resident doctor is £38,831. On top of that, they typically earn about 15% more for working antisocial hours, including nights and weekends. The best-paid resident doctors this year will earn a basic salary of about £74,000.
'This is important for people to understand this dispute. The union now believes that all doctors deserve to have the pay they have lost since 2008 restored. They are unshakeable and unwavering and determined in their beliefs that they are going to get that sum of money: starting with resident doctors and potentially extending to all other groups of doctors such as consultants,' Denis said.
How has the government responded?
There have been talks between the union and government ministers, but no breakthrough yet. A major sticking point has been that Streeting says this year's pay deal of 5.4% for 2025–26 is final.
'Streeting has said this is completely unaffordable and completely unreasonable. Talks have failed to bridge the gap and, as a result, anything up to about 55,000 resident doctors in England are legally entitled to go on strike from Friday onwards for up to six months,' Denis said.
'Streeting said there's no money to reopen negotiations. There have been discussions about whether some kind of student loan forgiveness or debt relief might be offered. Resident doctors' loans can be up to £100,000. Streeting has also floated the idea of less generous pensions in exchange for higher pay now. But none of these ideas have really got anywhere.'
The trouble, he added, is that while Streeting is only willing to talk to doctors about other issues, such as their working conditions, access to hot food, issues around leave, and training places, the BMA is absolutely focused on full pay restoration.
'So there's very little common ground: one side says they won't talk about pay, the other says they'll only talk about pay. It's hard to see how, after the disruption these strikes will cause, this dispute is going to be resolved,' Denis said. 'The two sides are just too far apart.'
What has the response been within and outside the NHS?
Denis canvassed views among senior doctors and hospital bosses last week to gauge the mood about this strike. The response was overwhelming and conclusive: they were against it.
'The consensus was that the resident doctors were being greedy, out of touch, and failing to read the room. They say the public finances are strained, and that over the last few years at least, these doctors have had good pay rises relative to other public sector workers. No other trade union is seeking anything like these sums. And no other union has a goal of full restoration,' Denis said.
Resident doctors have historically had significant public support, even when they were striking again and again. 'You had 55-65% of the public still seeming to be on the side of the doctors. People believed they deserved a hefty pay rise,' Denis said.
But that support has soured. Recent polling shows that previously strong approval by voters for strikes by resident doctors has dramatically reduced to just 26%.
'So they seem to have really lost the public support that they enjoyed. Even previously when they were taking the strike action, while they were being vilified and castigated, the public seemed to get it … that these doctors are the workhorse of the NHS, covering weekends and overnight shifts that consultants don't want to or don't have to do any more.
'I think the public view now seems to be that the resident doctors are being unreasonable,' Denis said.
What are the political ramifications?
This is a particularly significant moment for the Labour government because of its central NHS pledge is to bring down hospital waiting times to 18 weeks, Denis said. 'We hear every week about the NHS backlog, which is currently around 7.4m operations and treatments. The government has made some modest progress – getting it down from 7.6m to 7.4m, but these strikes could wreck that limited progress. This key NHS pledge could become unattainable.'
It's why Streeting has described these strikes as 'a gift to Nigel Farage'. He told a meeting of Labour MPs that ministers were 'in the fight for the survival of the NHS' and if Labour failed, Farage would argue for it to be replaced by an insurance-style system.
But resident doctors see their fight for fair pay as a fight for the soul of the NHS, citing widespread burnout among colleagues and a growing exodus from the health service.
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Denis added: 'The two sides seem very far apart on the fundamentals. I would really worry that we're back into a groundhog day situation, with strikes by younger doctors that occur so regularly and for such prolonged times as we saw under the last government are back to haunt this one.'
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