Can Wes Streeting avert the junior doctors's strike?
During the last round of industrial action – which spanned 44 days across 2023 and 2024 – 1.5 million appointments were cancelled, with the strikes costing the health service around £1.5 billion. This time around, as up to 50,000 medics prepare to picket for better pay in action that could affect up to a quarter of a million patients, Health Secretary Wes Streeting has hit out at the BMA's 'completely unreasonable' demands and warned of the potential cost of strikes to patients. While both sides agree the relationship between Labour's Department of Health and the doctors' union has been more 'constructive' than under previous Conservative governments, Streeting has remained firm that demands for full pay restoration – a pay rise of around 29 per cent – cannot be met this year.
The Health Secretary held a 90-minute meeting in Westminster with the union's co-chairs last Thursday, with talks dragging on past the hour that had been pencilled in. While Streeting refused to reopen negotiations on this year's pay uplift of 5.4 per cent, other ways of improving working conditions were discussed. Changes to pensions and student loan debt have been floated in recent weeks. The talks were lauded by both sides as being constructive, with more in the works – although as BMA co-chair Dr Melissa Ryan pointed out at the subsequent presser:
We have precious few days in order to make sufficient progress in order to avert strike action. Hopefully we can meet at a pace that is sufficient and reasonable.
Streeting is lucky that – for now – he is seen in a relatively positive light by the union: BMA officials begrudgingly praise his ability to understand the pay and working condition complexities facing the NHS. ('Wes gets it,' an insider told me.)
But while some hospitals have started rescheduling outpatient appointments and procedures that would have fallen in the strike dates, NHS England chief Sir Jim Mackey is urging health service bosses to keep elective operations going 'to the fullest extent possible' and only cancel in 'exceptional circumstances'. It's a new approach: in previous instances, a 'Christmas Day' attitude was adopted, with all but urgent care cancelled during periods of industrial action.
It's a move designed in part to put pressure on the doctor's union – and the BMA has been quick to lambast Mackey's decision. While the union adheres to the 'derogation' process – where hospitals call striking doctors back in emergencies – it doesn't support returning medics from the picket line for non-urgent work.
As the Times splashes this morning, BMA council chair Dr Tom Dolphin and deputy chair Dr Emma Runswick have written to the NHS England chief, urging him to tell hospitals to cancel all non-urgent care as current plans will, they believe, 'put patients at risk'. Union reps say the decision to try and run the service as normal will not only affect patient safety in emergency situations but also in planned procedures too – while likely leading to more same-day cancellations for patients.
Analysis by right-leaning think tank Policy Exchange suggests that each day of strike action could cost £17.5 million a day. Former Tory health secretary Victoria Atkins has warned Labour not to 'cave in…on pay, on student loans or other exceptional terms' – in a statement that underlines the fraught relationship between previous Conservative administrations and the doctors' union.
There does remain a concern that any movement on the salary uplift could prompt issues with other public sector workers, particularly nurses who are not happy with their uplift of 3.6 per cent. While the BMA is concerned solely with doctors, insiders are not particularly worried about this potential knock-on effect – saying that they also believe nurses are underpaid.
With less than three days to go until the strike is due to start, Streeting doesn't have long to avert the action. Could pushing the problem away for a year or two work? 'I think on pay, what we're seeing is not this year,' Streeting's parliamentary private secretary (and surgeon) Zubir Ahmed told me. 'It doesn't mean we'll never be able to move on pay in the future.' While positive noises were made after last week's discussions, the Health Secretary's refusal to budge on pay makes any other package – whether on student loans, pensions or exam fees – a harder sell. An eleventh-hour halt will be quite something to pull off.
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