Junior doctors’ strikes in 2016 were national news, and 2023 has seen a return of strike action amongst the backbone of the medical force. According to the BMA, ‘Junior doctors have experienced a cut of more than 25 per cent to their salaries since 2008-09. The lack of investment in wages by the Government has made it harder to recruit and retain junior doctors. This puts further pressure on the NHS and makes it harder to deliver care to the standards expected by professionals.’ As such, junior doctors are demoralised, facing burnout, and all-too aware that the health service they work for is increasingly not fit for purpose, and not delivering for them or patients. As such, many are choosing to leave the NHS, or leave the country entirely and work elsewhere.
The problem has been exacerbated by the fact that junior doctors were excluded from the 2022-23 pay award process, as their contracts were part of a multiple-year pay deal. However, the BMA junior doctors’ committee chairs have stated the strike is crucial, and that this pay deal was unfair. They explain that they have tried to get the government to negotiate multiple times, and yet have found no willingness to negotiate on the part of the government.
With the government refusing to negotiate, junior doctors voted to strike, with the BMA council endorsing a proposal from the junior doctors committee for an ‘escalated programme of industrial action by junior doctors in England, beginning with a full 72 hour walkout in March.’ This is the result of around 45,000 doctors, all of whom are BMA members, having been balloted, and reflects a very real, and potentially deleterious, negative view of the government amongst healthcare professionals, and – in this instance – amongst doctors specifically.
Junior doctors believe that an increase in pay is the only way to guarantee proper staffing, keep motivation, and thus to maintain patient safety and the safe functioning of the NHS. One of the junior doctors’ leaders stated, ‘If the Government does not increase pay as part of a wider funding package, then the current ragged workforce will collapse and the hospital consultants of the future will vote with their feet and leave.’
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Meanwhile, the Department of Health and Social Care stated that, ‘Junior doctors do an incredible job and it is disappointing some union members have voted for strike action at a time when the NHS is already under huge pressure from Covid, flu and tackling the backlog.’ With the potential for around 47,000 medics to walk out, with emergency cover therefore endangered, this is indeed a huge escalation in the ongoing battle between doctors and the government. According to the health minister, Maria Caulfield, the doctors’ demands are ‘unrealistic’ and will place patients’ welfare at risk. She explained further that, ‘we are absolutely concerned about the announcement that junior doctors won’t necessarily protect A&E and intensive care units. That’s a real worry because they’re the really sickest patients who need urgent care and help.’ She further expanded that the demands the doctors were making – a 26% pay increase – were unrealistic and untenable. She therefore argues that, as the demands are so high, this is unfair on patients – striking, without cover for A&E or ITU, will put patients at risk – all for an increase in wages that is potentially unrealistic. However, we must balance whether this is truly an unrealistic demand – wages have been far below inflation for years, and the lack of staffing, and relative under-pay, is an issue that has been plaguing the NHS for some years.
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In reality, much care is being taken to avoid impact to life-saving care. The following is taken from a briefing to healthcare providers:
‘Ahead of this action we are asking each Integrated Care System to coordinate an early self-assessment of the potential impact of strike action in each of the affected Trusts in your system, as well as the impact at ICB level… Please complete the template on the assumption that all junior doctors who are BMA members will take continuous strike action for 72 hours over 3 weekdays and that no derogations are agreed nationally or locally.’
One can therefore see that a huge amount of care will be taken to avoid interruption to life-saving care, with consultants, PAs,ANPs, and others likely to need to cover much of the work that junior doctors would have been responsible for across the 72 hour period.
