JUNIOR Doctors start their continuous four-day 96-hour strike at 06.59 today, Tuesday 11 April, and end it at 06.59 on Saturday 15 April.
Backed by the Council of the British Medical Association (BMA), they are demanding (i) pay restoration by 26 % to bring them back to the level of pay they had in 2008; (ii) an agreement with government for a mechanism to prevent any future declines of pay in relation to the cost of living and inflation; and (iii) the reform of the Doctors and Dentists Pay Review body which at present is not independent of government.
There are around 80,000 Junior Doctors (JDs) in the NHS. JDs’ salaries start around £25,000 to 30,000 per year, and have seen real term pay cuts of 26% since 2008/9
The Junior Doctors Committee (JDC) had given the government plenty of time to consider their intentions, as they took a decision in early 2022 to ballot their members in Spring 2023, if the government did not come forward with a decent pay offer.
The ballot for strike action opened on 9th January and ended on 20 February 2023.
37,000 members participated in the ballot – 77% of the membership, at that time (47,600 JDs were eligible to vote) and 98% voted for strike action, the biggest vote for such action in the history of the BMA.
The JDC responded: ‘In the name of our profession, our patients and the NHS, doctors won’t take it anymore. We have had a real-terms pay cut since 2008. This year we were offered an insulting 2%, which means with inflation at 10%, we are working a month for free.’
On 22 February the co-chairs of the JDC, Dr Laurenson and Dr Trivedi, met with government but only civil servants were present, with no pay offer.
On 2nd March, the JDC reps met Health Secretary Steven Barclay. Again, there was nothing on the table. The BMA then launched a strike fund.
On the first day of the 13 March strike, around 2,000 junior doctors formed a mass demonstration opposite Downing Street and with good humour, waved their placards and chanted: ‘Make us stay, Give us more pay,’ and ‘£14 an hour is not a fair wage for a junior doctor. Pay restoration now.’
There were large picket lines. On Wednesday 15 March, JDs joined the 50,000 strong march from Hyde Park organised by the National Education Union, and marched to Trafalgar Square, where they were joined by a second march coming up from Embankment formed mainly by the PCS civil servants’ union.
Altogether on that day nine unions representing three quarters of a million workers took strike action up and down the country, including NEU, PCS, RMT, ASLEF, Prospect, Hospital Specialist and Consultants Union, and BBC local journalists from the NUJ.
This joint action with other unions is new for the BMA, and was not seen in the 2016 strikes, because at that time JDs were facing an onslaught on their 2002 Dobson contract by the Tory government’s Department of Health led by Jeremy Hunt and NHS England, that confined the battle to them alone.
This year, however, the junior doctors have found themselves entering the fray when many different groups of workers have already engaged in the fight for pay rises to keep up with inflation.
Inflation has soared from 0.1% to over 10% in the course of 2022 which, coupled with massive energy prices, has precipitated thousands of workers, not just JDs, into worrying about paying their bills.
Today’s action will start the second strike that JDC has organised this year.
JDs have particular expenses which are overwhelming. Tuition fees for medical schools can reach £80,000. Then there are expensive exam and indemnity fees and, as is the same for other NHS staff, there is no more free hospital housing or hospital parking.
A key issue raised on the picket lines is the marked drop of the standard of care that the NHS is providing for patients, because of the lack of hospital beds and the lack of staff.
There is a massive workforce shortage of 133,000 staff in the NHS. This workforce shortage is at the heart of this week’s strike action.
It was bad during the pandemic, when staff sickness was very high and doctors, nurses and paramedics had to cover for absent staff, work through leave, stay late and wear themselves out caring for very sick patients.
But post-Covid, the pressure from pent-up demand for care, from funding cuts and lack of beds and staff, has caused excess patient deaths to soar because of delays to treatment.
BMA surveys have shown that junior doctors find themselves constantly working in underfilled rotas and forced to do extra shifts. Many work without the breaks they should have. Many take enormous responsibility at night for hundreds of ward patients, with no rest and no access to hot food.
Many are constantly worried about the risks they take when making stressful decisions about patients in overcrowded A&E departments with insufficient space and staff to address patient care properly. The BMA reports stressed doctors crying in cupboards.
The over-work because of lack of staff, the staying late and working unpaid hours, the skimping on teaching sessions, the lack of work satisfaction, and the ‘moral hazard’ that the NHS is being run down and that patients are not getting optimal care, means that many JDs are driven to look for less stressful and better paid jobs elsewhere. Many have gone abroad.
Ironically, on 10 January, the day after the JDs launched their strike ballot, the government tabled its ‘Strikes (Minimum Service Levels) Bill, which would require ambulance, fire and rail services to deliver minimum service levels.
Minister Grant Shapps said the bill ‘will give the government the power to ensure that vital public services will have to maintain a basic function by delivering minimum service levels, ensuring that lives and livelihoods are not lost.’
He said that ministers would consult on what an ‘adequate level of coverage looks like.’ He later accused striking ambulance workers of endangering patients’ lives.
Emma Runswick, BMA deputy chair, said this proposal is ‘laughable’, pointing out that ministers had ‘failed to ensure anything like minimum care standards of patient care or service delivery in the NHS for many months, if not for years.
‘For this government to believe that anti-strike legislation will make healthcare better is not only ridiculous but also dangerous.’
And that is the nub of this strike. Without the recruitment and retention of sufficient numbers of trained staff, the NHS is collapsing.
The strike is being organised in order to improve pay and terms and conditions, so that staffing can be brought to safe levels, thereby restoring the NHS itself.
The BMA has now performed a consultative ballot of its consultant members and they have voted overwhelmingly for strike action. They are disgusted by the way JDs are treated. There will be a definitive ballot of the consultants for strike action over pay and the DDRB (Review Body on Doctors’ and Dentists’ Remuneration) in May.
However, the Tory government has shown no sign that it will offer the JDs a pay rise in line with inflation. Its official policy is to ‘reform’ away the NHS as founded and to promote ‘patient choice’ and public-private partnerships as mandated by the Health and Social Care Act passed in July 2022.
The Treasury has stated that the new NHS staffing plan will not contain any numbers of the different staff required, whilst the Chief Executive of NHS England, ex-banker Richard Madders, has questioned whether NHS doctors are ‘over-qualified’ after seven years of training (five years medical school and two years on the wards as foundation doctors), suggesting that ‘you change the skill levels’ so patients can see ‘physician associates’ like they do in the United States.
The battle to save and restore the NHS with safe staffing of fully-trained doctors, nurses and paramedics is a task that requires action from the entire trade union movement.
A general strike is needed to save the NHS, to bring in a workers’ government with socialist policies, to re-nationalise the NHS under public ownership and control, to provide the high quality comprehensive care that patients need.
