A four-day strike this week by junior doctors in England will pit angry medics keen to secure a 35% pay rise against government ministers who scorn their demands.
The walkout from Tuesday morning to Saturday morning will be the most disruptive in the 75-year history of the NHS.
But the action will also show how radicalised doctors have become due not just to cuts in pay but also to the Covid-19 pandemic, to poor conditions and to the frustrations of working in a health service that is slowly imploding.
Their last campaign of industrial action, in 2015/16, over their contracts and the insistence by Jeremy Hunt, then health secretary, that they should work more at weekends, is also a big, though under-appreciated, factor in their thinking.
Unlike teachers, train drivers and other public-sector workers, doctors historically have rarely gone on strike. They have also always been among the best-paid staff on the state payroll.
However, a significant fall in real-term income since 2011 has helped energise a generation of junior doctors who have voted overwhelmingly – 98% on a 77% turnout in a ballot organised by the British Medical Association (BMA) – to strike until they achieve their goal. These 61,000 medics are the NHS workhorses and their refusal to work this week is likely to lead to about 250,000 appointments being cancelled.
Dr Joanna Sutton-Klein, a member of the BMA’s ruling council and a leading figure in the junior doctors’ campaign, recalls the “mood in hospitals of despondency and despair” after Covid, and how the struggles of the NHS last winter to provide safe, quick care to patients as A&Es and ambulance services became overwhelmed, confirmed it as “a really demoralising environment to work in”.
She said: “In recent months, as various staff groups in the hospital have begun to take back their pay, the sense of despair has been replaced with an atmosphere of hope and nervous excitement.”
By “take back their pay”, she means health unions’ campaigns for big pay uplifts, including the BMA’s claim that junior – or trainee – doctors deserve a 35% salary increase to make up for the 26.2% erosion in the real-terms value of their pay they have experienced since 2008/09.
Sutton-Klein says she and colleagues are “inspired by stories of big wins by other workers in unions … [such as] the junior barristers who won 15% through indefinite industrial action and the 28% rise that Luton airport workers won this year”.
The 2015/16 strikes are important in today’s dispute for two reasons. First, many junior doctors believed they lost, because the contract they loathed was ultimately imposed anyway, despite their year-long series of walkouts. They are determined to stop history repeating itself.
Second, that perception of failure “caused significant resentment and distrust” of BMA leaders within the rank and file. “Anecdotally,” says Sutton-Klein, “I’ve talked with many doctors who quit their BMA membership following the 2015/16 dispute in anger and didn’t rejoin until this year. The strategy around the current dispute is a response to the perceived strategic failures of 2015/16.”
That strategy involves the whole of the BMA’s leadership, including its committee representing consultants (senior hospital doctors), which backs the juniors 100%. Dr Philip Banfield, the BMA’s chair of council, is a staunch supporter of their cause.
The decision to take industrial action and the first walkout over three days last month has won the main doctors’ union many new recruits. The BMA says 17,000 doctors have joined its ranks since the start of the year, taking its membership to a record figure of 184,000.
The Daily Mail, Mail on Sunday and other newspapers have used the fact that Sutton-Klein, the BMA deputy chair, Dr Emma Runswick, and some other avowedly leftwing doctors are playing leading roles in the BMA and its junior doctors’ committee (JDC) as the basis for stories claiming that those “radical” medics have “hijacked” the union and “used ‘Marxist’ tactics” to get themselves and other pro-strike allies into key positions.
The news sites have highlighted the success of Doctors Vote, which Runswick helped set up, and Broad Left, in getting pro-strike campaigners elected to 59 of the 60 seats on the junior doctors’ committee, and then to 26 out of the 69 positions on the union’s full council, as proof that far-left “militants” were now calling the shots at the BMA.
This Sunday the health secretary, Steve Barclay, accused “militant” juniors of plotting “maximum disruption” for the NHS in the coming week.
A report published in January by the Policy Exchange thinktank into “the activists taking over the BMA”, written by Andrew Gilligan, a former journalist and adviser to Boris Johnson, provided much of the evidence for the government-friendly newspapers’ stories.
The truth is less dramatic. While some of the JDC’s members are left wing, others are not politically active or motivated in that way at all. And the 98% vote for strikes was junior doctors’ spontaneous, not orchestrated, response to deep frustration with their lot.
“The real story here is that we’ve successfully awoken tens of thousands of rank-and-file doctors to the fact their pay has been cut and persuaded them that they should join the campaign to win it back,” says Sutton-Klein.
Unions representing nurses and ambulance workers called off their strikes, moderated their initial demands, negotiated with Barclay and emerged with a potential deal which they have now put to their members.
By contrast, the JDC and health secretary are nowhere near that point and are engaged in an increasingly bitter war of claim and counter-claim. Resolution of the most debilitating strike ever to hit the NHS looks like a distant prospect and more strikes are inevitable.
