Summary
Here’s a summary of the day’s main events:
Junior doctors across England are staging a four-day strike, in a worsening dispute over pay which threatens huge disruption to the NHS. An estimated 350,000 appointments, including operations, are expected to be cancelled as a result of the action that follows years of what critics say are real-terms pay cuts that the government refuses to rectify.
Fears were expressed that patient safety would be put at risk by the strike action. While the BMA said it could not guarantee the safety of every patient, that was because the NHS was already so badly underfunded that patient safety was at constant risk.
Medics have had “absolutely nothing” from the health secretary regarding pay negotiations, the deputy chair of the BMA Council said. Dr Emma Runswick told BBC Breakfast that Steve Barclay could have averted the strike action “at any point”. She added that he “literally walked out of the room, having put nothing on the table” during one round of talks and that the BMA was looking to the government to make an offer.
There will be no talks with the BMA unless junior doctors abandon their starting position of a 35% rise and call off the strikes, Downing Street insisted. The health secretary claimed his door was open, but refused to have meaningful discussions with the BMA unless it lowered its demands.
Junior doctors on picket lines described friends and colleagues turning to food banks and having to borrow money just to make their rent. They said the pay increases they were looking for were likely to only represent a return to pay levels of 15 years ago – equating to an increase of about £5 per hour to £19.
Here’s our full report on the day’s industrial action:
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No 10 insists no talks with doctors unless pay demands are abandoned
There will be no talks with the BMA unless junior doctors abandon their starting position of a 35% rise and call off the strikes, Downing Street has said.
A No 10 spokesman said Rishi Sunak was being kept up to date about the impact of the industrial action.
It continues to be the case that we call on the BMA junior doctors to cease their strikes and revise their starting point for negotiations, which is 35%, which we continue to believe is unreasonable and is not affordable for the British taxpayer.
The 35% demand was “completely out of step with pay settlements in other parts of the public sector” and would cost £2bn.
We know that the strike action will have an impact on patient care. The last set of strikes saw around 180,000 operations cancelled and that was a three-day strike, so we’d expect to see higher numbers this week.
The BMA has said members’ real-terms pay has fallen by 26% over the last 15 years – and that its goal in the negotiations is ultimately to restore members’ living standards. Meanwhile, people on picket lines have described colleagues turning to food banks and borrowing money to meet their rents.
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The health secretary, Steve Barclay, has insisted his “door remains open”, claiming that he wants to engage in talks with junior doctors.
That’s despite the BMA’s claim that he has met with the union only briefly, made no “credible offer” to avert the strikes and did not attend the latest meeting in person. He told broadcasters:
The government has shown that it is willing to listen and to engage in meaningful and constructive talks. My door is open and we remain willing to engage constructively with the junior doctors.
But, clearly, a demand of 35%, which would involve some junior doctors receiving over £20,000 more in terms of their basic pay, is not reasonable to your viewers, to those who have to balance the wider issues of the economy and getting inflation down alongside recognising the very real pressures that the NHS and junior doctors have been under, not least from the pandemic.
We want to reach a fair and reasonable settlement with junior doctors – we recognise the hugely important role that they play within the NHS.
That’s why we stand ready to have meaningful and constructive talks with them, as we have had with other health unions, as we have in terms of responding at the budget to concerns from doctors regarding their pension.
So we are ready to have discussions with them but clearly a demand for 35% – over £20,000 for some junior doctors – is not fair or reasonable.
And that is why we’ve not been able to make progress so far, but we want to engage constructively.
We recognise junior doctors have been under significant pressure, particularly from the pandemic, and we want to work with them to find a fair and reasonable settlement.
The BMA has said its demands are an opening position and reflect 15 years of real-terms pay cuts imposed on junior doctors by successive governments.
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Nima Maleki, an emergency medicine trainee at the same hospital, said he has been at times “ashamed” of the care patients are receiving because of under-resourcing.
I’m seeing people not getting the care they should be, and for instance over the winter period I was ashamed of the care that I was giving to patients in A&E. But, often, I was being asked to do the job of two or three junior doctors and it makes it impossible for you to do your best for people.
On a personal level, I worry about my own family if they have to see a healthcare professional: go to A&E, have a planned appointment. I worry for them and I think what if it takes too long? What if they have an accident and they’re not seen in an appropriate amount of time?
What we’re asking for is not a pay rise; we’re asking for our pay to be restored back to what it was in 2008 to 2009. It’s the same job but actually we’re working so much harder while being paid in real terms a lot less.
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Sam Taylor-Smith, a junior doctor and BMA representative on the picket line outside Southmead hospital in Bristol, has said he was disappointed by Steve Barclay’s response to the industrial action and accused the health secretary of trying to look “tough” in front of unions rather than negotiate.
Dr Taylor-Smith led a group of about 30 junior doctors in a chant criticising Barclay, including the words: “There was a man named Steve, he caused the doctors a lot of grief, he refused our meeting, then took to late night tweeting.” He told PA news agency:
I’m really disappointed in Steve Barclay’s attitude to be honest. We wrote to him on 31 March, asking for a reopening of negotiations and asking him to take us seriously and offer us a serious pay offer. He waited five or six days to respond to that letter, so that doesn’t strike me as a man who is concerned about averting a strike at all possible costs.
He has then basically called our 35% a precondition – it isn’t: it’s our opening position – and refused to talk to us until we’ve basically taken our first offer off the table, which wouldn’t make any sense from a negotiation point of view.
We’ve said to him repeatedly that he could come to us with something today and we can call off the strikes for the rest of the four-day period but it doesn’t look like he wants to do that.
I think he’s just concerned with looking tough in front of unions rather than actually trying to avert strike action.
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Dr Hugh Adler, a senior registrar in infectious diseases who was on the picket line outside the Royal Liverpool university hospital, has said:
The headline reason we’re here today is pay erosion. People feel devalued, they’re struggling to make ends meet. People are choosing to leave the NHS and we’re seeing the gaps in the rota.
We want to stop this exodus and haemorrhaging of staff, particularly junior staff who are paid £14 an hour after coming out of a six-year degree. They could go to Australia and work fewer hours for more money.
Dr Mivanyi Kadala, who has been a junior doctor for nine years, was also on the picket line. The registrar in infectious diseases said:
One of the key things for me about all of this is how much the NHS is losing staff. If you haven’t got good staff retention you’re going to continuously struggle to offer a good service and something that will be safe for patients. Going on strike is difficult and people will be, very understandably, frustrated.
She said it was not a decision the BMA or any doctors had taken lightly but said if “painful decisions are not taken now we are in for more pain in the future”.
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In Leeds, Dr Stephen McAleer said it was “really disappointing and disheartening” that the government had not been willing to sit down with the BMA.
Since he started as a doctor nine years ago, he has noticed a profound change in his work.
There’s a lot more pressure, everyone’s a lot more stressed and stretched. One doctor is doing the work of two or three doctors. It can be really disheartening working long hours and seeing gaps persistently on the rotas. There are just not enough doctors.
People are demoralised and undervalued and they’re going abroad to places like Australia where they get twice the pay and better working conditions.
Alongside hearing from junior doctors, the Guardian wants to learn about how patients are being affected by the action. Have you or a loved one had an appointment cancelled? Has it been rescheduled – if so, to when? What does this mean for you?
At University College hospital in central London, junior doctors on the picket line have been talking about the real-world effects of years of pay stagnation. Fred Hill has said:
It feels very demoralising to be repeatedly given below-inflation pay rises that leave us lagging behind a lot of the workforce. It’s been a really tough couple of years with the pandemic happening and everyone stood up in a really big way.
I feel valued by a lot of my colleagues but I don’t think this government values us appropriately.
Arjan Singh, a member of the BMA’s junior doctor committee, said pay erosion means there are now not enough doctors to treat patients.
We’re 9,000 doctors short. Forty per cent of doctors right now want to leave and 500 patients are dying in the NHS needlessly every single week.
They have to see more patients quicker than ever before, and they make mistakes. When mistakes get made in places like this, people’s mothers and fathers don’t come back home.
If Steve Barclay or the government can agree that a junior doctor is worth £19 an hour, we’ll call off the strikes. Steve Barclay is awol. We don’t know where he is.
Now we’ve heard that he’s met up with the Ministry of Sound nightclub’s owners as many times as he’s met the BMA. That’s the health secretary of this country.
Dr Rebecca Lissmann, a trainee in obstetrics and gynaecology, said she felt “sick in her stomach” when the strikes were announced.
I don’t want to be on strike but I hope that patients can see that this action is also about keeping doctors in that NHS and to save the service.
I absolutely love my job but it is a really hard job. People’s lives are genuinely are at risk.
In obstetrics, you deal with people having some of the best or the hardest days of their life. You have big conversations with people having miscarriages.
To do that in a service that is chronically underfunded, where there are gaps in the rota being filled last minute, all the time, where I’m missing lunch and staying late. I think a lot of junior doctors feel they are not able to provide the care they would like to see for their patients because of the current situation.
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Katrina Forsyth joined the BMA picket line after finishing her night shift at St Thomas’ hospital in London. The junior doctor, who works in general surgery, said she has to rely on family and her partner to be able to afford to keep working in London.
We were clapped during Covid, I qualified early to try and help. When it comes to the point when we are really struggling to pay rent, people don’t care.
The doctor revealed she often has to tell three or four families a day a relative has died and she sometimes goes home and cries at the end of a shift.
We have had a massive cut and we are filling more gaps because people are leaving. It’s becoming less safe for patients.
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NHS staff are using food banks as they struggle to stay above the breadline, a trainee anaesthetist on the picket lines this morning has said. Ada Zembrzycka, who works at Whipps Cross hospital in east London, said:
If the pay cuts continue I will not only struggle to pay (for) my exams but for groceries and my tube tickets. Rent is increasingly going up and I can’t keep up.
Speaking outside St Thomas’ hospital in London, she added:
Junior doctors have received a 26% pay cut over the last 15 years yet we are not worth a quarter less than our colleagues were in 2008. Over seven million patients are on the NHS waiting list. To put that in perspective, that’s more than the population of Scotland.
Dr Zembrzycka, who earns £19 per hour, added:
I do have colleagues who have to borrow money from their families to pay rent this year.
Doctors on strike outside St Thomas’ have been cheered on by cyclists and motorists as they begin four days of industrial action.
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Doctors’ representatives have raised the prospect of more strikes, should the government continue to refuse to negotiate substantively on pay. Dr Vivek Trivedi told the PA news agency:
Strikes are by nature designed to be disruptive – to put pressure on the government to come to the table to ultimately work towards an end to this dispute.
Where we go forward is, of course, reserving the right for further industrial action if the government doesn’t negotiate with us. But that’s all we want them to do. We just want them to come to the table in an honest and meaningfully meaningful way.
But, of course, if they don’t, then we would reserve the right for further industrial action.
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The NHS Confederation, which represents NHS trusts, urged the government and the British Medical Association to “get on” with negotiations. Matthew Taylor, its chief executive, told ITV’s Good Morning Britain:
At the moment, it feels as though the BMA and the government are repeating their starting positions – well, that is your starting position, now get into negotiation. We did the same as this with the nurses, with the ambulance workers – we had months where the government wouldn’t negotiate, and then, when the talk started relatively quickly, they got to a deal that’s now being recommended to their workers.
So both sides are going to end up negotiating – we all know that – so I guess we want to say ‘Please get on with it’.
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Runswick echoed that, calling for “some degree of pay restoration” and blaming waiting times on deliberate actions on the part of government ministers. She told BBC Radio 4’s Today programme:
It’s because we are understaffed and underfunded. Why is that the case? Because the government over a number of years has run down the pay and conditions of healthcare staff – not just doctors, but all healthcare staff – to the extent that junior doctors have had a pay cut of over 26%, for consultants it’s an even bigger pay cut.
People are leaving the health service for better terms and conditions, better pay abroad. My colleagues are frequently going to Australia, New Zealand, Ireland.
We want to reverse that so that patients get the care that they deserve in a timely manner, reverse our workforce crisis.
To do that, we’re going to have to have some degree of pay restoration from this government and a change to the approach to the workforce.
It’s not us that are preventing there being negotiations happening. We would have meetings last week, this week, during strike action, around strike action, we would suspend strike action. We are absolutely happy to meet – it’s the government’s preconditions that are getting in the way of that.
We’ve never had any preconditions ever. We’ve put our request for pay restoration on the table, we’re happy to talk at any point and we have been since last August.
We would be happy to suspend strike action for a credible offer from the health secretary. We understand the disruption that it’s having because we work in the health service.
Patients already put at risk every day by NHS underfunding, union official says
Asked about the risks to patients, the BMA has pointed to what it characterises as the risk posed by the already parlous state of the NHS under successive Conservative governments.
Dr Sumi Manirajan, a deputy co-chair of its junior doctors committee, told Sky News:
I can’t guarantee that no lives will be put at risk but what I can guarantee is that 500 patients are dying (every week) waiting for care at the moment. What I can guarantee is that emergency care, essential care will be provided by expert clinicians in hospitals.
So what I’m saying is that, no, I can’t guarantee that no life will be at risk this week. But that’s because lives are being put at risk every single week.
We were able to do our 72-hour strike safely, and that demonstrates that we do have expert clinicians who can safely step down and we do have enough doctors to cover the wards.
If this changes, or if there was a mass casualty event, we urge every trust to contact us because patient safety is first and foremost.
There will be patients that have their appointments and operations cancelled – the reason for this is because the government won’t negotiate with us. They haven’t given us an opening offer and without an opening offer there’s nothing to negotiate.
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Government has offered nothing to avert strikes, union says
Junior doctors have had “absolutely nothing” from the health secretary regarding pay negotiations, the deputy chair of the BMA Council has said. Dr Emma Runswick told BBC Breakfast:
We’re not the side with the power here to start negotiations – we’ve been asking for literally months.
At any point, Steve Barclay could have entered negotiations with us.
When we met after the last round of industrial action he literally walked out of the room, having put nothing on the table. None of us want to be on strike here ... we’re looking for the government to move but we will continue, our mandate is incredibly strong.
We have to keep taking action until we can reverse the pay cuts, reverse the workforce trends that are really damaging our service, damaging our care to patients, and fix the situation in the NHS.
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Cover at NHS facilities is “very fragile” during the strike, Prof Powis has warned. He told BBC Radio 4’s Today programme:
We are … working very hard to ensure those emergency services are kept safe, that is our priority, but I’ve also got no doubt that that cover is very fragile, so we are relying on consultants and other staff to cover the work that junior doctors usually do.
Junior doctors are a significant part of our medical workforce – up to 40 to 50% of our medical staff – and so that cover is stretched thin in places, so it could be affected by sickness, by absence for other reasons.
So we will endeavour to keep patients safe, particularly in those emergency services but that is becoming harder every time we have this strike action.
Routine care will be affected … this will take weeks to recover from. Strike action such as this does have a significant disruptive effect.
Obviously we feel for patients who are affected, we will reschedule those procedures as quickly as possible but this is a significant set of industrial action that’s going to cause major disruption.
Clearly everybody wants people around the table to try and resolve these disputes, I do remain hopeful … Progress can be made and we all want that to happen to avoid further disruption.
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The 35% pay rise the BMA union has asked for is “not a tall ask”, Dr Vivek Trivedi has told BBC Breakfast.
This uplift that we’re asking for is only to reverse the pay cuts that we’ve had, doctors have had more than a 26% real-terms pay cut over the last 15 years. All we’re asking is for a doctor who’s paid £14 an hour to be paid £19 an hour, so it’s not a tall ask.
He has added that the walkout by junior doctors could be stopped if Barclay approached negotiations with a “credible offer”.
We’ve offered multiple dates to Mr Barclay to try and meet and he’s only met us twice, he didn’t have a mandate to negotiate once, and didn’t even give us an offer the second time.
NHS services “will be stretched”, the national medical director of NHS England Professor Sir Stephen Powis has warned, adding that the junior doctor strikes brought on by the dispute with the government “will cause significant disruption”. He has told BBC Radio 4’s Today programme:
We are going to see four days of industrial action by junior doctors, that’s the longest period of strikes we’ve had this winter and... it will cause significant disruption.
We’ve been working hard with local hospitals, with local health systems to ensure that predominantly consultants, but also other staff are there to put in place the cover that is required in emergency services in particular.
So that’s A&E departments, critical care, maternity services, but those services will be stretched... If you do have a life-threatening emergency it’s important you still call 999, still access A&E, but for any other condition then think carefully: use our services wisely.
There are other routes to take such as general practice, which will be affected but much less so, local pharmacy and of course 111 and 111 online should always be the first port of call for advice.
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And the shadow health secretary, Wes Streeting, has placed responsibility on the prime minister, saying:
The junior doctors’ strike this week will cause huge disruption to patient care. Where is the prime minister and why hasn’t he tried to stop it? Rishi Sunak says he ‘wouldn’t want to get in the middle of’ NHS pay disputes. Patients are crying out for leadership, but instead they are getting weakness.
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The co-chair of the BMA’s junior doctor committee, Dr Vivek Trivedi, said Barclay was being disingenuous, saying his organisation has been trying to meet him for months, and that it would still suspend strike action if the government made a credible offer.
We were knocking on the health secretary’s door, asking to meet with him to negotiate a settlement to this dispute, long before the current strike got underway.
We have been in a formal dispute since October. He refused to respond and meet us until we had a strike ballot result. He has had months to put a credible offer on the table and avert industrial action, so for him to say, ‘It’s disappointing,’ is at best disingenuous.
We have always maintained our aim is for full pay restoration – to reverse the more than 26% real-terms pay cuts Mr Barclay’s government have imposed on us over the past 15 years, putting starting salaries up by just £5 per hour to £19.
We have always maintained we are willing to negotiate on how to achieve pay restoration, so for Mr Barclay to suggest we had any preconditions is yet again disingenuous.
The reality is that the health secretary has had every opportunity to bring an end to the dispute. His decision to refuse to table a credible offer – indeed, he has not tabled a single offer so far – means that this action is solely due to this government’s repeated inaction.
We would still be willing to suspend strike action this week if the secretary of state makes a credible offer that can be the basis of negotiation.
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As the strikes begin, the health and social care secretary, Steve Barclay, has said:
It is extremely disappointing the BMA has called strike action for four consecutive days. Not only will the walkouts risk patient safety, but they have also been timed to maximise disruption after the Easter break.
I hoped to begin formal pay negotiations with the BMA last month but its demand for a 35% pay rise is unreasonable – it would result in some junior doctors receiving a pay rise of over £20,000.
If the BMA is willing to move significantly from this position and cancel strikes we can resume confidential talks and find a way forward, as we have done with other unions.
People should attend appointments unless told otherwise by the NHS, continue to call 999 in a life-threatening emergency and use NHS 111 online services for non-urgent health needs.
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Fears for patient safety during strikes
There are fears for patient safety during the strike and managers have said it has left care “on a knife edge”, while the NHS Confederation’s chief executive, Matthew Taylor, said the number of appointments cancelled – previously suggested to be 250,000 – was likely to rise by another 100,000.
Taylor called the situation “heartbreaking” and said he was considering asking the two parties to call in Acas, the conciliation service, to provide some basis for negotiations.
The BMA’s leadership has previously noted the dire state the NHS found itself in under successive Conservative governments, with members’ workloads and patients’ waiting lists at “record highs”.
The organisation claimed no “viable offer” was put forward at recent talks, and that the health secretary Steve Barclay did not even attend in person – leaving them with no remaining option but to take industrial action. Barclay has said:
I hoped to begin formal pay negotiations with the BMA last month but its demand for a 35% pay rise is unreasonable – it would result in some junior doctors receiving a pay rise of over £20,000.
The BMA has said its members’ pay has been eroded by 25% by years of wage stagnation and price inflation, and that it is seeking restoration of the pay levels seen 15 years ago.
The junior doctors taking strike action are trainee medics and range from the newly qualified to those who are very experienced and are at just below the level of a consultant.
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Junior doctors stage major strike action
Junior doctors across England are walking out on a four-day strike this morning, in a worsening dispute over pay which threatens huge disruption to the NHS.
An estimated 350,000 appointments, including operations, will be cancelled as a result of the action that follows years of real-terms pay cuts that the government refuses to rectify.
Members of the British Medical Association (BMA) have been mounting picket lines outside hospitals for the past hour, and will do so until Saturday morning, in the longest stoppage of the wave of unrest.
Nurses, ambulance crews and other health workers have also been taking action since last year.
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