In its long and venerable history dating back 192 years, the British Medical Association used to shy away from being called a “trades union”.
Collective bargaining was for “trades people”; the doctors were independent professionals. Their association was there to campaign for best practice and to offer advice to the politicians regulating health treatment.
That was when the reflex of most medical practitioners was to subscribe to the Hippocratic principle often paraphrased as “first do no harm”.
Much has changed. Today the BMA has no qualms about being described as the “doctors’ union”.
It has freely employed strong-arm negotiating tactics, familiar from industrial disputes, in pursuit of better pay for its members – including strikes, walkouts, deadlines and work to rules.
There can be no doubt that the strikes are doing harm to patient care.
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NHS England has just reported that 89,000 “appointments and procedures” had to be put off because of the three-day strike in December.
Since the industrial action started last March, 1.2 million appointments have been cancelled and rescheduled.
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The BMA rejected requests from the NHS to keep working in critical areas including fast-progressing cancers, corneal transplants and emergency caesareans.
Heated recriminations broke out as the BMA accused hospital managers of “weaponising” so-called “derogation requests” permitting them to recall staff to work if patient safety is “in jeopardy”.
Meanwhile, some A&E departments declared “critical” incidents with waiting times for treatment stretching as long as 16 hours.
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1:22
Patient backs NHS despite cancellations
PM failing to fix waiting list backlog
“Cutting NHS waiting lists” was one of the prime minister’s five pledges and this aim is seriously off track. Opinion polls taken during the dispute suggest that just over half of the public back the strikes (53%).
In a survey four months ago, people were more inclined to blame the government for the dispute (45%) than the BMA (21%), although 25% said they were both responsible.
Yet 11 months into the confrontation, the junior doctors, who lose pay on strike days, must be wondering what they are getting out of it. Their demand for a massive 35.3% pay rise still seems out of reach.
Having walked out of negotiations in December, Dr Vivek Trivedi, co-chair of the BMA junior doctors’ committee, now says he might be prepared to engage in more talks, saying “all we want is a credible offer that we can put to our members and we don’t need to strike again”.
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Although discontent over pay is widespread throughout the NHS workforce, most sectors other than junior doctors in England have accepted deals or, at the least, suspended their action.
NHS consultants accepted salary rises of up to 12.8% along with some pay reforms.
The Royal College of Nursing ballot for further strike action failed and a pay rise of 5.5% was imposed.
Health management is devolved. Junior doctors in Scotland accepted a 12.4% pay rise, on top of 4.5% in 2022/23. Junior doctors in Northern Ireland are balloting on a similar offer. In Wales, there is the prospect of a three-day strike from 15-18 January.
When negotiations broke down before Christmas, the government was offering a 3.3% increase on top of the 8.8% already imposed, taking the total for the English juniors above 12%.
Are the strikes really ‘saving the NHS’?
By the standards of the other disputes, a reasonable settlement should be within touching distance were it not for the sense of grievance, embodied in the claim that pay has been cut in real terms by more than a third since 2008.
Few independent analysts accept the BMA’s calculation, which relies heavily on RPI inflation fluctuations. In line with recent trends for national statistics, the independent Institute for Government says the CPIH, the consumer price index, would be a more appropriate indicator, meaning a cut of 11-16%.
This was in the post-credit crunch, austerity period when wages across the public and private sectors stagnated.
The public is sympathetic to junior doctors who help to keep them well, but should they be an exception?
Over time, pay structures change. The youngest and lowest paid of those now on strike were at primary school in 2008; is it rational to restore their pay levels to what they were then?
“Junior doctors” is an unsatisfactory catch-all term for a wide range of hospital doctors. “Doctors in training” – which some Conservative politicians attempted to popularise – hardly does them justice either.
The term covers all hospital doctors who are not consultants, ranging from those just qualified and still effectively indentured, to senior registrars.
First-year junior doctors earn £32,398, rising to £37,303 in the second year and £43,923 in the third. Registrars’ basic pay goes up to £58,000. Full-time NHS consultants earn up to £120,000.
On the picket lines, strikers often argue their action is not about their own pay but to save the NHS because, they say, many of their peers are leaving for better terms in Australia, New Zealand and Canada.
Conversely, as recent special grade immigration figures show, there are many qualified people abroad with conflicting aspirations who are anxious to come here to work in the NHS.
Much to ponder on how the NHS should work
The additional crisis brought on by the strikes has inevitably prompted some rethinking about how the NHS is working.
Speaking to Sarah-Jane Mee on the Sky News Daily’s How To Fix The NHS mini-podcast series, Dr Adrian Boyle, president of the Royal College of Emergency Medicine, observed “that everything flowed better” in A&E departments because senior doctors providing cover had more direct contact with patients and “there were fewer people coming into hospital for elective work and this meant more beds”.
Those statements about organisation in the NHS should provide consultants, junior doctors and potential patients with a lot to ponder.
The same goes for politicians, who the public holds primarily responsible for delivering their healthcare.
Steve Barclay took an abrasively inactive approach to the various NHS disputes when he was health secretary. In November he was moved to make way for the more emollient Victoria Atkins.
She says she wants “a fair and reasonable settlement” to end the strikes and is open to further negotiations provided the threat of more strikes is withdrawn.
Is the NHS broken – and would Labour do any better?
Atkins’ position is not much different from Wes Streeting, her Labour opposite number.
He has said for months that the disputes should be sorted out by negotiations with ministers and that a Labour government would not meet the 35% pay claim.
Streeting is of the view that reform, likely to discomfort some of the NHS’s vested interests, is more needed than extra cash.
Whatever view they take of the doctors’ actions, public pessimism about the NHS is on the rise.
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6:18
Labour won’t match doctors’ demands
Much as they love the NHS, growing numbers of the public say it is “broken” or “not fit for purpose”. There is also a live debate about whether doctors should lose the right to strike, just like the police and members of the armed services.
The pollsters regularly ask the question “should doctors be allowed to strike?”
Last summer, at the height of the consultants’ dispute, 50% said yes, 42% no. By November, support for doctors’ right to strike had dropped to 47% yes, 46% no.
The asking of that question alone would have astonished the founders of the BMA’s precursor, the Provincial Medical and Surgical Association, back in 1832.
The teenager who stabbed 15-year-old Elianne Andam to death in a row over a teddy bear has been found guilty of murder.
Hassan Sentamu, 18, attacked Elianne with a kitchen knife in “white-hot anger at having been disrespected” after she stood up for his ex-girlfriend, the Old Bailey heard.
He had been due to return items including a teddy bear to Elianne’s friend following their break-up but instead came armed, wearing two pairs of gloves and a facemask.
Elianne collapsed outside the Whitgift Centre in central Croydon, south London, after being stabbed four times in what police described as a “frenzied” attack, which was caught on CCTV, on 27 September 2023.
Her friend compared Sentamu to a character from the Netflix crime drama Top Boy and said Elianne had her hand out begging him to “stop”.
He threw his gloves and mask in a bin and hid the knife in a garden but was arrested within 90 minutes after police stopped a bus near his home in New Addington.
Sentamu, who was 17 at the time, admitted manslaughter but denied murder on the basis of “loss of control” because he has autism.
There were sobs in the public as he was found guilty by a majority verdict of 10 to two, while he stood propping himself up with both arms in the dock and crying.
He was also found guilty on a charge of having a blade. Sentamu had also denied this charge – claiming he had a lawful reason for carrying it.
Grime artist Stormzy was among thousands of mourners who gathered at a candlelit vigil after Elianne – who went to the private Old Palace of John Whitgift School – was killed, and there is now a memorial to her at the scene.
‘I’ll do it again’
The month after Elianne’s death, Sentamu got into a row with a fellow inmate in youth custody and when he was accused of killing girls, said: “I’ll do it again,” the court heard.
“I’ll do it to your mum,” he said. “Do you want to end up like her, six feet under? I’ll do the same again.”
Sentamu, who came to the UK aged five with his mother and three sisters, had a history of violent and aggressive behaviour, as well as making repeated threats to take his own life.
He was given a police caution after pulling a knife out in class and telling a teacher he wanted to kill himself when he was just 12 years old.
Sentamu was expelled from one school after threatening another child with a knife and in other incidents put girls in headlocks and threatened to stab a student with a pair of scissors.
While in foster care he threatened to harm a cat or chop off its tail, the court heard.
‘I can’t let this slide’
Weeks before he killed Elianne, who wanted to become a human rights lawyer, Sentamu said: “The real me is evil, dark and miserable” in a message to a friend.
The day before the attack, he had met Elianne and her friend, who had recently split up with him, at the Whitgift Centre, where the girls “teased” him and his ex-girlfriend splashed him with water.
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0:56
Attack caught on CCTV
Sentamu, who was studying sports science at Croydon College, later sent what police called a “chilling” message to a friend saying: “I can’t let this slide bro.”
He met Elianne, his ex-girlfriend and another of their friends the following day to swap belongings.
The girl handed him a plastic bag of his clothes, but he did not have her teddy bear as arranged, and Eliane snatched the bag back.
A Snapchat video shows Elianne smiling and laughing before her expression turned to “abject terror,” jurors were told.
Sentamu pulled the kitchen knife from his trousers and repeatedly stabbed her, plunging the blade 12cm into her neck.
‘He exacted vengeance on a girl running away’
Prosecutor Alex Chalk KC earlier told jurors Sentamu was “angry… having brooded on the insult and he took the knife to the scene to reassert dominance”.
“He exacted vengeance on a young girl clearly running away from him and posing no threat,” he said.
Sentamu, who was diagnosed with autism in 2020, did not give evidence.
His barrister Pavlos Panayi KC said it was not disputed the killing was a “grotesque overreaction” but the “central issue” in the case was Sentamu’s autism history and symptoms.
Metropolitan Police Detective Chief Inspector Becky Woodsford said it was a “violent, aggressive and frenzied knife attack on a young girl”.
“Elianne was doing what was right, she was standing up for her friend,” she added.
Sir Keir Starmer’s visit to the presidential palace in Kyiv was met with a message from Russia when a drone was blasted out of the sky above.
The prime minister was meeting President Volodymyr Zelenskyy to discuss the next steps for Ukraine, on Sir Keir’s first visit to Kyiv since his election victory last July.
The sound of anti-aircraft gunfire was audible in the palace courtyard as air sirens warned of possible drone attacks. While air sirens blaring are a daily occurrence in Ukraine, it’s rare for drones to be shot out of the sky over the presidential palace.
One drone was shot down, although eyewitnesses think there were at least two drones operating and suspect they were probably surveillance drones, as the one taken out didn’t explode on impact.
President Zelenskyy gave his Russian enemies short shrift, saying when the drone was detected: “We will say hello to them too.”
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1:07
Starmer and Zelenskyy lay flowers at memorial
An audacious move by Moscow, Sir Keir said the drone threat was “a reminder of what Ukraine is facing every day” and that the war was brought about by “Russian aggression”.
The PM reiterated his support for Ukraine’s eventual accession to NATO, and noted the discussion at the NATO summit in Washington last year – when its allies put Ukraine on an “irreversible path” to NATO membership.
However, President Zelenskyy, perhaps with an eye on the incoming Trump administration, was more forthright in his response to the question of Western allies supporting Ukraine’s membership. He told reporters the US, Slovakia, Germany and Hungary “cannot see us in NATO”.
President Trump has recently acknowledged Moscow’s longstanding opposition to Ukraine’s ambition to join NATO, given it would mean, as the president-elect said: “Russia has somebody right on their doorstep, and I can understand their feeling about that.”
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0:59
Starmer visits burns victims
‘Nothing is off the table’
This was a news conference big on symbolism as Sir Keir vowed to stand by Ukraine for as long as it takes and put Kyiv in the strongest possible position for negotiations with Russia.
He pledged to work with Ukraine in the months ahead to ensure security guarantees for the country in any ceasefire deal, while also opening the door to possible troop deployments in training or a peacekeeping capacity, saying “nothing is off the table”.
“We must be totally clear – a just and lasting peace comes through strength,” said Sir Keir.
The PM also pledged to send 1,540 artillery barrels to Ukraine as President Zelenskyy called for more weapons, blaming Russia’s advance in the eastern part of Ukraine on the slow supply of weapons.
A new mobile defence system and a ramping up in the training of troops were also promised by Sir Keir.
President Zelenskyy also acknowledged in the news conference that much is uncertain around this conflict and what security guarantees Ukraine might get from its allies ahead of conversations with Trump.
The NHS says hospitals in England are “jampacked” after their busiest week of the winter so far – but flu cases have fallen slightly.
Despite another 1,300 beds being opened up, only 6% of the nearly 104,000 total were free – down from 7.2%.
Flu continues to have a huge impact – with cases 3.5 times higher than last year – however, numbers are down from their recent peak.
NHS England said 4,929 beds were occupied by flu patients on average for the week ending 12 January, a dip of 9% from the 5,408 the week before.
It comes as many hospitals, in places such as Liverpool, Birmingham and Plymouth, have recently been forced to declare critical incidents due to flu cases pushing them to the brink.
“While it is encouraging news flu cases are no longer increasing, hospitals are not out of the woods yet,” said Professor Julian Redhead, NHS national clinical director for urgent and emergency care.
“Staff are working incredibly hard in sometimes challenging surroundings, but winter viruses are much higher than usual for this time of year.
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“And this coupled with the cold snap and problems discharging patients means hospitals are jampacked with patients – even as more beds have been opened to manage increased demand.”
There were 650 patients in hospital with vomiting bug norovirus last week, a rise of 4% on the previous seven days and 44% on last year; while 1,112 people were hospitalised with COVID.
For all winter viruses combined, bed occupation was 5,851, down 8% on the week before but far higher than the 2,169 last year.
Around 29 million flu, RSV and COVID vaccines have been carried this season and while the national booking system has shut, eligible people can still get a free jab at pharmacies or via their GP.
Meanwhile, the latest stats also show handover times from ambulance to A&E improved in the most recent week.
The average was just over 41 minutes, compared with nearly 54 minutes in the previous seven days. However, that’s still slower than the 38 minutes recorded last year.
Nurses have also revealed some patients are dying in corridors and going undiscovered for hours, according to a Royal College of Nursing report.
It said demoralised staff were looking after as many as 40 patients in a single corridor, unable to access oxygen, cardiac monitors, suction and other lifesaving equipment.