Adam Boulton: NHS pessimism creeping up as striking doctors push on with 35% pay demand
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.
These have culminated in the current “unprecedented” six-day strike by junior doctors in England, which is due to end at 7am on Tuesday.
There can be no doubt that the strikes are doing harm to patient care.
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.
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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“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%.
Junior doctors in Scotland have accepted a 12.4% pay rise
The level of doctors’ real-terms pay cut is disputed
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.
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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.
Health Secretary Victoria Atkins
Shadow health secretary Wes Streeting
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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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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.
A survivor of the Southport knife attack is calling for the use of blunt-tipped knives in home kitchens, in a campaign she says is “for the girls”.
In one of her first television interviews since the July 2024 attack, Leanne Lucas, 36, tells Sky News it was the “tip of the knife” that caused injuries that led to her “nearly dying”.
“I never, ever thought I’d be talking about things like this,” Ms Lucas tells Sky’s Katerina Vittozzi, “but since what happened in July, I really can’t sit still and not say how I feel”.
Ms Lucas was leading a group of children in a Taylor Swift-themed dance workshop when they came under attack by Axel Rudakubana, then aged 17.
“What happened before the incident was just pure joy,” Ms Lucas remembers.
“We were just having so much fun. And for that to be ruined and everyone’s life that was involved, to be shattered, is just not acceptable,” she says.
Bebe King, six, Elsie Dot Stancombe, seven, and Alice da Silva Aguiar, nine, were killed in the attack. Ten others, including Ms Lucas, were injured.
The attacker used a kitchen knife with a 20cm blade, purchased via the online retailer, Amazon.
“I don’t want this pain and this trauma that any of us have felt, I don’t want that to happen to another family,” Ms Lucas says.
Her new campaign, launched today, is called Let’s Be Blunt and aims to “raise social awareness” of safer-tipped knives.
Let’s Be Blunt aims to alert people to the dangers of sharp-tipped kitchen knives
“A safer option is to go for curved or blunt-tip knives… that reduces that risk of the kitchen knife being used ever as a weapon,” she says.
It’s an issue about which Ms Lucas feels “passionate”.
“[I] will not let evil win. I need to know that I’m doing this for the girls, for myself and for future generations,” she says.
“We don’t need to wait for government or the police to tell us what to do,” Ms Lucas adds, as she calls on the public to “do an inventory” of their kitchen knives.
Since the attack, Ms Lucas says she feels “like I’ve just had my eyes opened” to how “domestic tools can be weaponised”.
“I personally feel that knife crime has got out of control,” she adds.
According to the latest data from the Office for National Statistics, kitchen knives are the most common type of weapon used in knife homicides.
An example of some of the rounded-edge or safe-tipped kitchen knives now on sale
“You normally hear of the zombie knives, machetes, things like that,” Ms Lucas says.
“They sound dangerous but really, when you look at the figures, the highest figure is the domestic kitchen knife, which we have all got in our kitchen, which we use daily.”
Ms Lucas says “since the attack in the summer,” she has never “cooked with a pointed kitchen knife again” and that using a blunt-tipped knife makes her feel “safer”.
“Obviously, people can hurt people in many ways,” she says. “It’s about reducing that opportunity to cause life-damaging, life-threatening injuries that can take people’s lives.”
Reflecting on the personal nature of the campaign, Ms Lucas tells Sky News it was a “privilege” to be a survivor, but that she does not “want to be defined by what happened to us”.
“My work was for the girls,” she says. “My work was for the community… and just creating memories that will last a lifetime… and I don’t want this to be part of our memories.”
Ms Lucas says she hopes Let’s Be Blunt will “inspire” other Southport survivors.
“If I can show them that there’s hope and that real change came from what happened to us… If I can do that, then that’s what I’ll do.”
Marks and Spencer (M&S) has warned investors it is facing a £300m hit to trading profits as a result of last month’s ransomware attack.
The company said it was aiming to reduce the figure significantly through management of some costs, including the prospect of insurance payouts, but added disruption to its operations could last into July.
The continuing fallout from last month’s cyberattack is hanging over the retailer’s outlook as its online channels remain down for payments.
Website sales are expected to resume, at least partially, in a couple of weeks’ time.
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M&S said it could not comment on whether it had paid a ransom to the hackers.
Chief executive Stuart Machin, who blamed “human error” for the attack, told an analysts’ call the company was “on the road to recovery” and “getting back to business”.
It is widely believed the group fell victim to the same hackers, known as Scattered Spider, who were linked to similar attacks on the Co-op and Harrods towards the end of April.
Both M&S and the Co-op have admitted personal customer data was snatched, but say the thefts were limited to names and contact details, with payment details safe.
The Co-op said last week it was aiming to improve grocery availability in its stores but progress is believed to have been limited so far, with some empty shelves still being reported.
M&S has seen more than one billion pounds lost from its stock market value since it declared the incident on 22 April.
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The company said of its predicament: “Over the last few weeks, we have been managing a highly sophisticated cyber incident. As a team, we have worked around the clock with suppliers and partners to contain the incident and stabilise operations, taking proactive measures to minimise the disruption for customers.
“We are seeking to make the most of the opportunity to accelerate the pace of improvement of our technology transformation and have found new and innovative ways of working.
“We are focused on recovery, restoring our systems, operations and customer proposition over the rest of the first half, with the aim of exiting this period a much stronger business.
“Since the incident, Food sales have been impacted by reduced availability, although this is already improving. We have also incurred additional waste and logistics costs, due to the need to operate manual processes, impacting profit in the first quarter.
“In Fashion, Home & Beauty, online sales and trading profit have been heavily impacted by the necessary decision to pause online shopping, however stores have remained resilient.
“We expect online disruption to continue throughout June and into July as we restart, then ramp up operations. This will also mean increased stock management costs in the second quarter.”
The statement added the anticipated hit to operating profits this year will be around £300m for 2025/26, which will be reduced through management of costs, insurance and other trading actions. It is expected that costs directly relating to the incident will be presented separately as an adjusting item.
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Mr Machin thanked customers for being “unwavering in their support” for the chain.
“This incident is a bump in the road, and we will come out of this in better shape, and continue our plan to reshape M&S for customers, colleagues and shareholders,” he said.
M&S gave the update while revealing financial results for the year to 29 March.
They showed trading profits at a 15-year high. M&S reported a 22.2% rise to £875.5m, with sales up across each of its product divisions.
Shareholders were rewarded with a 20% increase in the final dividend.
However, that failed to placate investors as the share price fell by almost 3.5% at the market open on Wednesday.
Dan Coatsworth, investment analyst at AJ Bell, said of the update: “Marks & Spencer has lost a significant number of sales after temporarily halting online orders. Disruption to supplies meant gaps on the shelves and more lost sales in-store. It has also incurred extra waste and logistics costs, all having a negative impact on profit.
“The fact online operations might not be back to full power until later in the summer means the company still cannot achieve full earnings potential for some time to come. Marks & Spencer will be able to lower the total hit to profit once it claims on insurance, among other factors, but the cyber-attack has still knocked the business for six.
“There’s still a big unknown regarding any potential fines on Marks & Spencer from the Information Commissioner’s Office (ICO), which enforces data protection regulation.
“There are plenty of examples of companies that have been fined by the ICO for not taking appropriate steps to prevent data breaches. The maximum fine by the ICO is £17.5m or 4% of global annual turnover, whichever is higher. Marks & Spencer has just reported £13.8bn revenue, so 4% of that figure is £552m.
“That’s in a worst-case scenario, and any fine would account for many different factors. We’re unlikely to find out in the near term if there will be a fine as there will be investigations galore into exactly what’s happened and into the retailer’s overall data protection capabilities.”
The foreign secretary has denounced Israel’s actions in Gaza as “intolerable” but stopped short of saying it had committed genocide.
MPs could be heard shouting “genocide” in the Commons chamber as David Lammy announced the government was suspending its trade negotiations with Israel and summoning Tzipi Hotovely, Israel’s ambassador to the UK, to the Foreign Office.
The UK has also sanctioned a number of individuals and groups in the West Bank which it says have been linked with acts of violence against Palestinians – including Daniella Weiss, a leading settler activist who was the subject of Louis Theroux’s recent documentary The Settlers.
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Israel immediately criticised the UK government actions as “regrettable” and said the free trade agreement talks, which ministers have now backed out of, were “not being advanced at all by the UK government”.
Oren Marmorstein, a spokesperson for the Israeli foreign affairs ministry, said: “If, due to anti-Israel obsession and domestic political considerations, the British government is willing to harm the British economy – that is its own prerogative.”
Mr Lammy’s intervention came in response to Israel ramping up its latest military offensive in Gaza and its decision to limit the amount of aid into the enclave.
Tom Fletcher, head of the UN Office for the Coordination of Humanitarian Affairs, accused Israel of “deliberately and unashamedly” imposing inhumane conditions on Palestinians by blocking aid from entering Gaza more than 10 weeks ago.
He also told the UN’s security council last week that it must “act now” to “prevent genocide” – a claim that Israel has vehemently denied.
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Aftermath of strike on Gaza school-turned-shelter
Speaking in the Commons, the foreign secretary said the threat of starvation was “hanging over hundreds of thousands of civilians” and that the 11-week blockade stopping humanitarian aid reaching Gaza was “indefensible and cruel”.
Israeli Prime Minister Benjamin Netanyahu has agreed to allow a limited amount of aid into the besieged enclave in response to global concern at reports of famine.
Mr Lammy said Mr Netanyahu’s govenrment was “isolating Israel from its friends and partners around the world, undermining the interests of the Israeli people and damaging the image of the state of Israel in the eyes of the world”.
“We are now entering a dark new phase in this conflict,” Mr Lammy added.
“Netanyahu’s government is planning to drive Gazans from their homes into a corner of the strip to the south and permit them a fraction of the aid that they need.”
Referring to one of the far-right ministers in Mr Netanyahu’s government, he said Bezalel Smotrich “even spoke of Israeli forces cleansing Gaza, destroying what’s left of residents, Palestinians being relocated, he said, to third countries”.
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MPs from across the house shouted “genocide” as Mr Lammy said: “We must call this what it is. It is extremism. It is dangerous. It is repellent. It is monstrous and I condemn it in the strongest possible terms.”
In the Commons, a number of Labour MPs urged the government to go further against Israel.
Yasmin Qureshi, the Labour MP for Bolton South and Walkden, said there needed to be a “full arms embargo” and said: “Can I ask the foreign secretary what additional steps he’s going to be taking in order to stave off this genocide?”
Another Labour MP told Sky News that while the statement was “better than previously…without a concrete timeline and a sanctioning of responsible ministers, it’s hard to know what tangible difference it will make.”
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Israeli officials have said its plans to seize all of Gaza and hold it indefinitely. – which would move the civilian population southward – will help it achieve its aim of defeating Hamas.
Israel also believes the offensive will prevent Hamas from looting and distributing humanitarian aid, which it says strengthens the group’s rule in Gaza.
Mr Netanyahu has defended Israel’s actions in Gaza and reacted angrily to a joint statement penned by the leaders of the UK, France and Canada, in which they urged Israel to end its military offensive in Gaza and lift restrictions on humanitarian aid allowed into the enclave.
The Israeli prime minister said: “By asking Israel to end a defensive war for our survival before Hamas terrorists on our border are destroyed and by demanding a Palestinian state, the leaders in London, Ottawa and Paris are offering a huge prize for the genocidal attack on Israel on October 7 while inviting more such atrocities.
“No nation can be expected to accept anything less and Israel certainly won’t. This is a war of civilisation over barbarism. Israel will continue to defend itself by just means until total victory is achieved.”
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