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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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%.
Image: Junior doctors in Scotland have accepted a 12.4% pay rise
Image: 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.
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.
Image: Health Secretary Victoria Atkins
Image: Shadow health secretary Wes Streeting
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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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.
Ten child protection organisations have written an urgent letter to the home secretary expressing concern about the omission of child sexual abuse from the government’s violence against women and girls strategy, following a Sky News report.
Groups including the NSPCC, Barnardo’s and The Children’s Society wrote to Yvette Cooper to say that violence against women and girls (VAWG) and child sexual abuse are “inherently and deeply connected”, suggesting any “serious strategy” to address VAWG needs to focus on child sexual abuse and exploitation.
The letter comes after Sky News revealed an internal Home Office document, titled Our draft definition of VAWG, which said that child sexual abuse and exploitation is not “explicitly within the scope” of their strategy, due to be published in September.
Image: Poppy Eyre when she was four years old
Responding to Sky News’ original report, Poppy Eyre, who was sexually abused and raped by her grandfather when she was four, said: “VAWG is – violence against women and girls. If you take child sexual abuse out of it, where are the girls?”
The Centre of Expertise on Child Sexual Abuse, which is funded by the Home Office and a signatory to the letter, estimates 500,000 children in England and Wales are sexually abused every year.
The NSPCC “welcome” the government’s pledge to halve VAWG in a decade, but is “worried that if they are going to fulfil this commitment, the strategy absolutely has to include clear deliverable objectives to combat child sexual abuse and exploitation too”, the head of policy, Anna Edmundson, told Sky News.
Image: Poppy is a survivor of child sexual abuse
She warned the government “will miss a golden opportunity” and the needs of thousands of girls will be “overlooked” if child sexual abuse and exploitation is not “at the heart of its flagship strategy”.
The government insists the VAWG programme will include action to tackle child sexual abuse, but says it also wants to create a distinctive plan to “ensure those crimes get the specialist response they demand”.
“My message to the government is that if you’re going to make child sexual abuse a separate thing, we need it now,” Poppy told Sky News.
Rape Crisis, which is one of the largest organisations providing support to women in England and Wales, shares these concerns.
It wants plans to tackle child sexual abuse to be part of the strategy, and not to sit outside it.
“If a violence against women and girls strategy doesn’t include sexual violence towards girls, then it runs the risk of being a strategy for addressing some violence towards some females, but not all,” chief executive Ciara Bergman said.
A Home Office spokesperson said the government is “working tirelessly to tackle the appalling crimes of violence against women and girls and child sexual exploitation and abuse, as part of our Safer Streets mission”.
“We are already investing in new programmes and introducing landmark laws to overhaul the policing and criminal justice response to these crimes, as well as acting on the recommendations of Baroness Casey’s review into group-based Child Sexual Exploitation, and the Independent Inquiry into Child Sexual Abuse,” they added.
A 54-year-old man and a 15-year-old boy have been arrested on suspicion of arson with intent to endanger life after a restaurant fire in east London on Friday.
Two remained in a critical condition on Sunday morning, according to the Metropolitan Police.
The restaurant suffered extensive damage in the blaze.
Two further victims are thought to have left the scene before officers arrived, Scotland Yard said.
Image: Woodford Avenue from above. Pic: UK News and Pictures
Police are still trying to identify them.
CCTV footage seen by the PA news agency appears to show a group of people wearing face coverings walk into the restaurant and pour liquid on the floor.
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Seconds later, the inside of the restaurant is engulfed in flames.
“While we have made two arrests, our investigation continues at pace so we can piece together what happened on Friday evening,” said the Met Police’s DCI Mark Rogers.
“I know the community [is] concerned and shocked by this incident.
Image: The moment the fire broke out.
“I would urge anyone with any information or concerns to come forward and speak to police.”
Hospital porter Edward Thawe went to help after hearing screams from his nearby home.
He described the scene as “horrible” and “more than scary and the sort of thing that you don’t want to look at twice.”
He said: “I heard screaming and people saying they had called the police.”
The 43-year-old said he saw a woman and a severely burned man who may have been customers.
Another witness, who did not want to be named, said he saw three “severely burned” people being doused by the emergency services and given oxygen.
“I can only imagine the pain they were going through,” he said.
On Saturday, the London Ambulance Service told Sky News: “We sent resources to the scene, including ambulance crews, an advanced paramedic, an incident response officer and paramedics from our hazardous area response team.
“We treated five people for burns and smoke inhalation. We took two patients to a major trauma centre and three others to local hospitals.”
A new fast-track asylum appeals process will be introduced to speed up the process of deporting people without a right to remain in the UK, the home secretary has said.
As it currently takes, on average, more than a year to reach a decision on asylum appeals, the government plans to set up a new independent panel focused on asylum appeals to help reduce the backlog.
Home Secretary Yvette Cooper said “completely unacceptable” delays in the appeals process left failed asylum seekers in the system for years.
There are about 51,000 asylum appeals waiting to be heard.
The new independent body will use professionally-trained adjudicators, rather than relying on judges.
Ministers are introducing a new 24-week deadline for the first-tier tribunal to determine asylum appeals by those receiving accommodation support and appeals by foreign offenders.
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Police clash with protesters in Bristol
But they believe the current tribunal system, which covers a wide range of different cases, is still failing to ensure failed asylum seekers can be returned as swiftly as possible, nor can it accommodate a fast-track system for safe countries.
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It comes amid protests about the use of hotel accommodation for migrants.
The home secretary said the overhaul would result in a system which is “swift, fair and independent, with high standards in place”.
She said: “We inherited an asylum system in complete chaos with a soaring backlog of asylum cases and a broken appeals system with thousands of people in the system for years on end.
“That is why we are taking practical steps to fix the foundations and restore control and order to the system.
“We are determined to substantially reduce the number of people in the asylum system as part of our plan to end asylum hotels.
“Already since the election, we have reduced the backlog of people waiting for initial decisions by 24% and increased failed asylum returns by 30%.
“But we cannot carry on with these completely unacceptable delays in appeals as a result of the system we have inherited which mean that failed asylum seekers stay in the system for years on end at huge cost to the taxpayer.”
Official figures released earlier this month showed a total of 111,084 people applied for asylum in the UK in the year to June 2025, the highest number for any 12-month period since current records began in 2001.
‘Waving immigrants through even faster will not fix the problem’
Chris Philp, the shadow home secretary, said: “I think this goes nowhere near far enough.
“The underlying rights, which allows most illegal immigrants to stay here, are not changing. Simply waving illegal immigrants through even faster to full housing and welfare rights will not fix the problem.”
Image: Chris Philp
He added: “Immigration judges will still apply ever expanding common-sense defying definitions of ECHR rights to allow foreign criminals and illegal immigrants to stay here.”
But the Liberal Democrats have been more positive in their response, with shadow attorney general, Ben Maguire, saying: “A faster application process would mean that those with no right to be here are sent back swiftly and those who do have a valid claim can get a job, integrate and contribute to the community.”
Asked for his thoughts on the policy, immigration lawyer Harjap Singh Bhangal told Sky News that it “definitely sounds like some sort of solution”.
He pointed that the backlog of asylum seekers waiting for a decision is “huge”, around 51,000 people – and that during this time, they are not allowed to work.
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A new fast-track asylum appeals process will be introduced to speed up the process of deporting people without a right to remain in the UK.
He said: “The equivalent would be saying that imagine if A-level students this year sat the exams and were told ‘well, hold on, you’re not going to get your results for two years’ time. But in the meantime, you can’t go to university.’
“You’d have mayhem, and it’d be pandemonium in the street. You’d have broken people idle with nothing to do. Essentially, this is what’s happening to asylum seekers.”
He added that one of the reasons it takes so long for cases to be heard is because asylum seekers have to represent themselves in court, which can mean upwards of half a day is spent translating and explaining everything to them.
Mr Bhangal also said the immigration system is “broken”, because “they take ages to make a decision which could be made in one week”.