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.
WARNING: This article contains language and content some readers may find distressing
As a single mum, Lucy* looked forward to her rare nights out. A few years ago, during after-work drinks at a local pub, she started feeling unwell. When she collapsed and passed out, a bouncer called an ambulance. Lucy’s drink had been spiked.
The ambulance was crewed by two paramedics, a man and a woman. Still unconscious, Lucy was placed on a stretcher, strapped on to the bed, and driven towards the hospital.
After a scary episode, Lucy’s friends must have breathed a sigh of relief. She was safe, and being looked after. But, as the female ambulance driver looked in her rear-view mirror to check on Lucy, she says she saw the unimaginable – her male colleague sexually assaulting his patient.
Lucy still doesn’t remember what happened, but she has the police report and crime scene pictures of the inside of the ambulance.
Pointing to a photo of where she was strapped down, she says almost matter-of-factly: “He put my legs up, so my knees were up, and put his hand inside my groin area – possibly touching my vagina.”
When she regained consciousness, she was told what had happened to her. Years later, she is still struggling to process it.
The paramedic denied the charges and was found not guilty at trial, but later struck off by the paramedics’ regulator, the Health and Care Professions Council (HCPC).
They have a lower standard of proof than the criminal courts, and found against him, calling him a “serious threat to patient safety”.
Lucy still wouldn’t feel safe getting into an ambulance today. “It’s awful, you feel so violated and vulnerable,” she says.
“It’s a shock to think someone in that position would do that, when they’re supposed to be there to look after you.”
Her story is horrific, but Lucy is not alone. It forms part of a year-long Sky News investigation into sexual misconduct in the ambulance service, which has revealed a culture where abuse and harassment among staff are rife and patients are sexualised.
A senior ambulance boss admits the service has “let victims down”, while stressing that perpetrators are the “minority”.
Jason Killens, head of the Welsh Ambulance Service and the Association of Ambulance Chief Executives, says he expects “a steady increase” in the number of cases, with more paramedics being sacked for sexually inappropriate behaviour over the coming years, because of the work his organisation is doing to change the culture.
Data shared with Sky News shows one in five of the sexual misconduct complaints made against paramedics to their regulator, the Health and Care Professions Council, in 2023 were for acts against patients or members of the public.
While fewer than 1% of all HCPC members had concerns raised against them last year, in sexual misconduct cases, paramedics were hugely over-represented.
They make up just 11% of the HCPC register, but account for 64% of all investigations into sexual harassment against colleagues. The regulator’s chair, Christine Elliot, thinks the sexual misconduct cases are “just the tip of the iceberg”.
“This is all about patient safety,” she says. “Patients need to know when they see a practitioner, they can rely on them giving the best care possible with the best behaviour possible.”
‘Totally unnecessary breast examinations’
Cases like Lucy’s are rare but several whistleblowers across multiple trusts have spoken up about a culture in which “banter” or jokes about groping patients are commonplace.
Current and former paramedics claim to have heard patients, particularly young women, being sexualised by the men who had helped to treat or even save them.
One former paramedic revealed the phrase “totally unnecessary breast examinations” (or TUBEs), and said she had heard paramedics talking about “TUBEing” young, drunk women. She also claims to have seen a colleague grope another colleague’s breasts, telling her: “I just TUBEed you.”
A second woman said the same phenomenon was called “jazz hands” in her trust. Both said these were widely understood phrases which referred to colleagues accidentally, or deliberately, touching a woman’s breast during treatment.
A third paramedic told us she’d heard colleagues talk about patients in an explicitly sexual manner, saying things like: “She had nice tits” or “those were silicone”, while bragging about getting a patient’s number and having a “good feel”.
“That is assault. That is sexual assault,” she says.
‘It will be fun. Your career will progress’
“One of my biggest fears was that I wouldn’t be believed because of where I worked. It was the ambulance service and he was the man in charge,” says Ellie*, whose first job was as a call handler in an ambulance control room.
She loved the camaraderie and the idea that she was making a difference. Until one day, the manager called her into his office and invited her to a conference with him. At first, she was flattered and a little confused.
“He explained that he’d taken a liking to me and then he reached out and touched my leg.” Shocked, Ellie froze. “I was in my early 20s and didn’t know what his intention was. I was a bit naive, probably.” As he carried on talking, her boss slid his hand “as far up my thigh as it could go”.
Horrified, she shot back in her chair and asked him what he was doing.
“If you come, we’ll share a room. It will be fun. Your career will progress,” her boss replied.
“No,” she exclaimed, rushing out the room in a panic. Back at her desk, she carried on taking 999 calls while he watched over her.
Then she claims the messages started: “They were photos of his private parts, as well as messages suggesting meeting in the car park for sex and saying he wanted to kiss me. A whole manner of very descriptive sexual actions that he said he wanted to do with me.”
The messages carried on “for months”, she says, despite her pleading with him to stop. She was left dreading going to work for fear of seeing him, and avoided going to the toilet in case she ran into him in the corridor.
Eventually she showed the messages to HR, she says, but claims they suggested moving her to a different office. He wouldn’t be punished.
“It was sexual harassment,” Ellie says, caught between anger and despair. “They didn’t do anything. There was no investigation. No meeting with him that I’m aware of. No statement from me. Nothing. I was the problem.”
She eventually quit the service, but alleges he still works there to this day, an injustice that “makes me feel sick” she says.
An NHS England spokesperson said new national guidance and training has been recently introduced “to stamp out this awful behaviour”.
“Any abuse or violence directed at NHS staff is totally unacceptable and will not be tolerated, and the NHS is committed to tackling unwanted, inappropriate or harmful sexual behaviour in the workplace. We have recently introduced new national guidance and training that will help staff recognise, report and act on sexual misconduct at work to stamp out this awful behaviour,” they said.
‘We failed those individuals… I’m sorry’
Ellie’s story is simply “not right”, says ambulance boss Mr Killens.
“We failed those individuals,” he admits, saying “I’m sorry” to both staff and patients who have “been subject to poor behaviour from our people”.
Work is being done, he says, to tackle this kind of behaviour, citing it as his, and his organisation’s, top priority.
That will involve rooting out the perpetrators, but also playing the “long game” to change the culture “so that we can begin to tackle low level misconduct or inappropriate behaviour early, rather than let it fester and get worse,” he says.
According to the HCPC’s chair, cultural change is needed from leadership down. Sexual harassment, Elliot says, needs to be treated as high a priority as “waiting times and crumbling hospitals”.
Read more from this investigation:
Life as a female paramedic
‘Toxic’ culture of harassment revealed
But many of the victims we have spoken to say the HCPC takes too long (an average of three years) to investigate misconduct allegations.
Elliot agrees that isn’t good enough, but says they are running initiatives to speed things up, and wants to see legislative change to give her organisation more power to speed up investigations.
They have also created a sexual safety hub for both victims and witnesses of inappropriate behaviour.
It can be hard to hear allegations like Lucy and Ellie’s, contrasting their stories with a service in which the majority of people are dedicated to saving lives.
But it’s also clear that for far too long, abusers and those who commit sexually inappropriate behaviour have operated with impunity in the ambulance service. Some were perhaps protected by allegiances or cover-ups, many others simply hid behind the veneer of “banter”.
Ambulance and NHS bosses have made it clear to Sky News they are determined to root out not just the perpetrators of serious sexual violence, but also to stamp out the culture that breeds this behaviour.
But in the meantime women like Lucy, Ellie and countless others won’t hear an ambulance siren and feel safe, telling us they would even struggle to dial 999 in the case of a medical emergency.
*names have been changed
Illustrations by Rebecca Hendin
Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK
Consumer rights group Which? is suing Apple for £3bn over the way it deploys the iCloud.
If the lawsuit succeeds, around 40 million Apple customers in the UK could be entitled to a payout.
The lawsuit claims Apple, which controls iOS operating systems, has breached UK competition law by giving its iCloud storage preferential treatment, effectively “trapping” customers with Apple devices into using it.
It also claims the company overcharged those customers by stifling competition.
The rights group alleges Apple encouraged users to sign up to iCloud for storage of photos, videos and other data while simultaneously making it difficult to use alternative providers.
Which? says Apple doesn’t allow customers to store or back-up all of their phone’s data with a third-party provider, arguing this violates competition law.
The consumer rights group says once iOS users have signed up to iCloud, they then have to pay for the service once their photos, notes, messages and other data go over the free 5GB limit.
“By bringing this claim, Which? is showing big corporations like Apple that they cannot rip off UK consumers without facing repercussions,” said Which?’s chief executive Anabel Hoult.
“Taking this legal action means we can help consumers to get the redress that they are owed, deter similar behaviour in the future and create a better, more competitive market.”
Apple ‘rejects’ claims and will defend itself
Apple “rejects” the idea its customers are tied to using iCloud and told Sky News it would “vigorously” defend itself.
“Apple believes in providing our customers with choices,” a spokesperson said.
“Our users are not required to use iCloud, and many rely on a wide range of third-party alternatives for data storage. In addition, we work hard to make data transfer as easy as possible – whether it’s to iCloud or another service.
“We reject any suggestion that our iCloud practices are anti-competitive and will vigorously defend against any legal claim otherwise.”
It also said nearly half of its customers don’t use iCloud and its pricing is inline with other cloud storage providers.
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How much could UK Apple customers receive if lawsuit succeeds?
The lawsuit will represent all UK Apple customers that have used iCloud services since 1 October 2015 – any that don’t want to be included will need to opt out.
However, if consumers live abroad but are otherwise eligible – for example because they lived in UK and used the iCloud but then moved away – they can also opt in.
The consumer rights group estimates that individual consumers could be owed an average of £70, depending on how long they have been paying for the services during that period.
Apple is facing a similar lawsuit in the US, where the US Department of Justice is accusing the company of locking down its iPhone ecosystem to build a monopoly.
Apple said the lawsuit is “wrong on the facts and the law” and that it will vigorously defend against it.
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Big tech’s battles
This is the latest in a line of challenges big tech companies like Apple, Google and Samsung have faced around anti-competitive practices.
Most notably, a landmark case in the US earlier this year saw a judge rule that Google holds an illegal monopoly over the internet search market.
The company is now facing a second antitrust lawsuit, and may be forced to break up parts of its business.
Read more: Google faces threat of being broken up
File pic: Reuters
And in December last year, a judge declared Google’s Android app store a monopoly in a case brought by a private gaming company.
“Now that five companies control the whole of the internet economy, there’s a real need for people to fight back and to really put pressure on the government,” William Fitzgerald, from tech campaigning organisation The Worker Agency, told Sky News.
William Fitzgerald at Lisbon’s Web Summit, where he spoke to Sky News
“That’s why we have governments; to hold corporations accountable, to actually enforce laws.”
UK
Referees’ body taking ‘very seriously’ video that appears to show David Coote snorting white powder
A video appearing to show a Premier League referee snorting white powder is being taken “very seriously” by the referees’ body.
Professional Game Match Officials Ltd (PGMOL) suspended David Coote on Monday over derogatory comments he allegedly made about ex-Liverpool manager Jurgen Klopp and the club in previous footage.
PGMOL and the Football Association are investigating Coote who, it is alleged, used an expletive to describe Klopp and called Liverpool FC “shit”.
Now it has emerged the UEFA Referees Committee also suspended Coote until further notice on Monday, ahead of the upcoming round of UEFA matches “when it became aware of his inappropriate behaviour”, it said.
On Wednesday evening, another video appeared on The Sun’s website which it said showed Coote snorting white powder during this summer’s Euros in Germany, where he was officiating.
A PGMOL spokesperson said: “We are aware of the allegations and are taking them very seriously. David Coote remains suspended pending a full investigation.
“David’s welfare continues to be of utmost importance to us and we are committed to providing him with the ongoing necessary support he needs through this period. We are not in a position to comment further at this stage.”
The Sun said the video was filmed on 6 July, the day after the Euro 2024 quarter-final clash between Portugal and France, for which Coote was an assistant VAR.
A statement from UEFA said: “The UEFA Referees Committee immediately suspended David Coote until further notice on 11 November – in advance of the upcoming round of UEFA matches – when it became aware of his inappropriate behaviour.”
David Coote. File pic: PA
The previous video footage, appearing to show Coote making derogatory remarks about Klopp and the Anfield club, began circulating online on Monday.
He was subsequently suspended by PGMOL pending a full investigation, and the FA then said it was also investigating the matter.
Coote officiated Liverpool’s most recent Premier League game – a 2-0 win over Aston Villa on Saturday night.
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He was criticised by some fans after Liverpool forward Mohamed Salah was brought down by Aston Villa player Leon Bailey.
Liverpool forward Darwin Nunez went on to score after play wasn’t stopped – but a replay showed Coote had chosen not to stop the game because he believed the challenge on Salah wasn’t a foul rather than because he wanted the Reds to keep their advantage.
The PA news agency has approached the FA for comment regarding the Sun’s story.
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