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
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.
An alleged attack by the Manchester Arena bomb plotter on prison officers at a high-security jail “will stick with” those impacted “for the rest of their lives”, a former officer and colleague of the victims has said.
Hashem Abedi is accused of violently assaulting officers at HMP Frankland in Durham last weekend, using hot cooking oil and an improvised, or homemade, weapon.
He was serving his sentence in a separation unit, known as a “jail within a jail”, after being found guilty of 22 counts of murder for helping his brother Salman Abedi carry out a suicide bombing at an Ariana Grande concert in 2017.
The attack has raised fresh questions about the safety of prison staff.
Inmates inside separation units had access to cooking facilities, which has now been suspended.
Abedi was moved back to Belmarsh after the alleged attack
‘It will stick with them for life’
Matthew, who only wants to be referred to by his first name, worked with the officers who were hospitalised following the attack.
“I’ve spoken to ex-colleagues who I’m still friends with,” he told Sky News.
“They’ve not discussed the specifics of the incident, but they’ve said it will stick with them for the rest of their lives.”
Matthew broke down as he described the “obscene” and “ludicrous” levels of violence that staff face inside prison.
He’s worked at a number of different jails.
“I’ve been there when you’re mopping your colleagues’ blood… when you’ve seen a serious assault, and you don’t know if they’re gonna be OK, and then 10 minutes later, you’ve got to get back on with your day, you’ve got to carry on running the regime,” he said.
“It is difficult, and it is awful.”
Matthew worked with the officers who were hospitalised
‘No adequate protection’
There were 10,496 assaults against prison staff in England and Wales in the 12 months to September – a 19% rise on the previous year.
“The reality is there’s no adequate protections for prison staff, and that’s a great frustration,” the general secretary of the Prison Officers’ Association union, Steve Gillan, told Sky News.
Having visited HMP Frankland earlier in the week, and spoken to many of the officers who were involved, Mr Gillan described the mood among colleagues as one of “anger, frustration, and sadness”.
The association, which represents prison officers, is calling for a “reset” – and for staff to be given stab-proof vests and tasers in “certain circumstances”.
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‘The entire system needs to change’
Justice Secretary Shabana Mahmood said she shared “the country’s shock and anger” at the attack.
The government has launched a review that will look at how it was able to happen, and will also consider how separation centres are run.
The Prison Service is also conducting a “snap” review into whether protective body armour should be available to frontline staff.
But ex-officer Matthew said “nobody is ever truly safe” in the prison service, with staff facing “impossible challenges every day”.
“The entire system needs to change,” he added. “From the ground up.”
Unwary travellers returning from the EU risk having their sandwiches and local delicacies, such as cheese, confiscated as they enter the UK.
The luggage in which they are carrying their goodies may also be seized and destroyed – and if Border Force catch them trying to smuggle meat or dairy products without a declaration, they could face criminal charges.
The new jeopardy has come about because last weekend, the government quietly “extended” its “ban on personal meat imports to protect farmers from foot and mouth”.
This may or may not be bureaucratic over-reaction.
It’s certainly just another of the barriers EU and UK authorities are busily throwing up between each other and their citizens – at a time when political leaders keep saying the two sides should be drawing together in the face of Donald Trump’s attacks on European trade and security.
Keir Starmer’s been embarking on a reset with European leaders. Pic: Reuters
The ban on bringing back “cattle, sheep, goat, and pig meat, as well as dairy products, from EU countries into Great Britain for personal use” is meant “to protect the health of British livestock, the security of farmers, and the UK’s food security.”
There are bitter memories of previous outbreaks of foot and mouth disease in this country, in 1967 and 2001.
In 2001, there were more than 2,000 confirmed cases of infection resulting in six million sheep and cattle being destroyed. Footpaths were closed across the nation and the general election had to be delayed.
In the EU this year, there have been five cases confirmed in Slovakia and four in Hungary. There was a single outbreak in Germany in January, though Defra, the UK agriculture department, says that’s “no longer significant”.
The UK imposed bans on personal meat and dairy imports from those countries, and Austria, earlier this year.
Authorities carry disinfectant near a farm in Dunakiliti, Hungary. Pic: Reuters
Better safe than sorry?
None of the cases of infection are in the three most popular countries for UK visitors – Spain, France, and Italy – now joining the ban. Places from which travellers are most likely to bring back a bit of cheese, salami, or chorizo.
Could the government be putting on a show to farmers that it’s on their side at the price of the public’s inconvenience, when its own measures on inheritance tax and failure to match lost EU subsidies are really doing the farming community harm?
Many will say it’s better to be safe than sorry, but the question remains whether the ban is proportionate or even well targeted on likely sources of infection.
Read more: The products you can’t bring into Britain from the EU
No more gourmet chorizo brought back from Spain for you. File pic: iStock
A ‘Brexit benefit’? Don’t be fooled
The EU has already introduced emergency measures to contain the disease where it has been found. Several thousand cattle in Hungary and Slovenia have been vaccinated or destroyed.
The UK’s ability to impose the ban is not “a benefit of Brexit”. Member nations including the UK were perfectly able to ban the movement of animals and animal products during the “mad cow disease” outbreak in the 1990s, much to the annoyance of the British government of the day.
Since leaving the EU, England, Scotland and Wales are no longer under EU veterinary regulation.
Northern Ireland still is because of its open border with the Republic. The latest ban does not cover people coming into Northern Ireland, Jersey, Guernsey, or the Isle of Man.
Rather than introducing further red tape of its own, the British government is supposed to be seeking closer “alignment” with the EU on animal and vegetable trade – SPS or “sanitary and phytosanitary” measures, in the jargon.
A ban on cheese? That’s anything but cracking. Pic: iStock
UK can’t shake ties to EU
The reasons for this are obvious and potentially make or break for food producers in this country.
The EU is the recipient of 67% of UK agri-food exports, even though this has declined by more than 5% since Brexit.
The introduction of full, cumbersome, SPS checks has been delayed five times but are due to come in this October. The government estimates the cost to the industry will be £330m, food producers say it will be more like £2bn.
With Brexit, the UK became a “third country” to the EU, just like the US or China or any other nation. The UK’s ties to the European bloc, however, are much greater.
Half of the UK’s imports come from the EU and 41% of its exports go there. The US is the UK’s single largest national trading partner, but still only accounts for around 17% of trade, in or out.
The difference in the statistics for travellers are even starker – 77% of trips abroad from the UK, for business, leisure or personal reasons, are to EU countries. That is 66.7 million visits a year, compared to 4.5 million or 5% to the US.
And that was in 2023, before Donald Trump and JD Vance’s hostile words and actions put foreign visitors off.
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More bureaucratic botheration
Meanwhile, the UK and the EU are making travel between them more bothersome for their citizens and businesses.
This October, the EU’s much-delayed EES or Entry Exit System is due to come into force. Every foreigner will be required to provide biometric information – including fingerprints and scans – every time they enter or leave the Schengen area.
From October next year, visitors from countries including the UK will have to be authorised in advance by ETIAS, the European Travel and Authorisation System. Applications will cost seven euros and will be valid for three years.
Since the beginning of this month, European visitors to the UK have been subject to similar reciprocal measures. They must apply for an ETA, an Electronic Travel Authorisation. This lasts for two years or until a passport expires and costs £16.
The days of freedom of movement for people, goods, and services between the UK and its neighbours are long gone.
The British economy has lost out and British citizens and businesses suffer from greater bureaucratic botheration.
Nor has immigration into the UK gone down since leaving the EU. The numbers have actually gone up, with people from Commonwealth countries, including India, Pakistan and Nigeria, more than compensating for EU citizens who used to come and go.
Editor’s note: Hands off my focaccia sandwiches with prosciutto! Pic: iStock
Will European reset pay off?
The government is talking loudly about the possible benefits of a trade “deal” with Trump’s America.
Meanwhile, minister Nick Thomas Symonds and the civil servant Mike Ellam are engaged in low-profile negotiations with Europe – which could be of far greater economic and social significance.
The public will have to wait to see what progress is being made at least until the first-ever EU-UK summit, due to take place on 19 May this year.
Hard-pressed British food producers and travellers – not to mention young people shut out of educational opportunities in Europe – can only hope that Sir Keir Starmer considers their interests as positively as he does sucking up to the Trump administration.
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