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.
In a workshop in the far corner of the Styal prison estate, glass, plastic and metal are being smashed to the beat of pumping music.
Women at workstations are dismantling electronics with the energy of gym enthusiasts.
TVs and laptops, discarded at local recycling centres across England, have ended up here, on the edge of Wilmslow, Cheshire.
But amid the whiz of drills, the crunch of screens being separated from their plastic casings and the clatter of electronic boards ripped out and chucked in big bins, something else is being recycled – women’s lives.
“You get a lot of frustration out, because obviously a lot of girls have got a lot of anger, you know,” says Joanne*, who is serving time for drug offences.
She has joined this activity not for the £10 per 70 TVs she breaks apart, but because the programme – called Recycling Lives – could give her the skills and the support to keep her out of jail in the future.
Only 12% of women are employed six months after leaving prison, compared to 25% of men. In the general population employment levels between men and women are 78% to 72%.
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Ex-prisoners with a job are far less likely to re-offend. So, women prisoners are at a disadvantage. Often a man is connected to the crime they committed.
“For 90% of the women in prison, there’s always a male involved in why they’ve committed crime, it is the case with me as well,” says Joanne, who tells me she was pressured into dealing drugs by her partner.
Official Ministry of Justice statistics say that at least 60% of women in prison are victims of domestic violence and most will have experienced some form of abuse as a child.
Many, too, are mothers and they feel the guilt of separation every day. Joanne says of her son: “It’s my sister picking him up from school, not me.
“It’s my sister there on Christmas day, not me. Birthdays, all the special occasions. It’s heart-breaking.
“People think prison is easy. You are ripped away from your family and your children. It’s not easy.”
As if in illustration, the glass cracks on an iPad, as she peels it away with her screwdriver.
Official figures say there are around 3,500 women in prison and it is estimated that about half are mothers.
‘I’m trying to give them a future’
The workshop manager Yvonne Grime knows this all too well. A former serial offender herself, she’s the first former inmate at Styal to now hold a set of keys to the prison.
“The biggest thing for me [as a prisoner] was leaving my children,” she says, “and I still carry that guilt round, but I have come through it.”
Part of her redemption is to help the women in her workshop. The Recycling Lives programme transformed her life, and she wants to give back.
She says: “I’m trying to give them a future. I’m trying to give you some hope that they can that they can change.
“Get the children back, find a job, find a home. There is light at the end of the tunnel.”
Her work is part manager and part mentor. “When I first started, I thought I’m just going to come in and run this workshop,” she said.
“I didn’t realise I had to be their mum, their dad, their brother, their sister, the doctor, the nurse, the everything that comes with it.
“If I had a salary for every one of those professions, I’d be absolutely minted.”
Styal isn’t what you expect a prison to look like.
Inside the high fences and barbed wire are sixteen austere red-brick Victorian houses.
Once an orphanage, they’re now the prison’s accommodation blocks.
Ted the prison cat, wanders from block to block, and has already served several of his nine lives in the compound.
Along with recycling TV sets, women can learn to guide and drive forklift trucks.
They are quick with their tools, spinning through one appliance after another with remarkable and methodical destructive pace.
But the real advantage of the programme is that it continues on the outside. Only 6% of people who go through Recycling Lives go on to commit further crime. The general reoffending rate is 25%.
In a warehouse in Preston, former inmates are involved in recycling food from supermarkets and farms, then sent to foodbanks.
Here we meet Naomi Winter, who – three years since being released from jail – is now a manager at the food distribution depot.
The hardest thing about prison for her too was being separated from a child.
“I was put in prison when my baby is only three months old,” she said.
“So, it was like losing an arm, like losing a piece of my DNA.
“I still woke up for night feeds in the night and stuff like that.”
She says there wasn’t the mental health provision inside of prison to help her deal with post-natal depression, and she spent way too much time alone with her thoughts.
She was in and out of prison for drug offences and violence eight times by the age of 30 and first jailed aged 15, for breaching an anti-social behaviour order (ASBO).
She feels even short prison sentences can ruin lives, and says: “You take women who’s robbed a block of cheese to feed the child.
“They put them in prison for 28 days. They take the home, take the kids, they lose the family, and they get out with nothing. You just create a criminal right there.
“You’ve just created a woman who’s got nothing to lose. You’re also releasing them with a sleeping bag in a tent and telling them to go and sleep in the woods.”
Alternatives to custody
The government recognises that prison isn’t working for many of the women who end up there.
It’s why, with women being mostly non-violent offenders and serving short sentences, the government is setting up a Women’s Justice Board to look at reducing the number who go into prison with alternatives such as community sentences and intervention projects tackling the root causes of re-offending.
The Lord Chancellor and Justice Secretary, Shabana Mahmood, told Sky News: “For many women, prison isn’t working. Most women in prisons are victims themselves. Over half are mothers, with a prison sentence separating parent and child.
“That’s why I am establishing a new Women’s Justice Board, tasked with reducing the number of women in prison by exploring alternatives to custody for female offenders.”
Chief Executive of Recycling Lives, Alasdair Jackson says: “There are certain things we all need as human beings: One is a place to live, one is a job to be able to pay for that place to live and then a support network.
“But there are a lot more factors that women have to contend with; there’s children, there is maybe domestic abuse, there’s everything that goes on around that, but when you give people a chance, when you give people the skills that they need, it is life-changing.
“And when you change a woman’s life, you are often changing the family’s life and the children’s life.”
Prison is supposed to be part punishment, part repair job. But there are limited programmes like Recycling Lives, and for many women entering jail currently, the only recycling is back into criminality.
The world’s oldest man has died at the age of 112, the Guinness World Records has announced.
John Tinniswood was born in Liverpool on 26 August 1912, the year the Titanic sank. He was a lifelong Liverpool FC fan, born just 20 years after the club was founded.
He died on Monday at a care home in Southport, Guinness World Records said.
In a statement, his family said: “His last day was surrounded by music and love.
“John always liked to say thank you. So on his behalf, thanks to all those who cared for him over the years, including his carers at the Hollies Care Home, his GPs, district nurses, occupational therapist and other NHS staff.”
In April 2024, aged 111, he became the world’s oldest living man, following the death of 114-year-old Juan Vicente Perez from Venezuela.
Mr Tinniswood’s key advice for staying healthy was to practice moderation. “If you drink too much or you eat too much or you walk too much; if you do too much of anything, you’re going to suffer eventually.”
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But when asked the secret to his longevity after turning 112 in August, Mr Tinniswood put it all down to “just luck”.
“I can’t think of any special secrets I have,” he said. “I was quite active as a youngster, I did a lot of walking.
“Whether that had something to do with it, I don’t know. But to me, I’m no different [to anyone]. No different at all.
“I just take it in my stride like anything else, why I’ve lived that long I have no idea at all.”
Apart from a portion of battered fish and chips every Friday, Mr Tinniswood did not follow any particular diet, and said earlier this year he felt “no different” turning 112.
“I don’t feel that age, I don’t get excited over it. That’s probably why I’ve reached it.
“I just take it in my stride like anything else, why I’ve lived that long I have no idea at all.”
He lived through both world wars and was a Second World War veteran – having worked in an administrative role for the Army Pay Corps.
In addition to accounts and auditing, his work involved logistical tasks such as locating stranded soldiers and organising food supplies. He went on to work as an accountant for Shell and BP before retiring in 1972.
He met his wife, Blodwen, at a dance in Liverpool. They were together for 44 years before Blodwen died in 1986.
Mr Tinniswood is survived by his daughter Susan, four grandchildren and three great-grandchildren, and lived to be the fourth-oldest British man in recorded history.
His family added: “John had many fine qualities. He was intelligent, decisive, brave, calm in any crisis, talented at maths and a great conversationalist.
“John moved to the Hollies rest home just before his 100th birthday and his kindness and enthusiasm for life were an inspiration to the care home staff and his fellow residents.”
The oldest ever man was Jiroemon Kimura from Japan, who lived to the age of 116 years 54 days and died in 2013.
The world’s oldest living woman, and oldest living person, is Japan’s 116-year-old Tomiko Itooka.
Two teenage boys have been arrested after the suspected stabbing of a 12-year-old girl.
South Wales Police were called to Barry Island in the Vale of Glamorgan at around 5pm on Sunday to a report of an assault near the Harbour Road car park in the seaside resort.
The girl, whose condition is described as not life-threatening, was taken to the University Hospital of Wales in Cardiff with serious injuries.
Police say they have arrested two local boys, aged 13 and 15, on suspicion of causing grievous bodily harm and they both remain in custody.
The younger of the two has also been arrested on suspicion of possession of a bladed article.
Detective Inspector Phil Marchant from South Wales Police said the incident and “the ages of those involved” would “cause worry within the community”.
He said the two suspects are “known to the victim” and were arrested within an hour.
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“At this stage we are not looking for anyone else in connection with the assault,” he added.