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.
Nvidia boss Jensen Huang has told Sky News the AI sector is a “long, long way” from a Big Short-style collapse.
Speaking outside Downing Street following a roundtable with government and other industry figures, the head of the world’s first $5tn company defended his sector from criticism by investor Michael Burry.
Mr Burry and his firm, Scion Capital, gained notoriety for “shorting” – betting against – the US housing market ahead of the 2008 financial crash.
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He was portrayed by Christian Bale in the 2015 film The Big Short, which also starred Steve Carell, Brad Pitt and Ryan Gosling.
Earlier this week, filings revealed Mr Burry has now bet against Nvidia and on social media, he has suggested there is a bubble in the sector.
Some $500bn was wiped off technology stocks overnight Tuesday into Wednesday, Bloomberg reported.
Speaking to Sky News, Mr Huang said: “I would say that we’re in the beginning of a very long build out of artificial intelligence.”
Christian Bale portrayed Michael Burry in the 2015 hit film. Pic: Reuters
Defending his company and investment, Mr Huang said AI is the first technology that requires “infrastructure to be built” and that Nvidia has seen “great returns” from AI, and that is why it is expanding.
Mr Huang said better training of AI has led to much “better” and “useful” answers, and that means “the AIs have become profitable”.
“When something is profitable, the suppliers want to make more of it, and that’s the reason the infrastructure build out is accelerating,” he added.
Pushed on whether he was worried about a situation like the Big Short, Mr Huang said: “We are long, long away from that.”
The UK government is betting big on AI in the hopes that it can save money by using it and generate growth by building the infrastructure to back it up.
Asked if she was worried about the market, Technology Secretary Liz Kendall told Sky News: “I have no doubts that AI is going to transfer all parts of our economy and our public services.”
Mr Burry and his firm, Scion Capital’s bets against Nvidia and other companies were revealed by regulatory filings earlier this week.
The investor also posted on social media for the first time in more than two years, warning of a bubble.
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Concerns have been raised about the market surrounding AI, and the growth many companies are experiencing.
Nvidia is the largest producer of the specialist computer chips that are used to train and use AI models.
Politics
‘Hope won’: London mayor Sadiq Khan compares newly-elected New York mayor to his leadership
New York has followed London by choosing hope over fear in electing Democrat Zohran Mamdani as its new mayor, Sir Sadiq Khan said.
Mr Mamdani, 34, defeated former New York governor Andrew Cuomo and Republican Curtis Sliwa to become the city’s first Muslim mayor and the first of South Asian heritage.
London mayor Sir Sadiq drew comparisons to his own 2016 victory as he congratulated Mr Mamdani, who will become New York’s youngest mayor in more than a century when he takes office on 1 January.
Sir Sadiq Khan. Pic: PA
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Sir Sadiq called it a “historic campaign”, adding on X: “New Yorkers faced a clear choice – between hope and fear – and just like we’ve seen in London – hope won.”
Education Secretary Bridget Phillipson also congratulated Mr Mamdani, telling Sky News: “I wish him well.
“It’s a wonderful job to have secured.”
Green Party leader Zack Polanski said Mr Mamdani’s success “will resonate throughout the world” as he called it a “story where no one is left behind”.
“It’s time to write that story across England and Wales too,” he added.
Zohran Mamdani with his wife, Rama Duwaji. Pic Reuters
Mr Mamdani’s victory was a setback for Donald Trump, who had thrown his weight behind Andrew Cuomo, a former Democrat running as an independent.
The mayor-elect described himself as “Trump’s worst nightmare” and said New York had shown “a nation betrayed by Donald Trump how to defeat him”.
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The US president had threatened to cut federal funding to New York if Mr Mamdani won.
In his victory speech, Mr Mamdani said: “New York will remain a city of immigrants, a city built by immigrants, powered by immigrants and as of tonight, led by an immigrant.
“If anyone can show a nation betrayed by Donald Trump how to defeat him, it is the city that gave rise to him.”
Kemi Badenoch is calling for the government to “get Britain drilling again” – as Sir Keir Starmer heads to COP30.
The Tory leader has launched a joint campaign with the Scottish Conservatives to demand the moratorium on new oil and gas licences is lifted.
They are also calling on the chancellor to scrap the energy profits levy – an extra 38% tax on North Sea oil and gas profits – at the upcoming budget on 26 November.
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The Conservatives want the government to recognise that it believes gas will be a key part of the future energy mix to secure energy and lower bills to “deliver a stronger economy”.
They have launched the call to “get Britain drilling again” as the prime minister flies to Brazil for the COP30 summit after he reiterated the government’s dedication to clean energy goals and the UK’s role as a global climate leader on Tuesday.
He admitted COP30 would present a “challenge” due to slow global progress in cutting emissions, but said: “I’ve thought climate change has been our biggest challenge as a species for a very long number of years now.”
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Speaking on a visit to Aberdeen, Ms Badenoch said the UK, in particular northeast Scotland, is facing an oil and gas “emergency due to the anti-growth policies of the Labour government in Westminster and the SNP in Holyrood”.
She warned the offshore oil and gas sector “risks disappearing altogether”, which she said would mean job losses in Scotland and the rest of the UK, and leave the country more reliant on overseas energy imports.
Ms Badenoch said: “Scotland, and the whole United Kingdom, faces a growing oil and gas emergency thanks to Labour’s inability to put our national interest first.
“By the end of Labour’s first term in office, it’s not inconceivable that Scotland’s oil and gas sector will be at serious risk, with domestic production currently set to half by 2030.
“That would be a shocking indictment of Labour’s energy policy, and a dangerous act of economic self-sabotage.
“Enough is enough. Keir Starmer must find the backbone to ditch Ed Miliband’s Net Zero fanaticism, which is forcing up bills and driving away industry.
“Instead, the prime minister should do what our economy needs, scrap the energy profits levy and end the moratorium on new licences in the North Sea.
“If the Labour government fails to act, we could be witness to the end of our domestic energy security as we know it.”
North Sea oil exploration platforms lie in the Cromerty Firth in northern Scotland in 2003. Pic: AP
A Labour Party spokesperson accused Ms Badenoch of “doubling down on the same failed Tory energy policy that caused the worst cost-of-living crisis in a generation”.
“The Conservatives’ anti-growth, anti-jobs, anti-investment position on clean energy would cost hundreds of thousands of jobs, leave Britain reliant on insecure expensive fossil fuels and lock families into higher bills for generations to come,” she added.
“It’s the same old Tories, with the same old policies. It didn’t work then and it won’t work now.”
There have been a series of oil and gas closures this year.
Grangemouth, Scotland’s only oil refinery, stopped processing crude oil after a century of operations in April, with 430 job losses.
The union Unite said political leaders had “utterly failed” the workers and would face “electoral wrath”, while the area’s Labour MP, Brian Leishman, said he was “disgusted” by the broken promises.
Harbour Energy, the UK’s largest oil and gas producer, cut 250 jobs in Aberdeen in May, blaming the government’s fiscal rules and regulations.
The Prax Lindsey Oil Refinery in Lincolnshire ended production in August, with 125 job losses, after the group went into administration and the government was unable to find a buyer.
In October, oil and gas contractor Petrofac, which employs about 2,000 people in Scotland, filed for administration, but its core operating subsidiaries and North Sea business have continued to trade as normal while it looks at restructuring or selling.
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