Adam Boulton: NHS pessimism creeping up as striking doctors push on with 35% pay demand

Published

2 years ago

January 7, 2024

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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.

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.

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.

Politics

How No 10 plunged itself into crisis ahead of a perilous budget

Published

5 hours ago

November 12, 2025

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How No 10 plunged itself into crisis ahead of a perilous budget

Double-dealing, plotting, declarations of loyalty and treachery – in recent weeks the nation has feasted on Celebrity Traitors.

But these sorts of antics emanating from Downing Street, a couple of weeks out from a critical budget, feels far less entertaining and only serves to further hurt a struggling prime minister.

It wasn’t the intention. Allies of Keir Starmer have been alive to growing talk of a possible post-budget challenge, which has building amid growing concerns from MPs about the upcoming manifesto-breaking budget, the continued dire polling, and a Downing Street forever on the back foot.

There was a decision, as I understand it, from the PM’s team, in light of questions being asked about a possible challenge, to put it out there that he would stay and fight a leadership challenge should it come.

Politics latest: Starmer denies authorising attack on Streeting

I was briefed about this on Tuesday by allies that wanted to make the case to the parliamentary party about the perils of trying to oust a sitting prime minister 18 months into the parliamentary term.

My contacts made it very clear to me that the PM would fight any challenge, in turn triggering a three-month leadership battle that would spook the markets, create more chaos and further damage the Labour brand.

They also stressed the PM has no intention of giving way just 18 months in. The intention was to try to see off any plot and scare the parliamentary party into line at the prospect of a full-on meltdown should the challenge come.

But the decision by some of the PM’s allies to anonymously also drop the name of prime traitor suspect – Wes Streeting – into briefings has badly backfired and plunged No 10 into crisis.

‘Frustration’ after PM’s allies went ‘too far’

As for the clean-up job, Mr Streeting – already carded for the morning round ahead of a speech on the NHS on Wednesday – has come out to declare his loyalty (tick), but also take aim at the No 10 briefers, and called on the PM to take them to task.

On the part of No 10, I was told by sources on Wednesday morning that there wasn’t an attempt to brief against the health secretary – there is a view that some of Sir Keir’s allies might have gone too far, rather to make it clear the PM was prepared to fight a challenge if it came.

I am told by one No 10 source there is “frustration” over how his played out and it had “got out of control”.

“Wes is doing a good job, is an asset and doing a big speech today making the broader case of not cutting spending ahead of the budget,” said a source.

But putting the genie back in the bottle is no easy feat. MPs are furious at the briefings and exasperated that No 10 have made a mountain out of a molehill, with some suggesting that there wasn’t an active plot post-budget, and they have created a crisis when there wasn’t one.

“They’ve done this before,” observed on senior party figure. “They pick a fight of their own making and imply everything is a calamity ahead of a big possible negative, be it the budget or the Batley and Spen by-election [in an effort to get MPs to rally around the PM].

“It’s worked in the past; I think they have misplayed it this time. They have started a fire they cannot put out.”

The prime minister has been left badly burnt in all of this. He was forced at PMQs to defend his health secretary and his chief of staff as Kemi Badenoch goaded him over No 10’s “toxic culture”, and called for him to sack Morgan McSweeney, his chief of staff.

The PM told his party that he “never authorised” briefings against his cabinet and that it was “completely unacceptable”. But when his team were later asked about what the PM was going to do about it, they didn’t appear to have an answer.

If he takes no action, it will only feed into the sense among many in his party that Sir Keir doesn’t have a grip of his operation and is not leading from the front. That’s difficult when his health secretary, having professed his loyalty, has called on the PM to deal with those briefing against him. It’s a mess.

Budget measures to calm febrile party

And this mess comes at a time that is already so difficult for this government. Number 10 and No 11 knows exactly how difficult the coming weeks are going to be.

The chancellor has been out pitch rolling her budget, trying to explain the reasons behind potential manifesto-breaking pledges and arguing that the alternatives – cutting spending and a return to austerity or breaking fiscal rules, and the knock on effect in the markets – are far worse.

The prime minister is also going to be out making the case as Downing Street and the Treasury work out how they can possibly try to sell a manifesto-breaking budget to voters already completely disillusioned with this Labour administration.

I’m told that the current working plan is to do a combination of tax rises and action on the two-child benefit cap in order for the prime minister to be able to argue that in breaking his manifesto pledges, he is trying his hardest to protect the poorest in society and those working people he has spoken of being endlessly in his mind’s eye when he takes decisions in No 10.

The final decisions are yet to be taken, but the current thinking is to lift the basic rate of income tax – perhaps by 2p – and then simultaneously cut national insurance contributions for those on the basic rate of income tax (those who earn up to £50,000 a year). That way, the chancellor can raise several billion in tax from those with the ‘broadest shoulders’ – higher-rate taxpayers and pensioners or landlords.

At the same time, the chancellor intends to move on the two-child benefit cap – although it’s unclear if that will be a full or partial lifting of that cap – in order to argue that Labour is trying to still protect those on lower incomes from tax hikes.

Those two measures will be designed to try to calm a febrile party and prevent panic after the budget. As one informed MP put it to me, the combination of tax rises for wealthier workers and more support for parents with more than two children are arguments that many MPs could get behind.

More bad news at moment of peril

This is also why No 10 getting ahead of a possible post-budget coup has surprised me a little, given that pretty much all the conversations about a possible challenge to the PM have been linked to the ballot box test next May.

One party figure told me on Wednesday it would be “insane and catastrophic” to for the party to try and bring down a Labour PM over a Labour budget, given, for a start, how the markets would react, and thinks the No 10 briefing is a reflection of how “paranoid and out of touch” the Starmer operation is with the parliamentary party.

But it is also true that there is a settled view among some very senior figures in the party that Sir Keir lacks the charisma, leadership and communication skills to take on Nigel Farage, while broken manifesto promises will kill his hopes of standing for a second term. As one figure put it to me: “Breaking those promises will destroy him. The public won’t give him a hearing again. We need a clean skin.”

The whispered plots around Westminster are now front page news – not something the Sir Keir would have wanted as he prepares to front up what is shaping up to be his biggest test as prime minister yet, should he break the most sacred of his manifesto pledges on not raising VAT, income tax and national insurance on working people.

There is no doubt the budget will be a moment of peril – and those who wanted to be faithful to the PM this week have somehow only managed to make his situation even worse.

Politics

Reform pulls out of BBC documentary amid Trump legal threat

Published

5 hours ago

November 12, 2025

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Reform pulls out of BBC documentary amid Trump legal threat

Reform UK has pulled out of a BBC documentary about the party amid a row over the broadcaster’s misleading editing of a Donald Trump speech.

The Rise Of Reform had been due to air in January, fronted by Laura Kuenssberg, and was being made by the independent production company October Films.

An internal memo sent to all Reform MPs, councillors and other senior figures, and seen by Sky News, told party officials to stop assisting with the documentary.

A senior official wrote: “Hi all, as you will be aware October Films have been filming a documentary with Kuenssberg on the rise of Reform.

“As part of this, they have been visiting and filming at Reform councils and speaking to our councillors and council leaders across the country.

“We want to be clear that October Films have always conducted themselves professionally, and there is no suggestion from our side that they would maliciously misrepresent Reform UK. However, following the Panorama documentary the trust has been lost.”

The email continued: “If you are approached to participate, we would strongly advise you decline. If you have already participated, we would strongly advise that you contact October Films and explicitly withdraw consent for your footage to be used.”

Production company ‘shocked’ over misleading edit

Meanwhile, a source close to October Films told Sky News the company was “shocked” it wasn’t told about concerns over the Panorama Trump documentary, despite an internal review at the corporation highlighting the misleading edit back in January.

October Films worked on the one-hour Panorama special, Trump: A Second Chance with a majority in-house BBC team, which included a BBC director, executive producer, editor and lawyer.

The source told Sky News: “October Films were not informed there was any question of integrity with the edit. Had they been given the opportunity, they would have insisted on the edit being changed.”

October Films – who are an Emmy and BAFTA-winning independent producer, with credits including BBC2’s Laura Kuenssberg: State of Chaos, Channel 4’s Levison Wood: Walking With…, and CNN’s First Ladies – are understood to have first learned of the misleading edit when a leaked BBC memo was published in The Telegraph.

Sky News understands the concealed cut in the president’s speech was present in the first version of the film shown to executive producers at an early viewing, with those producers not told an edit had been made.

Despite subsequent internal viewings, and various changes and tweaks to other parts of the film ahead of sign-off by senior editorial figures, as well as the BBC’s compliance and legal teams, the clip containing the president’s spliced quotes remained intact as part of the final edit.

Sky News approached the BBC for comment and were told they had “nothing to add to the BBC Chair’s letter to CMS committee”.

In his letter, Samir Shah described the edit as an “error of judgement” and admitted it “did give the impression of a direct call for violent action”.

October Films declined to comment.

Where was the documentary shown?

The 57-minute Panorama special – Trump: A Second Chance? – first aired on BBC One on 28 October 2024, a week before the US election.

The documentary aired in the UK and was put on iPlayer.

A shorter international version was cut, but the Capitol speech moment was not included in that cut-down version.

The film never aired in the US and couldn’t be viewed in the US on iPlayer as the content was geoblocked.

What was the misleading edit?

While the BBC say the film received “no significant audience feedback” at the time, the corporation says it has since received over 500 complaints after an internal memo detailing investigations into impartiality was leaked to The Telegraph.

The most contentious issue raised in the memo was the cutting together two parts of a long Trump speech, which he had made on 6 January 2021.

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This was the day of the storming of the Capitol building in Washington by Trump supporters who believed the 2020 election had been stolen by Joe Biden.

In the documentary, the clip was presented as one sentence, in which Mr Trump appeared to say: “We’re gonna walk down to the Capitol and I’ll be with you and we fight. We fight like hell and if you don’t fight like hell, you’re not gonna have a country anymore.”

In reality Mr Trump’s words, “We’re gonna walk down to the Capitol and I’ll be with you,” came around 50 minutes before he said, “and we fight. We fight like hell….” The cut had been covered by crowd shots.

When were issues over the cut first raised?

The author of the leaked memo, Michael Prescott, former adviser to the BBC’s Editorial Guidelines and Standards Board (EGSB), says he first raised concerns over impartiality after watching the documentary when it aired on the BBC.

He says his complaint led to an investigation by senior EGSC advisor David Grossman, with a report delivered in January 2025. He said this report raised the alarm over the edit of Mr Trump’s Capitol Hill speech.

Mr Prescott said that following the review BBC executives “refused to accept there had been a breach of standards and doubled down on its defence of Panorama”.

He says he was told at an EGSC meeting in May 2025 that it was “normal practice to edit speeches into short form clips”.

It was after this meeting in May that Mr Prescott says he wrote to the BBC chairman, Samir Shah, asking him to “take some form of action,” but “received no reply”.

What’s the fallout been and what’s next?

The misleading edit has already led to the departure of BBC director-general, Tim Davie, and the head of BBC News, Deborah Turness.

Adding to the BBC’s problems, on Monday, the corporation received a letter from Mr Trump’s lawyers, threatening to sue them for $1bn.

They have been asked to issue a “full and fair retraction” of the documentary, “apologise immediately” and “appropriately compensate” the US president.

The BBC has been given a deadline of 10pm UK time on Friday to respond.

Politics

Prosecutors request February or March retrial for MEV bot brothers

Published

7 hours ago

November 12, 2025

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Prosecutors request February or March retrial for MEV bot brothers

Anton and James Peraire-Bueno, two brothers indicted for their alleged role in money laundering and fraud involving a $25 million exploit of the Ethereum blockchain, could face a second trial as early as February.

In a Monday filing in the US District Court for the Southern District of New York, lawyers representing the US government requested a federal judge schedule a retrial for the Peraire-Bueno brothers “as soon as practicable in late February or early March 2026.”

The request came about three days after a judge declared a mistrial in the case, following the jurors’ inability to reach a verdict.

Law, Trial, Court, Crimes — *Source:* *Courtlistener*

The brothers were charged with conspiracy to commit wire fraud, money laundering, and conspiracy to receive stolen property related to their role in using maximal extractable value (MEV) bots to exploit $25 million in digital assets in 2023.

The case drew attention from many in the crypto industry for the possible ramifications of a guilty verdict on trading on Ethereum. The brothers could still face decades in prison if they were to be found guilty at retrial.

What could change in a second trial?

Jurors took more than three days to deliberate before reporting to the judge that they were unable to reach a verdict. During that time, the jury asked several questions clarifying statements in testimony offered at trial, as well as the definition of “good faith.”

“Yesterday, half of the jury spontaneously broke down in tears, and several members of the jury have reported multiple nights of sleeplessness,” according to a letter filed on the public docket on Monday. “While this is a lesser concern, we have all endured the financial and psychological hardship of being sequestered from our jobs and family for nearly a month.”

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