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.
London and the UK’s leading status in the global financial system is “fragile”, the boss of Goldman Sachs has warned, as the government grapples with a tough economy.
Speaking ahead of a meeting with the prime minister, David Solomon – chairman and chief executive of the huge US investment bank – told Sky News presenter Wilfred Frost’s The Master Investor Podcast of several concerns related to tax and regulation.
He urged the government not to push people and business away through poor policy that would damage its primary aim of securing improved economic growth, arguing that European rivals were currently proving more attractive.
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He said: “The financial industry is still driven by talent and capital formation. And those things are much more mobile than they were 25 years ago.
“London continues to be an important financial centre. But because of Brexit, because of the way the world’s evolving, the talent that was more centred here is more mobile.
“We as a firm have many more people on the continent. Policy matters, incentives matter.
“I’m encouraged by some of what the current government is talking about in terms of supporting business and trying to support a more growth oriented agenda.
“But if you don’t set a policy that keeps talent here, that encourages capital formation here, I think over time you risk that.”
He had a stark warning about the recent reversal of the “Non Dom” tax policy, which occurred across both the prior Conservative government and the current Labour government, which has played a part in some senior Goldman partners relocating away from London.
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Richard Gnodde, one of the bank’s vice-chairs, left for Milan earlier this year.
“Incentives matter if you create tax policy or incentives that push people away, you harm your economy,” Mr Solomon continued.
“If you go back, you know, ten years ago, I think we probably had 80 people in Paris. You know, we have 400 people in Paris now… And so in Goldman Sachs today, if you’re in Europe, you can live in London, you can live in Paris, you can live in Germany, in Frankfurt or Munich, you can live in Italy, you can live in Switzerland.
“And we’ve got, you know, real offices. You just have to recognise talent is more mobile.”
Goldman is understood to have about 6,000 employees in the UK.
Rachel Reeves is currently seeking ways to fill a black hole in the public finances and has refused to rule out wealth taxes at the next budget.
Mr Solomon expressed sympathy for her as her tears in parliament earlier this month led to speculation about the pressure of the job.
“I have sympathy, I have empathy not just for the chancellor, but for anyone who’s serving in one of these governments,” he said, referring to the turbulent political landscape globally.
Commenting on the chancellor’s Mansion House speech last week, he added: “The chancellor spoke here about regulation, she’s talking about regulation not just for safety and soundness, but also for growth.
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Takeaways from chancellor’s Mansion House speech
“And now we have to see the action steps that actually follow through and encourage that.”
One area he was particularly keen to see follow through from her Mansion House speech was ringfencing – the post financial crisis regulation that requires banks to separate their retail activities from their investment banking activities.
“It’s a place where the UK is an outlier, and by being an outlier, it prevents capital formation and growth.
“What’s the justification for being an outlier? Why is this so difficult to change? It’s hard to make a substantive policy argument that this is like a great policy for the UK. So why is it so hard to change?”
The Master Investor Podcast with Wilfred Frost is available across multiple podcast platforms
Social media limits for children are being planned by the government to tackle “compulsive” screen time, the technology secretary has told Sky News.
Peter Kyle said he was concerned about “the overall amount of time kids spend on these apps” as well as the content they see.
A two-hour cap per platform is being seriously considered after meetings with current and former employees of tech companies. A night-time or school-time curfew has also been discussed.
Children would be blocked from accessing apps such as TikTok or Snapchat once they have hit the limit, rather than just reminded of how long they have been scrolling, it is understood.
An announcement on screen time is expected this autumn.
Mr Kyle said: “I’ll be making an announcement on these things in the near future. But I am looking very carefully about the overall time kids spend on these apps.
“I think some parents feel a bit disempowered about how to actually make their kids healthier online.
“I think some kids feel that sometimes there is so much compulsive behaviour with interaction with the apps they need some help just to take control of their online lives and those are things I’m looking at really carefully.
“We talk a lot about a healthy childhood offline. We need to do the same online. I think sleep is very important, to be able to focus on studying is very important.”
Charlotte, 17, said she believes there needs to be ‘harsher controls’
He added that he wanted to stop children spending hours viewing content which “isn’t criminal, but it’s unhealthy, the overuse of some of these apps”.
“I think we can incentivise the companies and we can set a slightly different threshold that will just tip the balance in favour of parents not always being the ones who are just ripping phones out of the kids’ hands and having a really awkward, difficult conversation around it,” he added.
Mr Kyle spoke exclusively to Sky News after meeting with a group of pupils from Darlington who have spent a year participating in regular focus groups about smartphones and social media, organised by their Labour MP Lola McEvoy.
The tech secretary is considering limiting screen time to two hours
They took part in a survey of 1,000 children from the town, mostly aged 14 and 15, which found that 40% of them spent at least six hours a day online. One in five spent as long as eight hours scrolling.
Most of the under-16s (55%) had seen inappropriate sexual or violent content – often unprompted. And three-quarters of the under-16s had been contacted online by strangers.
In the session in parliament, in which the children were asked what they were most concerned about, Jacob, 15, said: “A lack of restrictions on screen time I would personally say, which leads to people scrolling for hours on Tiktok.
“People just glue their eyes to their phone and just spent hours on it, instead of seeing the real world.”
Tom, 17, said: “I get the feeling you have to be quite tech savvy to protect your kids online. You have to go into the settings and work out each one. It should be the default. It needs to be straight away, day one.”
Matthew, 15, said: “I think because everybody is online all the time and there’s no real moderation to what people can say or what can be shared, it can really affect people’s lives because it’s always there.
“As soon as I wake up, I check my phone and until I go to bed. The only time I take a break is when I eat or am talking to someone.”
Some of the teenagers had spent 12 or even up to 16 hours a day online.
MP Lola McEvoy has been holding focus groups with teens to find out how severe the issue is
Nathan, 15, said: “When, for example, a 13-year-old is on their phone ’til midnight, you can’t sleep, your body can’t function properly and your mind is all over the place.”
But there was scepticism about what could be done.
Charlotte, 17, said: “If your parents sets a restriction on Instagram and say, ‘right, you’re coming off it now’ – there’s TikTok, there is Pinterest, there is Facebook, there’s Snapchat, there so many different other ones, you can go on, and it just builds up and builds and builds up, and you end up sat there for the entire evening just on social media. I think we need harsher controls.”
Several of the pupils who met Mr Kyle detailed being contacted by adult strangers, either on social media apps or online gaming, in ways which made them feel uncomfortable.
Mr Kyle said: “It is madness, it is total madness, and many of the apps or the companies have taken action to restrict contacts that adults – particularly strangers – have with children, but we need to go further and I accept that.
“At the moment, I think the balance is tipped slightly in the wrong direction. Parents don’t feel they have the skills, the tools or the ability to really have a grip on the childhood experience online, how much time, what they’re seeing, they don’t feel that kids are protected from unhealthy activity or content when they are online.”
The tech secretary is in the process of implementing the 2023 Online Safety Act, passed by the previous government.
From this Friday, all platforms must introduce stronger protections for children online, including a legal requirement for all pornography sites accessed in the UK to have effective age verification in place – such as facial age estimation or ID checks.
Briony and Matthew took part in the group
Mr Kyle added: “I don’t just want the base level set where kids aren’t being criminally exploited and damaged, that shouldn’t be the height of our aspirations. The height of our aspirations should be a healthy experience.”
Labour MP Lola McEvoy, who organised the focus group, said: “I knew things were bad online for children and young people but their testimony revealed the extent of explicit, disturbing and toxic content that is now the norm.
“Their articulation of the changes they wanted to see was excellent and they’ve done our town and their generation proud.”
Tiktok, Pinterest, Meta and Snapchat were contacted for comment, but none provided an on the record statement. The companies have accounts for under-16s with parental controls and some set reminders for screen time.
TikTok has a 60-minute daily screen time limit for under-18s after which they must enter a password to continue, and a reminder to switch off at 10pm. The company say this is to support a healthy relationship with screen time.
Pinterest have supported phone-free policies at schools, in the US and Canada and say they are looking to expand this elsewhere.
The UK will prohibit its public sector, such as its health service and local councils, from paying ransomware in a bid to “smash the cyber criminal business model.”
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