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%.
Image: Junior doctors in Scotland have accepted a 12.4% pay rise
Image: 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.
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.
Image: Health Secretary Victoria Atkins
Image: 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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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.
Jota and Silva were driving to Santander to catch a ferry back to England ahead of the start of Liverpool’s pre-season training on Monday, CNN Portugal reports.
The news outlet reports that Jota was advised against flying back to England due to recent surgery.
Police said the accident happened at 12.30am when the Lamborghini the pair were travelling in veered off the road.
Image: Palacios de Sanabria in the north of Spain
“A vehicle left the road and everything indicates a tyre burst while overtaking,” the Guardia Civil in Zamora told Sky Sports News in a statement.
“As a result of the accident, the car caught fire and both people were killed. Pending the completion of forensic tests, one of the deceased has been identified as Diogo Jota, a Liverpool FC player, and his brother, Andre Felipe.”
A Spanish government source told the PA news agency that police were investigating the crash as “a possible speeding incident”.
Image: The aftermath of the crash. Pic: AP
Image: Pic: AP
Police added that no other vehicles were involved in the incident.
Pictures of the aftermath of the crash showed debris scattered along the side of the road, including what appeared to be charred parts of the vehicle.
It comes just 10 days after the player married his long-term girlfriend, Rute Cardoso.
Image: Diogo Jota holds the Premier League trophy aloft after the club’s title win in the 2024/25 season. Pic: Reuters
Image: Diogo Jota walks the pitch with his family in 2022.
Pic: PA
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The footballer, whoplayed as a striker for Liverpool, began his career in his native Portugal and played at Atletico Madrid in Spain before moving to England.
He joined the Merseyside club from Wolverhampton Wanderers in 2020.
Image: Former Liverpool manager Jurgen Klopp with Diogo Jota. Pic: PA
Image: Portugal’s Cristiano Ronaldo (left) and Diogo Jota (right) during a training session. Pic: PA
Jota played an important role throughout his five years with the Reds, including scoring six times in Liverpool’s recent Premier League-winning season.
He scored a total of 47 times in 123 matches for the club. He also played 49 times for the Portugal national side, scoring 14 times.
Silva, 25, played for Penafiel, a Portuguese second division club.
Image: Diogo Jota holding the trophy on the team bus during the Premier League winners parade in Liverpool. Pic: PA
Teammates and football legends pay tribute
A statement issued by Liverpool FC said the club was “devastated” by their player’s death.
“The club have been informed the 28-year-old has passed away following a road traffic accident in Spain along with his brother, Andre,” the club said in a statement.
“Liverpool FC will be making no further comment at this time and request the privacy of Diogo and Andre’s family, friends, teammates and club staff is respected as they try to come to terms with an unimaginable loss.
“We will continue to provide them with our full support.”
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1:38
Sky’s Greg Milam reports from Anfield Stadium where Liverpool fans are hearing about the death of Diogo Jota.
The Portuguese football federation said it was “utterly devastated by the deaths”.
“Far beyond being an exceptional player, with nearly 50 caps for the national team, Diogo Jota was an extraordinary person, respected by all teammates and opponents, someone with a contagious joy and a reference within his own community.
“We have lost two champions. The passing of Diogo and Andre Silva represents irreparable losses for Portuguese Football, and we will do everything to honour their legacy daily.”
The Portugal and Spain women’s teams held a minute’s silence for Jota and Silva before their match in the Women’s Euros in Switzerland on Thursday evening.
Image: Floral tributes left at Anfield this morning. Pic: Sky
It came after Liverpool’s manager Arne Slot said in a statement: “What can anyone say at a time like this when the shock and the pain is so incredibly raw? I wish I had the words but I know I do not.
“All I have are feelings that I know so many people will share about a person and a player we loved dearly and a family we care so much about.
“My first thoughts are not those of a football manager. They are of a father, a son, a brother and an uncle and they belong to the family of Diogo and Andre Silva who have experienced such an unimaginable loss.”
Jota’s former manager at Liverpool, Jurgen Klopp, offered his thoughts in a post on Instagram.
“This is a moment where I struggle! There must be a bigger purpose, but I can’t see it,” he said.
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“I’m heartbroken to hear about the passing of Diogo and his brother Andre. Diogo was not only a fantastic player, but also a great friend, a loving and caring husband and father.
“We will miss you so much. All my prayers, thoughts and power to Rute, the kids, the family, the friends and everyone who loved them.”
Liverpool captain Virgil van Dijk posted on Instagram: “What a human being, what a player, but most importantly what an unbelievable family man.
“You mean so much to all of us and you always will!”
Cristiano Ronaldo, Jota’s captain in the national team, said: “It doesn’t make sense. Just now we were together in the National Team, just now you had gotten married.
“To your family, your wife, and your children, I send my condolences and wish them all the strength in the world.
“I know you will always be with them. Rest in Peace, Diogo and Andre. We will all miss you.”
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1:16
Diogo Jota married his long-term girlfriend just two weeks ago
Jota’s Liverpool teammates Darwin Nunez, Cody Gakpo and Dominik Szoboszlai have also paid tribute.
Szoboszlai wrote: “Words cannot describe how heartbroken and devastated we are… Your smile, your love for the game will never be forgotten.
“We will miss you so much, but you will stay with us forever, on and off the pitch.”
Jota’s former teammates Trent Alexander-Arnold, Sadio Mane, Roberto Firmino and Thiago Alcantara have also shared messages on social media.
Mane posted a picture of himself and Jota with heartbreak emojis.
It came as Liverpool legend Kenny Dalglish wrote on X: “You feel helpless, knowing there’s so little we can do to ease the pain for his wife of just two weeks, his three beautiful children.”
Liverpool legend Steven Gerrard shared an image of Jota on Instagram and wrote: “Condolences to his family and friends during this incredibly sad time.”
Liverpool owners Billy Hogan, John Henry and Tom Werner, who are part of the Fenway Sports Group, said: “This tragic situation and the reality of it is truly shocking, devastating and has left us numb with grief.”
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Football icon Lionel Messi has also paid tribute, sharing an image of Jota on Instagram with the message “QEPD” – short for the Spanish phrase ‘que en paz descanse’, which translates to “may he rest in peace'”.
European football clubs such as Barcelona and AC Milan have also shared messages, along with basketball player LeBron James and tennis icon Rafael Nadal.
Meanwhile Liverpool FC have opened a physical and digital book of condolence for supporters and members of the public to sign.
The physical book is at the club’s stadium, in the Anfield Road Stand reception area until Sunday evening.
An avid video gamer, Jota also owned an eSports team and regularly streamed on Twitch.
The joy that filled the final weeks of Diogo Jota’s life makes his death even more devastating to comprehend for his family and millions of fans worldwide.
The most illustrious title of his career was won in May, when he paraded through Liverpool with his teammates and the Premier League trophy.
More success came with Portugal as he won the Nations League for a second time alongside Cristiano Ronaldo in June.
And then came the bliss at marrying his childhood love Rute Cardoso, watched by their three children.
Just yesterday Jota posted a video from the ceremony on social media alongside the message “a day we will never forget”.
The happiest of days was remembered before the tragedy that killed Jota and his brother Andre Felipe in northwest Spain.
Image: Diogo Jota and wife Rute. Pic: rutecfcardoso14/Instagram
Brothers – whose careers both developed at their hometown club, Porto – so tragically dying together.
“Football has lost two great men,” Porto president Andre Villas-Boas said, as fans descended on the club’s stadium to mourn.
At Anfield, Liverpool fans are grieving the versatile forward who was so often in the shadow of Mohamed Salah, as he was under Ronaldo at Portugal.
But he knew how to sacrifice stardom to contribute to the squad.
Image: Diogo Jota holds the Premier League trophy with Wataru Endo and teammates. PIc: Reuters
The last of his 65 Liverpool goals was the winner in the Merseyside derby against neighbours Everton in April – helping the club become the record 20-time champions of England.
A Premier League winners’ medal joining those from the FA Cup and League Cup, won by the 28-year-old after he joined the Reds in 2020.
It was Wolverhampton Wanderers who gave Jota a platform to shine in England after he joined from Atletico Madrid.
Promotion was gained to the Premier League in 2018, and they more than just avoided relegation, but secured back-to-back top-seven finishes.
Jota was a reason why.
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0:48
Fans react to Jota death
He was also why Wolves could embark on such a memorable European campaign, and scored two hat-tricks in the run-up to the Europa League quarter-finals in 2020.
“The memories he created will never be forgotten,” Wolves said.
For the football world, the loss of such a talent so young will be hard to comprehend.
And so many are reflecting on the fragility of life as football grieves from Liverpool to Portugal – and beyond.
The father of a grooming victim who was raped by more than 60 men has said she still lives with the “trauma every single day”.
Marlon West, 51, said Scarlett, now 20, was an academic student at a school in Greater Manchester.
She was happy with a good friendship group and enjoyed riding her horse, Jasper.
But her life changed after she was attacked by a gang at a bus station – they started bullying her and she decided it was better to become their friends.
An older female member then started grooming her for rape gangs made up of Muslim men, her father told Sky News.
Image: Scarlett before she was groomed
Mr West said six men were involved in grooming her from the age of 14 but she was raped by more than 60 before the abuse finally stopped shortly before she turned 18.
By then, she was too terrified to leave home.
“Scarlett isn’t a survivor and a lot of these other girls aren’t survivors,” he said. “The reason being is they’re still living with the trauma every day.”
Mr West, an advanced nurse practitioner for mental health services at the NHS, said his daughter was thrown out of school aged 14 and would go missing for weeks at a time.
On one occasion, he tracked her down to a property in Derbyshire, but when he eventually persuaded police to attend, he was told Scarlett was “safe” with the woman who groomed her and “her friends”.
Image: Scarlett enjoyed riding her horse
Mr West said he was “absolutely furious” when police and social services dismissed the abuse as “a lifestyle choice” and was so desperate he put Scarlett into care when she was 15.
“I couldn’t keep her safe,” he said. “It’s the hardest decision of my life.”
But within a week of her returning home, when she had to leave the care system after turning 16, she was going missing again.
Mr West said the female groomer had stayed in contact with Scarlett and “was literally waiting for her” when she came home.
She was then trafficked all over the country, including Bradford, Birmingham and London.
Image: Marlon West and his daughter Scarlett
Mr West said he had to “scream” at police to track her down before they raided a property in Rochdale where she was found along with heroin and crack cocaine.
Scarlett was arrested and released on bail, but wasn’t charged because she was on a Home Office database as being at risk of trafficking, he said.
“Even though that [arrest] was inappropriate, that stopped it because she was terrified of going out of the house, which she still is now to a certain extent.”
Mr West believes the abuse also came to an end because she was getting older and her abusers were no longer interested.
“This is not just about child sexual exploitation but also criminal exploitation – she was doing county lines, she was picking up firearms for them,” he said.
Image: Scarlett and her dad Marlon
Mr West said any child can be at risk of grooming.
“They’re stereotyping a lot of these survivors, that they’re coming from broken homes, or they’re in care,” he said.
“A groomer doesn’t stand outside a school gate and think, ‘I’m not grooming her because her dad’s a doctor or her dad’s a GP’ – they don’t care. Once they target, that’s it.”
Mr West was speaking as a report by police watchdogs revealed Greater Manchester Police has live grooming investigations involving 714 victims and survivors.
The force said it has 1,099 lines of enquiry relating to potential suspects but only 269 who are confirmed.
“I think there’s more – a lot of survivors haven’t come forward. One, because they’re probably still being groomed and secondly because they’re terrified of GMP and how they’ve been treated in the past,” he said.
“It’s higher than it’s ever been. Services such as police and social services are terrified of political correctness.
“The groomers know they can get away with it because there aren’t many arrests and so it’s increased.”
GMP Chief Constable Sir Stephen Watson promised to go after child rapists and paedophiles “relentlessly” after the publication of the report, which was largely positive about the force’s turnaround in tackling the gangs.
But Mr West believes they are “still failing”, although he welcomed the investigation opened into his daughter’s case.
He said he is “hopeful” the national inquiry into grooming gangs by the government last month “will expose a lot of the cover-ups and give accountability” but is worried about the involvement of services such as councils and police forces because of a lack of trust.
A GMP spokesperson said: “We have met with Scarlett and her father and we’re conducting an extensive investigation into their allegations.
“While we understand the impact of their experiences cannot be undone, we aim to ensure that the experience of the GMP of today would be much improved from that of previous years.”
A Tameside Council spokesperson previously said they were legally unable to comment on Scarlett’s case.
But they said: “Where any concerns or issues are raised we work closely with individuals, families and our partners to provide support and resolve, as appropriate.
“Where individuals aren’t satisfied with the services received, we do have a statutory complaints procedure and individuals can ultimately take their complaint to the Local Government & Social Care Ombudsman.”