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.
Canterbury MP Rosie Duffield has resigned from the Labour Party.
The 53-year-old MP is the first to jump ship since the general election and in her resignation letter criticised the prime minister for accepting thousands of pounds worth of gifts.
She told Sir Keir Starmer the reason for leaving now is “the programme of policies you seem determined to stick to”, despite their unpopularity with the electorate and MPs.
In her letter she accused the prime minister and his top team of “sleaze, nepotism and apparent avarice” which are “off the scale”.
“I’m so ashamed of what you and your inner circle have done to tarnish and humiliate our once proud party,” she said.
Rosie Duffield. Pic: UK Parliament/Jessica Taylor/Handout via Reuters
Sir Keir has faced backlash after a Sky News report revealed he had received substantially more freebies than any other MP since becoming Labour leader.
Since December 2019, the prime minister received £107,145 in gifts, benefits, and hospitality – a specific category in parliament’s register of MPs’ interests.
Ms Duffield, who has previously clashed with the prime minister on gender issues, attacked the government for pursuing “cruel and unnecessary” policies as she resigned the Labour whip.
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She criticised the decision to keep the two-child benefit cap and means-test the winter fuel payment, and accused the prime minister of “hypocrisy” over his acceptance of free gifts from donors.
“Since the change of government in July, the revelations of hypocrisy have been staggering and increasingly outrageous,” she said.
“I cannot put into words how angry I and my colleagues are at your total lack of understanding about how you have made us all appear.”
Ms Duffield also mentioned the recent “treatment of Diane Abbott”, who said she thought she had been barred from standing by Labour ahead of the general election, before Sir Keir said she would be allowed to defend her Hackney North and Stoke Newington seat for the party.
Her relationship with the Labour leadership has long been strained and her decision to quit the party comes after seven other Labour MPs were suspended for rebelling by voting for a motion calling for the two-child benefit cap to be abolished.
“Someone with far-above-average wealth choosing to keep the Conservatives’ two-child limit to benefit payments which entrenches children in poverty, while inexplicably accepting expensive personal gifts of designer suits and glasses costing more than most of those people can grasp – this is entirely undeserving of holding the title of Labour prime minister,” she said.
Ms Duffield said she will continue to represent her constituents as an independent MP, “guided by my core Labour values”.
UK
King Charles hails ‘uniquely special’ Scotland as it marks Holyrood milestone – before being hugged by woman
The King has paid tribute to Scotland as a “uniquely special place” for the Royal Family as he marked the 25th anniversary of the Scottish parliament.
At the ceremony to commemorate a quarter of a century since parliament opened at Holyrood, the King said: “Speaking from a personal perspective, Scotland has always had a uniquely special place in the hearts of my family and myself.
“My beloved grandmother was proudly Scottish, my late mother especially treasured the time spent at Balmoral, and it was there in the most beloved of places, where she chose to spend her final days.”
He said we are all “united by our love of Scotland”, paying tribute to its “natural beauty”, “strength of character”, “diversity of its people”, “passions and frequently deeply held beliefs”.
“From the central belt to the north Highlands, across the islands in Ayrshire, in the Borders, the cities, towns and villages, all the coastal communities, who I wonder, could not fail to be moved by this complex Caledonian kaleidoscope?,” he asked as presiding officer Alison Johnstone and the Queen sat beside him.
After he gave the speech, the King was hugged by a member of the public – who said she did so “because of him being unwell”.
The 75-year-old was diagnosed with cancer in February but has since returned to public duties.
Yvonne Macmillan, 59, from East Renfrewshire, attended the anniversary ceremony with her husband Russell who is registered blind and chosen as a “local hero” for work in their area.
“I asked him if he was feeling better and if I could give him a hug. I actually said to him: ‘Can I hug you?’,” she said.
“As I hugged him I said, ‘God bless you’, so it was like God giving him a hug.”
The King listens to the presiding officer of the Scottish parliament at Holyrood. Pic: PA
The Queen sits alongside the King as he makes his speech on Saturday. Pic: PA
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While Sir Tony Blair’s Labour government legislated for Scottish devolution in 1997 – parliament officially opened at Holyrood on 1 July 1999.
The King has made six visits to the parliament since 1999 – while his mother Queen Elizabeth II made 10 visits during her lifetime.
The King arrives at the Scottish parliament on Saturday. Pic: PA
Scottish First Minister John Swinney is one of a number of MSPs who have been at Holyrood since the start of devolution.
He said in his own speech in Edinburgh on Saturday that the parliament has “placed itself at the very heart of the nation”, describing it as a “vessel of enlightenment, invention and creativity”.
The King shakes hands with First Minister John Swinney in Edinburgh on Saturday. Pic: PA
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The SNP’s Christine Grahame is another MSP who has been there since the start.
“Free tuition, free prescriptions, game-changing policies to tackle child poverty, the ban on smoking, the baby box, ScotRail back in public ownership – none of this would have been possible without the Scottish parliament and the strength of our commitment to self-determination,” she said on Saturday.
The King said the devolved parliament has the ability to “touch and to improve the lives of so many individuals”.
Former first ministers Nicola Sturgeon and Humza Yousaf take a selfie as they wait for the King. Pic: PA
But he added that “there remains much more to be done” for Scotland, the rest of the UK, particularly with regards to climate change.
“Let this moment therefore be the beginning of the next chapter,” he told those assembled.
“The achievement of the past and the commitment shown in the present give us the soundest basis for confidence in the future.”
A moped riding phone thief was caught red-handed after police tracked the device down hours after he snatched it from a woman’s hand.
CCTV footage released by police showed a masked moped rider mount the pavement in Croydon, south London, to swipe a phone from a woman’s hand on 6 March, while another victim had theirs stolen while they waited for a bus an hour later.
Amari Scott, 20, looked surprised when confronted by officers inside a shop, where he was found with two mobile phones.
Amari Scott was caught red-handed. Pic: Met Police
“We’ve just had a moped rob a mobile phone off the pavement and the phone is pinging in this location,” one of the officers told him in body-worn camera footage before Scott was handcuffed and led away.
Police also recovered a stolen motorbike and Scott, from Sutton, south London, was later jailed for four years.
Two teenagers who committed four robberies in the space of just half an hour were also arrested as part of a crackdown in Croydon.
Aged 16 and 17, the teens were issued with referral orders after pleading guilty to charges of robbery, attempted robbery and attempted grievous bodily harm.
Amari Scott was jailed for four years. Pic: Met Police
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They were behind a spree of eight robberies across Croydon and nearby Bromley, including four within 30 minutes on the morning of 5 August.
Their crimes, which included the knife point robbery of a rough sleeper outside Croydon library, were caught on CCTV.
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One of the teenagers tried to discard a knife before she was arrested after a foot chase, telling officers: “The knife wasn’t mine”.
The other ran away, leaving a knife and his bag, but was lying in bed at home when he was arrested shortly after.
Two teenagers committed four robberies in 30 minutes. Pic: Met Police
The Metropolitan Police said officers are intensifying efforts to tackle robbery and theft, encouraging victims to report incidents as they happen to increase the chances of catching the criminals.
Chief Inspector James Weston said: “We understand the impact that robbery has on victims – it is invasive and frightening.
“That’s why our teams are working so hard to deter and catch offenders to reassure our local community.
“Thanks to the hard work of officers, our partners and community grassroots organisations, we are stepping up our efforts and tackling the issues that matter most to the people of Croydon.”
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