Underpaid, overworked, and struggling to hold up a health service in collapse. It was only a matter of time before junior doctors said enough is enough.
Today, junior doctors in England are on strike, their third round of strike action since March, and plan a minimum of three days of industrial action each month throughout the summer if the government does not improve its offer of a 5 percent salary rise. A re-ballot is on the cards, too, potentially extending the legal mandate for industrial action into 2024.
Like nurses, ambulance workers and other healthcare workers who've taken strike action, junior doctors have suffered dramatic real-terms pay cuts over the years-down by more than a quarter since 2008. The result has been a recruitment and retention crisis as many make the move abroad or retrain in other professions in pursuit of better pay and conditions.
New statistics released today suggest the crisis is set to get worse: 53 percent of junior doctors plan to quit or are thinking about quitting the NHS as a result of the government's response to industrial action, while 83 percent say they feel less valued than before the dispute started.
Tribune sat down with co-chair of the British Medical Association (BMA) Junior Doctors Committee, Dr Vivek Trivedi, to discuss what's been happening in negotiations and what is at stake in this dispute.
Can you briefly outline what this dispute is all about?
Junior doctors have endured a more than 26 percent real-terms pay cut over the last fifteen years. And that's actually only up until 2022. Fully qualified doctors are graduating after five or six years of medical school and earning a mere fourteen pounds an hour. They're just not being valued in the UK, and that's driving them away. They're going to places like Australia, New Zealand and Canada where their pay is better and they are treated better. That's not good for the NHS, it's not good for patients, it's not good for anyone. We need to do something to stop that.
Many of the issues you outline appear to be long-term trends within the NHS. Was there a particular moment when you decided industrial action was the way forward?
It has certainly been building up, as you say. There have been a few trigger points in recent years. The pandemic was definitely one. Junior doctors stepped up. We actually disregarded our contractual terms for things like personal safety in order to assist the national effort. We got claps, but claps don't pay the bills. The government awarded every other profession in the healthcare sector bonuses for Covid, which were still sub-inflationary at the time, but junior doctors were excluded from that. We were not given anything more than a 2 percent uplift. And then, subsequently, with the cost of living, it has got worse.
Why are junior doctors being treated differently?
In 2016, the government imposed a contract on junior doctors. There was a huge shift in contractual terms on things like hours that you can work per week. As part of that contract, we'd be awarded a minimum of 2 percent per year for the next four years. But it wasn't ever a 2 percent maximum. There was a specific clause in that agreement that could be reviewed by the government or the DDRB (Review Body on Doctors' and Dentists' Remuneration), which is the supposedly independent Pay Review body, but the government chose to ignore that clause and put restrictions on the DDRB, and prevented them from recommending uplifts for junior doctors.
Now, I'm not sure what they were trying to achieve apart from diminishing morale, because all that did was send a message to the workforce that they're not valued for the work and training they've done, for the work that they put in during Covid and the difficulties that many of my colleagues are facing during the cost of living crisis. We have been writing to the government about pay for a long time. We've sent letters to the Prime Minister. It seems he is the one setting the mandate on public sector pay awards. We've had no response from the various health secretaries over the last year or so. All we wanted was an honest conversation to put our case forward, but they weren't interested in even pretending to listen. We told them that if you don't listen, we will be forced to ballot for industrial action.
This was in the summer of last year?
Exactly. In August, we told them our plans. In October 2022, we started a formal trade dispute. In November, we applied to the BMA Council for an application to ballot members for strike action. Again, no answer from any of the ministers. And then, in January, we released the dates of our ballot timetable and announced what our first form of action would be if we had a successful ballot-a seventy-two-hour walkout in March. We could have had negotiations to even avoid a ballot, but, again, no response. It's only after the ballot that we actually met with Steve Barclay [The Health Secretary]. Interestingly, we met some civil servants in the run-up to the ballot who literally told us there's no point talking until you have a ballot. What kind of message does that send apart from 'we're not interested in constructive talks; we're only going to do it if we're absolutely forced to do so'?
We've now had two waves of strike action by junior doctors. When we look at other disputes in the NHS and elsewhere, there's been a shift from the government. Negotiations have taken place and offers have been made. Where are we at now in terms of negotiations?
We've met Steve Barclay on a number of occasions now. We met him in March, again in April and then in May. A lot of trust has been lost, and that needs to be rebuilt by the government showing they are serious about change. Because, as I said, they imposed a contract on us, they've imposed conditions on our pay review body, and they're the ones who imposed a wage freeze on us to begin with. And on top of that, they've refused to even speak to us for so long. The ball is definitely in their court to extend an olive branch.
Can you talk us through what those negotiations have been like?
We met Steve Barclay on the 2 March. He told us he didn't have a mandate to negotiate. We then met him again after our first round of action on 22 March, at which point he told us he did have a mandate to negotiate but, for whatever reason, refused to give us an offer and refused to negotiate. He told us to leave. We then called for a second round of action in April. That led to a series of negotiations in early May, where we were meeting three times a week, virtually mainly, but there were a few personal visits. There did seem to be a change in tone from the government in the initial few meetings.
Ultimately, we were looking for pay restoration for doctors. We've been clear on that from the start. We put forward proposals to try and devise creative ways that we might be able to get there. The government weren't really that interested in anything that we were putting forward. And when we wanted a counter-offer just to see where they're at, they offered us a five percent consolidated offer, as well as a one-off £1500 bonus, and then a very non-committal unclear proposal to cover exam fees that weren't fleshed out in any way. We went into these talks in good faith to try and reach a deal because, ultimately, doctors don't want to go on strike. We don't want to have to call for industrial action. But if they're not going to speak to us in a meaningful way, then we're not left with any other choice.
This offer appears to mirror what has been put on the table for nurses and other public sector workers. In fact, just last week, civil servants were offered this exact same pay deal. It seems as though the government are very stubborn on this figure, and they're not willing to move on it.
Yes, which is a bit nonsensical, really. What they're trying to do, I presume, is show equality. But equality is not the same as equity. You can't treat everyone with a one-size-fits-all approach when people are in different positions. Junior doctors have had a far greater real terms pay cut than almost everyone else in the public sector. In fact, the only professions worse off than junior doctors are consultants and GPs. The offer is a below-inflation real-terms pay cut. It erodes our pay further rather than restores it. It shows two things: either they're unaware of what doctors are frustrated about, which is sheer incompetence, or, and this is a scary part, they are aware, but they just don't care. And they're willing to let doctors feel undervalued, they're willing to let doctors leave, and they're willing to let the standards of care drop.
We've all seen the same statistics; waiting lists are only increasing. 7.4 million people are waiting for procedures now. And lots of them have been waiting more than two years. I'm an anaesthetist. I see patients coming for elective and emergency surgery and look after them in intensive care. And the number of patients whose surgeries are classified as non-urgent and postponed is incredible. They're waiting for more than two years. It might not be life-threatening, but they're still in pain, and it's still impacting their quality of life.
For a government that claims to pride itself on economic competence, I find it a bit perplexing because so many of these patients waiting for appointments or surgeries are not working. There is a huge amount of economic inactivity because of people who are too sick or unable to work. We simply don't have enough doctors to look after them and treat them well because we don't value them.
Consultants are currently being balloted on industrial action, with a potential strike in late July. The Royal College of Nursing are also re-balloting nurses on strike action. Is there any prospect for coordination of industrial action?
We will be looking at strategies to increase our leverage. I'm sure everyone that works in the healthcare sector will be thinking about patient safety. We would not be proposing any strike action that we thought would have an impact on patient safety. What we found from our strikes so far, and what we've seen from the nursing strikes, is that patient safety is able to be maintained as there has been appropriate cover from other workers. If we can coordinate in ways that allow us to increase that leverage but maintain patient safety, we're happy to explore and consider that.
Patient safety is another aspect of this dispute, isn't it? We hear a lot about public safety from the government when they're attempting to justify their Minimum Service Levels Bill.
I commend the government for trying to ensure that there is patient safety on strike days, and I only wished that they cared about patient safety on non-strike days. Pre-Covid, we used to think winters were really bad because people would be waiting in corridors, being treated in places that they shouldn't be treated. What we've seen over the last few years is that it's become the norm. You can now be allocated a role as a corridor doctor or a corridor nurse. What used to happen only in winter is now all year long. It's just getting worse and worse and worse. There is no respite for the NHS. And it's a vicious cycle. That's not a nice environment to work in. And people don't feel that they're able to do well for their patients.
It is crushing to work in a system that is set up against you. And so, staff leave, which means the remaining staff pick up additional workloads, which increases burnout, prompting more staff to leave. It's a negative cycle, and we need to stop it. The only way we can do that is to value our staff. Pay them so they feel valued enough to stay.
What's it been like on the picket lines? Have you had much public support?
There's been a tremendous amount of support on the picket lines. We hear cars honking as they go past and people stop by to say thank you or to say well done. Words of encouragement like that mean a lot to us because it can sometimes be a bit bleary picketing, especially if it's raining or snowing.
Patients are fed up. They're fed up with having to wait more than two years for treatment, they're fed up with waiting more than twelve hours when they go to A&E, they're fed up with not being treated properly. And they recognise that, whether it's a hospital or a GP practice, the staff there are trying to look after them despite the constraints.
So many patients I've spoken to who had their appointments postponed because of strike action are offering their support. It's such a bittersweet feeling because I feel terrible that they've had to postpone things. I've spoken to people who've postponed twice or even three times. It might have been staff shortages on one day and then strikes on the second time, for example, and I feel terrible that they've had their appointment pushed back. But I have to put that blame squarely on the government, because not only have they presided over a period where the waiting list has exponentially exploded, but they are the only reason that we've had to strike in the first place. They have the power to prevent the strikes from ever occurring, and patients can understand that.
We're going through the biggest wave of strikes in decades. In 2016, you were somewhat isolated in terms of industrial action. This time round, many workers in other sectors are engaged in similar struggles. That must have a big impact.
There's a lot of solidarity. Our first set of strikes overlapped with a number of strikes from other organisations. I was in Manchester at a cross-union demonstration. If lots of workers from different sectors are coming to the same decision to strike, not only is there a sense of solidarity with that, but there is an increased sense of validation.
Some junior doctors tell me that the NHS is simply beyond repair and they intend to leave at the first opportunity they get. In fact, your own survey released today reveals that two-thirds of junior doctors fear the NHS won't survive the next ten years and 53 percent of those surveyed report making plans for leaving or are thinking about leaving the NHS as a result of the government's response to industrial action. What would your response be to those people?
That's, unfortunately, a really common question. It's really sad. I don't condemn anyone that leaves to be treated better elsewhere, but I don't think the NHS is beyond repair. It is salvageable. Ultimately, we saw the NHS flourishing when it had more funding. We saw waiting lists go down when it had more funding, we saw patients being treated in a timelier manner when it had more funding, and there were more staff per capita when it had more funding. Funding isn't the only issue, but it is the most significant issue. If we can get on top of that, then we can break that vicious cycle that is destroying morale across the NHS.