At 7 AM on Tuesday, 11 April 2023, just after an extended Easter holiday weekend, “junior doctors” in England- a varied mix of people between their mid-twenties and early forties-embarked upon their second strike of the year. The 96-hour walkout by 47, 652 junior members of the British Medical Association (BMA) coincides with the Easter school holidays and will end at 7 PM on Saturday, 15 April. It is predicted to be the most disruptive ever in the history of the NHS, being the first time juniors will withdraw all emergency medical care, in peak holiday season. The strike received the go-ahead following a ballot of almost 27,000 BMA members, in which 98 per cent voted in favour of abstaining from their usual duties. The first strike, from 13 to 15 March, had not yielded the desired results for junior doctors, even as 175,000 appointments and operations were postponed to no avail.
Junior doctors are seeking a 35 per cent pay rise, demanding “pay restoration” to 2008-2009 levels to remedy a 26.6 per cent fall in real-term wages over the last 15 years. Relatively low pay, poor working conditions, and the allure of a better lifestyle and work-life balance are driving many juniors away from England, to distant, yet greener, pastures in Australia, New Zealand, and Canada. The cost-of-living crisis, student debt, expensive accommodation, and the hidden costs of registration fees, compulsory training, educational courses, Royal College examinations, and even hospital car parking, are all adding up to stress the finances of junior doctors.
Support for their action varies, with some suggestions that the public sympathises more with the nurses and paramedics, compared to doctors who are believed to be mostly the products of a middle-class background and a private education, with a stable and lucrative career topped up with generous pensions to look forward to. The right-wing press has sided with Health Secretary Steve Barclay and with the Labour Party leadership in declaring the junior doctors’ demands unreasonable at a time when many sectors of the workforce are also hard-pressed and demanding higher wages. Some right-wing journalists also claim to have identified both “hard-left” as well as privileged and entitled juniors within the ranks of the BMA’s Junior Doctors’ Committee.
The latest strike action is certain to inflict more pain on an already flagging NHS, from the added burden of postponed outpatient clinic appointments and cancelled operations. Consultants, GPs, pharmacists, and nurses will stand in for junior doctors, who are the engines of the hospital machinery, in the first comprehensive strike by juniors. The NHS will prioritise emergency departments, critical care units, maternity services, and neonatal care over elective activity. The public have their own part to play, having been cautioned to be careful, drink less alcohol than usual, and to generally desist from contacting 999 or attending emergency departments unless they first decide they have a life-threatening emergency.
At one time, junior doctors were even more downtrodden than they are now. They first resorted to industrial action over unsatisfactory pay and conditions in late 1975, taking on a Labour government over new junior staff contracts. At the time, junior medical staff were contracted for a far longer working week, of up to 120 hours, and often worked alternate weekends, in return for a fixed salary. The juniors demanded a 40-hour standard week, with extra pay for overtime work, payable at higher rates. A series of one-day work-to rule protests began, during which they worked a maximum of 40 “office hours” a week in casualty departments, ending their shifts at 5 PM. This industrial action began on 9 October 1975 and lasted until 11 December that year. Junior doctors established the principle of overtime pay when they accepted a 40-hour working week (10 Units of Medical Time, of 4 hours each), with a higher rate of pay for any additional work.
The next tranche of strikes, lasting between 24 to 48 hours, took place four decades later- in 2016: on 12 January, 10 February, 9 to 10 March, and 26 to 27 April. This industrial action was the juniors’ response to a new 80-page contract, which would enable a new “seven-day NHS” to deliver the “same high quality care every day of the week.” This was based on a contested ‘weekend effect’, whereby it was claimed that people admitted to hospitals on weekends were more likely to die, probably because of lower numbers of healthcare and support staff, an inadequate skill mix, and limited access to diagnostic services. The working week, normally between 7 AM and 7 PM, Monday to Friday, was increased from 7 AM to 10 PM. Monday to Saturday. This reduced the number of hours for which premium rates were payable, increased the number of antisocial hours of work paid at the standard rate, thereby slashing take-home pay. An automatic annual pay progression was replaced by pay increases linked to increasing seniority of grade worked rather than to length of employment. A modified contract was agreed upon by BMA, NHS Employers, and government on 18 May 2016, only to be rejected by a vote of 58 per cent of BMA members against. The BMA’ s Junior Doctors Committee chair resigned on 5 July, and the contract was phased in between October 2016 to October 2017.
Junior doctors’ strikes have proved less successful in recent years, as “financially prudent” governments choose to negotiate on their own terms and appear ready to sit it out in a war of attrition, even when the threat of further strikes loom in the horizon. While the issue of doctors’ wages remains contentious, the biggest victim of all will be the NHS itself, which has already reached a state of “managed decline” in the eyes of some. What seems unfortunately lacking is a desire for compromise and a willingness to return to the negotiating table. May ample wisdom be bestowed upon both the government and the BMA, so we can sail away from this most unhelpful stand-off.
Ashis Banerjee