Junior doctors have voted to extend their strikes – by a whisker. Turnout for yesterday’s vote collapsed to less than 53 per cent – a whisker above the threshold needed to make it legal. Framed as a pay dispute, the strikes are the result of a needlessly ruined career structure, and a government perversely willing to leave British doctors unemployed.
The strikes started after an early February 2023 ballot in which turnout was more than three quarters and 98 per cent were in favour. In the following strikes, support remained at or above 90 per cent, but turnout kept dropping. In March 2024 it was 62 per cent, last July it was 55 per cent.
Some readers will feel juniors merit more pay; I suspect there are few who think the injustice is such that they are right to strike. But then I haven’t met a single junior doctor who feels that way, and as a hospital consultant I meet a large number in teaching hospitals and district generals alike. They’re not shy of telling me their feelings and I’m not shy of asking. They feel underpaid – people generally do – but none support the strikes for that reason.
Being a junior doctor is, in many ways, a miserable job
What upsets them is the mess that’s been made of workforce planning. Their jobs and training posts are now routinely given to foreign doctors. They see their own careers being threatened or stalled or ruined. It is beyond question that there are some juniors who really are determined to strike in order to get a pay rise. Perhaps most of those have BMA posts; I’ve not met one in the wild.
Against that, Wes Streeting and the Department of Health have not taken substantive action to solve the problem of British medical jobs being given to foreign doctors and British doctors being left unemployed. They have made noises about major changes, but no more. They have created new posts, spending our money inventing new junior doctor jobs the NHS hasn’t needed, but they haven’t addressed the real problem.
Certain approaches are restricted by law. For employers themselves to decide they will prioritise British applicants would be indirect discrimination and fall foul of the Equality Act. There are mechanisms by which the government could get round this, like the old Resident Labour Market Test. But fundamentally it is the government’s job to set the law, so they are not being serious when they object that the law limits what they can do.
The NHS is an appalling employer that I’ve served for decades. Being a junior doctor is, in many ways, a miserable job. You are at the whim of opaque and unforgiving rotas, often kept secret from you until the last moment. Management is incompetent and the training schemes are mindlessly bureaucratic.
Gone are the awful days of 100-hour weeks, thank heaven, but also gone is much of what made the early years bearable. Hospitals used to provide free accommodation because juniors worked such long hours and were moved so frequently that nothing else was practical. The rooms were grotty but you had the esprit de corps of living with your colleagues. When you went to work you had the same sense of belonging to a core team, a ‘firm’. Today rotas favour shift work, with colleagues who vary from day to day.
Superimposed on that are other practicalities. The pay of juniors has declined since 2008, as they are fond of pointing out. This is a more favourable date for comparisons than others, but it’s still true.
The purchasing power of doctors’ salaries has declined overall too, in large part because of the utter mess we have made of our housing stock. No longer are the nice bits of town the places where the doctors live; like everyone else, they’re crowding into what remains. The Doctors’ and Dentists’ Review Board was founded in 1960 to make life fair for a profession that couldn’t take industrial action, working for a monopoly employer. Over the years, the perception is that it has come to recommend whatever rise the government says they can afford.
In a December letter to the junior doctors, asking them not to go ahead with their Christmas strikes, Streeting wrote of bringing in legislation to prioritise UK graduates. His language was careful and revealing. He wants to prioritise those who have graduated in the UK, regardless of their citizenship, rather than those who are British, regardless of where they trained. His distinction favours diversity over patriotism, but it would be hugely better than the current mess, and the Health Secretary should not make an easy win for the country contingent on the juniors calling off their strikes.
Streeting just needs to wait for this strike mandate to expire; the next time turnout is likely to be too low to make the ballot results legal. Or he could decide that prioritising British doctors for British jobs would be a win for the juniors, a win for the NHS and patients, a win for him, and would cost nothing. If he can fix the problem that’s driving so much anger, the slim majority willing to vote for strikes will evaporate.
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