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The Weekly paper of the New Communist Party of Britain

Doctors on the Picket Line

by New Worker correspondent

A group of professionals rarely seen on the picket line are Junior Doctors in the NHS in England, who took another round of strike action, this time for 96 hours from Tuesday until Friday. Coming just after the long Easter weekend and before a normal weekend, it will in effect be a 10-day strike. This is a considerable stepping-up of action since last month’s three-day walkout.

The fact that many consultants will be on holiday will add to the impact of the strike. Their aim is to secure real-terms pay increases to counter the post-2008 decline. Thus they are demanding a 35 per cent increase, which predictably the Government says is unrealistic. Apart from securing an increase for this year they are also fighting for an agreement with the Government to prevent any future declines against the cost of living and inflation, and reforms to the Doctors’ and Dentists’ Review Body (DDRB) to ensure that future pay increases “can be recommended independently and fairly to safeguard the recruitment and retention of junior doctors”, in the words of their union, the British Medical Association (BMA).

The BMA also states that Junior Doctors (who are not all young, the term covers everyone from the newly qualified to those on the verge of consultancies) have seen their wages reduced by more than a quarter in the last 15 years. They note that the low salaries have dramatically boosted the recruitment of British doctors of all ages in Australia rather than Britain. “As a result the NHS is finding it harder to deliver care to the standards expected by professionals,” they point out.

The small Hospital Consultants and Specialists Association union are also taking part with its 600 junior doctors, accusing the government of refusing to drop pre-conditions for talks to resolve the dispute.

The response of the Government is a continual refusal to negotiate with the BMA and to indulge in a session of shroud waving, saying that 350,000 operations and appointments will be cancelled.

Although the DDRB is in theory independent of government its recommendations have long been ignored by successive governments, hence the present large claim. The headline claim of 35 per cent might raise eyebrows amongst even New Worker readers, but in recent years the medical profession has suffered badly.

The BMA highlights the fact that the lowest junior doctor salaries puts them on a par with some Starbucks coffee makers. This works out at about £29,000 yearly in the first year. Unsocial hours payments give the average first-year doctor an extra 30 per cent. In the second year, basic pay rises to £16.30 per hour with most also getting another 30 per cent in extra payments (for extra work). By the end of on-job training they get a basic of £28 per hour with the same extras, which can take them up to £77,000. In Australia the starting salary is £65,000.

Apart from the pay issues there is also the question of hours. Senior consultants boast of putting up with 120-hour weeks in the good old days of their youth but the European Working Time Directive (WTD) in theory put a stop to that by 2009, with hours limited to 48 per week, to the approval of the BMA. Whilst in theory this would allow more time for training, it also saw many managers adopted a shift system and ‘request’ that junior doctors take on extra shifts. NHS doctors also have to cover the increasing number of vacancies as their colleagues head for hospitals nearer to Bondi Beach.

To give just one example of the pressure young doctors are under, on Tuesday the BBC reported from the picket line at the Royal Leicester Infirmary. Here a young doctor said that: “At the moment every single time you go to work, you have people off sick.” At best “you have staffing which is only just covering what it needs to”. Every day he was “completely exhausted and lumbered with responsibility” in his “eight months since leaving medical school”. Naturally he was thinking of leaving medicine.

Medical salaries have fallen far behind other less difficult professions such as accountancy. Paying off student loans is especially burdensome for medics. Some are comparatively small things, such as the loss of proper catering in hospitals, which has been replaced by vending machines and privatised caterers who will no longer rustle up end-of-shift free bacon rolls to make life easier. The ending of hospital accommodation is a more important matter that forces doctors and nurses into time-consuming searches for expensive rented accommodation.

The present strike, perhaps the most far reaching, is not of course the first dispute involving doctors. Nye Bevan famously said that he had to “stuff the doctor’s mouths with gold” to get them to accept the NHS, in particular he had to allow them to continue with their private practices. Decades later, in 1975 the latter issue sparked protests from consultants that resulted in them keeping their privileges.

Junior doctors took strike action in 2016, which was noteworthy for their refusal to provide emergency care that had been the norm in earlier disputes.

The December 2022 disputes that involved ambulance workers and nurses is still unresolved, but that action forced the present Health Secretary to make a new offer of a five per cent raise with a one-off bonus of 8.2 per cent for low-paid workers. Many nurses in both the Royal College of Nursing (RCN) and Unison are extremely annoyed at their union calling off action and recommending poor offers in ongoing ballots.

Returning to the 2023 pay dispute, the co-chair of the BMA’s junior doctors committee, Vivek Trivedi, said at a rally in Trafalgar Square on Tuesday that the pay claim was perfectly acceptable, and pointed out there were 9,000 doctor vacancies in the NHS and over seven million patients on hospital waiting lists.

North of the border, the BMA’s Scottish Junior Doctors are presently balloting for a 72-hour full withdrawal of labour in May in pursuit of a pay claim to “reverse ongoing pay erosion and restoring junior doctor pay to 2008 levels, after it has been cut by 23.5 per cent over the last 15 years”. The committee’s Chair, Chris Smith, deplored the present state of the NHS, highlighting staff shortages: “We make up 44 per cent of the doctors in the NHS in Scotland, and we are on our knees. Indeed, many are considering leaving, or have already left – driven abroad or out of medicine altogether by being overworked yet underpaid.” The solution, he said, was “restoring junior doctor pay to 2008 levels in order to retain the staff we so desperately need both now and long term”. He condemned the SNP Secretary for Health who “has singularly failed to even commit to start the meaningful negotiations that we believe with goodwill on all sides can lead to a solution”.

The BMA in Wales is also demanding that the Welsh Government to restore the pay of junior doctors to the level as it was in 2008. Junior doctors’ pay has been cut by 26 per cent in real terms since 2008 whilst the number of patients waiting to start treatment has nearly tripled. The BMA also highlights the extra burden of student debt has increased and notes that working in Wales pays less well than in the rest of Britain. As a result “doctors are leaving Wales to work in other countries. Students are leaving medical school before finishing their training or deciding not to study medicine at all”.

Whilst not yet involved in the present dispute, the BMA in Northern Ireland supports the action. Tom Black, chair of BMA’s Northern Ireland council, warned that low morale and successive low pay awards were driving young doctors to work abroad and experienced doctors to retire early.

Also in Northern Ireland the picture was slightly different when one-day strikes involving nurses and ambulance staff took place on the last day of March and the first Monday of April after unions were told that the local health authority did not have any money to make an increased pay offer. The province’s Department of Health has failed to extend the new NHS pay offer made in England and Wales to its workers. Unison complained that neither the secretary of state nor any officials from the Northern Ireland office attended pay talks with unions.

Patricia McKeown, the union’s regional secretary for Northern Ireland, complained: “UK ministers should know by now that workers in Northern Ireland will not tolerate being left behind.

“The secretary of state holds the responsibility to sort this problem now, he cannot sit on the fence. He cannot blame anyone else. It is his government that has failed to make money available for health workers in Northern Ireland.