Rishi Sunak and Steve Barclay must have hoped it was all over.
Last month, several health unions representing NHS nurses, ambulance workers and physiotherapists announced that a pay deal struck with the Government would be put to their members. It followed the most turbulent period in NHS history, as strikes collided with a winter crisis that saw record waits for treatment in A&E and for ambulances.
In the same week, the British Medical Association (BMA) agreed to pause industrial action to enter “intensive” talks on pay with ministers. NHS bosses could breathe a sigh of relief once again.
But hopes of a breakthrough were premature. Within days, the talks had collapsed in acrimony and the BMA had announced a four-day strike involving nearly 60,000 junior doctors – the most disruptive and wide-ranging industrial action in the history of the health service.
Pay restoration
The essence of the BMA’s argument is simple: junior doctors’ pay has fallen considerably in real terms since 2008. By the union’s calculation, a 35 per cent pay rise is needed to correct this decline.
In cash terms, junior doctors have seen a pay rise of 16.9 per cent between 2008 and 2022.
However, the BMA point out that the retail price index (RPI) figures has jumped by 58 per cent during that time – leaving many younger doctors out of pocket and struggling with rent, bills and other living costs.
The public might understandably gawp at a 35 per cent pay demand at a time when households and companies are tightening their belts.
But even CPI inflation, which is more commonly used in pay negotiations, has risen by 40 per cent during the period – meaning a doctor’s income has declined by 16 per cent.
On Twitter, some consultants have shared copies of their payslips from the early noughties. Shockingly, their take home pay was the exact same as it is today.
The BMA is determined to achieve “pay restoration” at all costs and has indicated that it would not accept the deal offered to nurses and paramedics, which involves a 5 per cent pay rise for next year and a lump sum payment of between £1,655 and £3,789.
An expensive vocation
Training to be a doctor does not come cheap. Six years of medical school accrues student debt of well over £50,000 and there are additional mandatory costs, such as Royal College exams, licence to practise fees and even hospital car parking.
However, pay improves dramatically as doctors climb the career ladder. Indeed, the term “junior” is highly misleading as it can apply to a doctor with 8 years of experience.
While the basic salary of a Foundation Year One Doctor is around £29,000, medics outperform graduates in every other industry ten years after leaving university, according to the Department for Education (DfE).
Five years into their career, a junior doctor can expect to earn a base salary of around £51,017, according to the British Medical Journal. This is without the extra pay accrued by weekend work or during “unsociable” hours.
Junior doctors are aware that their pay will improve, but say it is scant consolation for those struggling to pay exorbitant rent or energy costs in the early years of their career.
NHS in crisis
While pay forms the central part of the dispute, it must also be seen through the lens of the brutal working conditions in the NHS.
Junior doctors are entering a health service in crisis, underlined by the worst performance figures on record.
The BMA argues that medics cannot deliver the care they have been trained to in such a dysfunctional environment. Shifts become an exhausting and demoralising experience.
Worryingly, the state of the NHS is prompting an increasing number of junior doctors to leave for Australia, where British medics are in high demand and the pay and working conditions are significantly better.
No end in sight
The stalemate between the BMA and the Government means that flexible solutions to end the dispute are scarce.
Downing Street has insisted that it will not open talks with the BMA until the union drops its demand for a 35 per cent pay rise. Meanwhile, the union insists that the figure is not a “precondition” of talks and has accused Mr Barclay of failing to make a “credible” offer to kick off negotiations.
It took many months for the Government to agree to talks with the Royal College of Nursing (RCN), who demanded a 19 per cent pay rise. Similar – albeit less personal – barbs were publicly exchanged between both sides until a deal was thrashed out in private.
But it is far from certain that nurses and other health workers will accept this pay deal, with the RCN in particular said to be expecting an extremely close ballot.
A nightmare scenario for Mr Barclay could involve a continuation of strikes by nurses and paramedics on top of the junior doctors’ dispute. Faced with a crumbling NHS, and a public not swayed against striking staff, it may well be the Government that blinks first.
Patients, yet again, are caught in the middle of a dispute they are powerless to influence.
