Why are doctors threatening to go on strike again?

One of the factors that most contributed to a sense of national malaise, the comprehensive rejection of the Conservatives, and the election of a Labour government last year was the almost constant turbulence caused by strikes in the public sector, and especially in the NHS.

There were some hopes – perhaps unrealistic, possibly hyped by Labour politicians – that a change of government would end the disruption to hospital services for good. Yet the British Medical Association is, once again, balloting its members on industrial action, and it is now Wes Streeting who is on the other side of the negotiating table. There may be some difficult months ahead...

We don’t call them “junior” any more, because it was misleading – many are well into their careers, albeit not yet at consultant status – and also a bit demeaning. So they’re now known as “resident” doctors, but their complaints are the same. Just as they demanded of previous Tory secretaries of state, they want Streeting to restore the real-terms value of their salaries compared to 2008 levels.

A long period of below-inflation settlements has had a sizeable cumulative effect, and implies a pay rise of about 23 per cent. By comparison, the Department of Health and Social Care is offering an average of 5.4 per cent (a 4 per cent rise plus a “consolidated payment” of £750).

The result of the ballot, which has just opened, will be made public soon after it closes on 7 July. If the proposed mandate for industrial action is approved, it will last from this summer until January 2026.

Maybe. The chief executive of the Royal College of Nursing (RCN), Nicola Ranger, has warned the government that her members will “bare their teeth” if ministers “dither and delay” and “continue to insult this profession”, adding: “You know how this could escalate.”

Thus far, the RCN is merely “surveying” its members over whether they are satisfied with the 3.6 per cent increase indicated by the government, and what action, up to and including withdrawal of their labour, they would be willing to take if this were what they were left with.

The 3.6 per cent uplift covers all NHS Agenda for Change staff – nurses, health visitors, midwives, ambulance staff, porters and cleaners. The starting pay for a nurse now stands at around £31,050 this year.

First, that they have been fully funding the increases recommended by the independent pay review bodies, which have the task of independently proposing a fair settlement – precisely to avoid strikes and to take the politics out of the issue.

Second, they have offered a “partnership” to rebuild the NHS on a sustainable basis, and a “journey” to better pay.

Third, the rises now scheduled are substantial. Streeting writes in The Independent, for example, that “resident doctors have seen their pay increase by 28.9 per cent compared to three years ago. The average starting salary of a full-time resident doctor is now around £38,800 – up nearly £9,500 since 2022/23.”

Last, and most ominously, he tells the doctors and others that if they don’t help him fix the NHS, then more radical and far less palatable change – privatisation – will become inevitable under the Conservatives or Reform UK.

Misery, and a very tangible sense of failure attached to the Labour government that promised so much. Last year, for example, just before the election, Streeting, then shadow health secretary, declared: “I will be asking the Department of Health and Social Care to get talks back up and running urgently so that we can try and negotiate an end to this dispute once and for all.”

Ironically, Labour’s new Employment Rights Act, once it is passed, will make it easier for the unions to win a strike ballot, and abolishes the “minimum service levels” previous Tory legislation mandated in case of strikes affecting vital services (though established codes of conduct relating to the BMA, the RCN, and the unions do try to cover this too).

Politically, Streeting, Rachel Reeves and Keir Starmer would end up exactly where their Tory counterparts Victoria Atkins, Jeremy Hunt and Rishi Sunak were before – and for the same reason, ie there isn’t the money to pay for everything. So some voters might wonder why they bothered voting Labour.

The main electoral winners from protracted strikes would thus probably be Nigel Farage and Reform. They would argue that the resulting chaos “proves” that the old NHS is no longer fit for purpose, and that a new system of private health insurance would work better (but with no concrete guarantees about its funding or service levels).

Some doctors might do well out of such a privatisation, in certain fields of medicine; but not necessarily, and in any case, the net result might be an impoverished and defunded rump “safety net” NHS for the poor and destitute.

That would include those with employers who don’t provide private healthcare, and those who can’t afford to pay the health insurance premiums themselves, including groups such as pensioners and the unemployed, who would have to rely on the government to pay their health insurance premiums. This would result in a much-denuded NHS backstop specialising in what the private system can’t cover – cancers, dementia, mental illness and the like.

It’s an appalling prospect, but one that represents Streeting’s best chances of winning his arguments with the BMA, the RCN and Unison, and indeed the electorate: apres moi, le Farage.