Today tens of thousands of junior doctors went on strike in England – around half the total medical workforce.
How do doctors withhold their labour without hurting patients? It’s an important question. It was just as important in 1975, the first time junior doctors went on strike in England. GP Tom Frewin described to the BBC how at the time, his role in a neurosurgery unit meant he couldn’t afford to join his fellow medics on a picket line – such were the emergency natures of his cases. “To walk out and let people die was not on the cards.”
Doctors today face similar conflicts. The British Medical Association, for example, has a page on its website about the ethics of taking industrial action. It emphasises that the decision to strike is an individual one for each doctor, where they should weigh up the risk to their patients, the current risk of harm due to the state of the NHS, as well as personal impacts on them. One passage is worthy of note:
“Saying that industrial action raises ethical issues does not mean that it is unethical. It means that there is a need to balance the rights, duties and responsibilities owed to different parties, and all relevant factors, to reach a decision about the best course of action.”
Doctors are workers. That means they have the right – morally as well as legally – to strike. It’s just that they have a much more difficult process ahead of them. The RMT needs no webpage about the ethics of industrial action. The CWU does not require its members to weigh up the risks to their customers.
It is difficult to become a doctor without caring a great deal about human life, and those going on strike do not do so lightly.
“Leading health experts” and “NHS bosses”
In contrast to this agonised consideration, there is a very different picture being painted by the media. The average reader of mainstream news might be forgiven for thinking that doctors have lost their minds and are setting fire to their Hippocratic oaths en masse. Let us observe some of this reporting – from Britain’s foremost left wing newspaper, no less:
“Critically ill patients ‘will inevitably die’ due to junior doctors’ strike”
This story comes courtesy of “leading health experts”. Who are they? Three in total, senior doctors in London, and they are referring to 30-40 planned operations at their hospitals that are being postponed due to the strike. The patients have serious heart conditions, and are ranked as P2s – the second highest-priority patient group, just below emergency cases. Their risk of cardiac arrest rises significantly the longer they have to wait for surgery.
A serious situation, no doubt. But let us consult the BMA’s ethics guidance again: in deciding whether or not to strike, we must consider “the current risk of harm to patients due to the state of the NHS”.
Within the NHS, there already are over seven million people waiting for elective care – a number that has tripled over the past decade. And the average waiting time for treatment is 15 weeks. For heart conditions alone, there were 350,000 people on waiting lists as of September last year – some of whom had been waiting for over a year. Not all of these will be P2 cases, but on balance the current risk of harm to patients due to the state of the NHS far outweighs the risk of harm due to strikes.
Another article here from the Guardian:
“Junior doctors’ strike could delay 250,000 appointments, say NHS bosses”.
Again, who are “NHS bosses”? The quote turns out to come from a group called NHS Confederation, which is a membership body for organisations that compose – or orbit around – the NHS. Its vital work includes a significant commercial partnership with Palantir, and fact-sheets busting myths around NHS privatisation.
Is it any shock that neither these “bosses” nor their members’ club have much to say about the real reasons behind this strike? Yet their talking points have been printed and reprinted. This is the tone with which the doctors’ strike has been largely reported by England’s mainstream journalists.
Some aspects of these stories remain consistent over time: in 1975 just as today, the senior doctors had to have their say. As one consultant memorably wrote in a letter to the Times: “can it be right that a doctor be struck from the medical list for having sexual relations with a patient, while it appears to be legitimate to deliberately withhold treatment in the cause of doctors’ own financial gain?”
This argument against going on strike has clearly not aged well. Future generations may view the current crop of talking points through a similar lens.
The current risk of harm
Each of these news stories are also attack lines, and they are immediately recognisable as such. The form changes, but the content remains the same: you are selfish for striking. You are killing patients by doing this.
The truth is that NHS patients are already being killed, every day, in a multitude of negligent ways. This is most notable when it comes to the delays and problems with emergency care, which are causing an estimated 300-500 deaths every week. The delays are bad enough that some people have reported calling 999 and waiting for ten minutes before anyone answers the phone.
All of these problems spiked massively during COVID, and have been exacerbated by an ageing population, but a properly funded and managed public health service would have a greater chance of weathering these storms. Instead we have an NHS that has been defunded, marketised, and forced into competition with a rapacious private sector.
It was Thatcher’s government who introduced the NHS Trusts in 1990: organisational units acting as public sector corporations, “competing” against each other for patients and funding in an “internal market”. Blair, who promised to replace the internal market, strengthened it instead; Cameron, who pledged no more “top-down reorganisations” of the NHS, oversaw in 2012 the most chaotic reorganisation in NHS history.
The internal market wastes vast amounts of money – around £5 billion every year – with no evidence of any sort of success. And the tendrils of privatisation penetrate ever deeper: if you combine direct spending, outsourcing of services like catering and pharmacies, and private providers of primary care, a full 26% of NHS England spending is on the private sector.
When doctors come out of medical school to start their decade or so of in-hospital training, one of their first experiences is getting assigned to an NHS Trust at a semi-random location in Britain. Some of them uproot their lives every couple of years to move to a new part of the country. Still others are part of the unlucky few who find there’s no job waiting for them at all.
Those who arrive on their first day often find themselves in crumbling buildings running out of bed space, with ancient IT systems on single computers shared between a dozen medics. Here, all the crises of overcrowding and wait times come into vivid technicolour.
The A&Es are full and the ambulances are waiting outside because there aren’t enough beds in the hospitals. There aren’t enough beds because nobody has paid for them, because private hospitals have offloaded the trickier patients into the public system, and because there isn’t social care for the elderly outside of the hospital which would allow them to be discharged.
So junior doctors work overtime on top of long hours and night shifts, because there aren’t any colleagues around and they can’t go home with a patient half-treated. This constant stress makes the quotidian abuses all the more demeaning: the bureaucracy, the training requirements, the cost of hospital parking (staff are certainly not permitted to park for free). Is it any wonder the UK is haemorrhaging doctors?
There are many reasons to go on strike, but underneath them all is the fundamental understanding that you are being treated as machinery and not as a human being. As one junior doctor working in a Manchester hospital put it to me: “It’s disheartening that a lot of people see us as overpaid lackeys when we devote our lives to this. The way things currently are, you have to.”
A first in English history
This is the context for the junior doctors’ strike action from 11-14 April. The BMA are walking out alongside another doctors’ union, the Hospital Consultants and Specialists Association, and they are coming in the wake of industrial action from their NHS colleagues – nurses, ambulance workers, and midwives.
Their key demand is for “pay restoration”, meaning pay rises to match historic inflation. Because doctors’ wages have remained the same since 2008, they have effectively received a real-terms pay cut of 26% over that time. The BMA in particular also wants to agree on a mechanism with the government to prevent any future real-terms wage declines, as well as to reform the review body process for pay increases.
This is the longest doctors’ strike in English history, with four days out of work coming right after the four-day Easter weekend. And while during its previous action the BMA made exemptions – “derogations” – for workers in certain areas of emergency care, that is no longer the case.
But these are careful and considered decisions. Mike Greenhalgh, Co-Deputy Chair of the BMA Junior Doctors Committee, said that patient safety will be maintained this time as it was during the last action in mid-March. “We met with the NHS employers four times a day. There was a mechanism for them to say if they felt that patient safety was being compromised, and we didn’t have a single request for any derogations during that time.”
In addition the union has said it will meet requirements for life-and-limb cover by considering pulling junior doctors off the picket line if individual hospitals report lives are in immediate danger.
What will it achieve?
We need to support these strikes and agitate for their success. 1975 once again gives us historical precedent: after months of “go-slows”, walkouts, and partial strikes, the junior doctors won a partial victory. The government coughed up an extra £2.3 million to fund overtime pay, and they conceded to demands for reduced hours.
If these current demands are successful, it will help to solve the understaffing problem by stemming the tide of people leaving the NHS, and provide an attractive prospect to recruit new doctors into the organisation. If this happens in combination with significant political change, it could be the start of a new funding regime for the NHS.
Pay restoration for doctors certainly won’t solve the NHS’ problems. It won’t stop the private-healthcare political project, through internal NHS privatisation as well as through the growing external private healthcare sector. It won’t solve the lack of social care in Britain, nor address the causes of ill health, which are as much social as they are biological: poor working conditions, low income, pollution, unsafe housing, unhealthy food, decaying communities. These are diseases of capitalism that are much broader than any trade union struggle can address.
But that’s not the point; the struggle to address these issues is long and difficult, and strikes are a vital part of this struggle. As a great man once said: “when the workers state their demands jointly and refuse to submit to the money-bags, they cease to be slaves, they become human beings… strikes, therefore, always instil fear into the capitalists…
“…every strike reminds the workers that their position is not hopeless, that they are not alone.”
For contrast let us quote a much lesser man – the Shadow Secretary of State for Health and Social Care – who recently told LBC radio, “no, I don’t support the strike actually” and in the House of Commons described “catastrophic strikes… wreaking havoc on patient care”.
Wes Streeting is not on the patients’ side. It’s the junior doctors who are on their side, and their position is neither hopeless nor alone: the postal workers, the rail workers, the nurses and the ambulance staff, the firefighters, the public sector workers, the teachers and the university staff, the factory and service sectors, and the whole mass of Britain who relies on the NHS are alongside them.
Dan Rodney is a member of YCL’s Manchester Branch