Junior doctors’ strike: what are the risks?

Junior doctors in the UK have begun a four-day strike over pay in what could be the most disruptive industrial action taken by healthcare workers yet.

Speaking to BBC Radio 4’s Today programme, Professor Stephen Powis, NHS England’s national medical director, said that the 96-hour walkout would be “the most disruptive industrial action in NHS history”. He warned it could take the health service “weeks” to recover from the strikes.

More than 175,000 treatments and appointments were cancelled during last month’s three-day walkout by junior doctors, but senior NHS figures estimated that this time, between 250,000 and 350,000 appointments and operations could be cancelled.

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Up to 47,600 junior doctors across England will not be working from 11-15 April as the British Medical Association (BMA) has asked for a 35% pay rise to compensate for 15 years of below-inflation wage increases.

The government has called that an “unreasonable request”, said the BBC, and, writing in The Sunday Telegraph this weekend, Health Secretary Steve Barclay said it was “widely out of step with pay settlements” agreed by other health and public sector unions.

What did the papers say?

According to the Daily Mail, health leaders fear the impact of the junior doctors’ strike could be “greater than any previous picket” as the industrial action comes after the bank holiday Easter weekend “when there is usually a spike in pent-up demand”.

“Fewer consultants will also be available to cover for striking juniors as many will be on holiday,” added the paper. As a result, “even critical services such as emergency departments and maternity wards are likely to be operating with a skeleton staff, although bosses will prioritise urgent care”.

The strikes are happening at a time when the healthcare system is “still trying to rebalance itself in a post-pandemic world living with Covid”, wrote Sky News.

While each month it seems that “another part of the Covid apparatus gets dismantled” – such as the end of the ONS infection survey and the closing of the NHS app at the end of this month – the pandemic’s “legacy” means that “the NHS is seeing pressures usually reserved for the winter all year round”.

Demand for healthcare services is the highest it’s ever been, said Dr David Shackleton, an A&E consultant at West Middlesex Hospital, leaving waiting times longer and causing delays in seeing the sickest people.

And Matthew Taylor, chief executive of the NHS Confederation, warned on Monday that industrial action this week posed risks to patient safety and called on the public to avoid “risky behaviour”.

However, Dr Sumi Manirajan, from the BMA, told Sky News that last month’s walkouts showed patients’ safety was not compromised and hospital units could be filled with existing staff.

“We were able to do 72-hour strikes safely, that demonstrates that we do have expert clinicians who can safely step down and we do have enough doctors to cover the wards,” she said. “If this changes or there is a mass-casualty event we urge every trust to contact us because patient safety is first and foremost.”

The BMA has said it has plans to call doctors off picket lines if lives were in immediate danger, in line with trade union laws, reported the BBC. But the industrial action by junior doctors “contrasts with recent strikes by nurses and ambulance workers, which saw unions agree to exempt certain emergency services”, said the broadcaster.

Junior doctors, however argue they are striking "for patient safety as much as about pay, saying that current pay levels are affecting recruitment and leading to many doctors leaving the profession”.

What next?

Junior doctors “have a grievance”, said The Sunday Telegraph, but “finding a doctor, as opposed to a role, whose income has fallen by 35 per cent over the past 10 years would not be easy”, the paper said, “yet that is the pay demand being made by the BMA”.

The BMA is couching its demands in “altruism, claiming such an increase is necessary to avert a retention crisis in the NHS”, said the paper. “The threat is that these well-trained doctors will up sticks and leave the profession or even the country unless their demands are met”, it added, “which hardly sounds like a commitment to the health service they wish to preserve.”

But this week’s industrial action will show “how radicalised doctors have become due not just to cuts in pay but also to the Covid-19 pandemic, to poor conditions and to the frustrations of working in a health service that is slowly imploding”, said The Guardian.

And junior doctors’ last campaign of industrial action, which took place in 2016 over contracts and weekend working hours, is “also a big, though under-appreciated, factor in their thinking”. Many junior doctors believe they ultimately lost that dispute as “the contract they loathed was ultimately imposed anyway, despite their year-long series of walkouts”. And now they are “determined to stop history repeating itself”.

The BMA has delayed the ballot for a consultants’ strike until May, following what it described as “constructive talks with the Treasury” and “positive discussions” with Barclay. But “there has been no such movement or indication of a mutual understanding in the government’s stand-off with junior doctors”, said Sky News.

Barclay accused the BMA of maintaining an “unrealistic position”, which meant talks ground to a standstill, accusing the union of being “intent on maintaining a militant stance rather than working with the Government and NHS management to meet the best interests of their members and of patients”.

Speaking to the BBC, the BMA said it had “no offer whatsoever” from the health secretary.