|Volume 53 Number 27, September 23, 2023
Photo: Lewes Cook
Consultants and junior doctors in England took strike action as a single united force on September 19-20. This is the first time that both sections of doctors have been on strike simultaneously. This comes after nurses in England, Scotland and Wales have also taken action and are continuing to speak out.
The junior doctors previously held a four-day walkout in August, coinciding with a two-day walkout of radiographers, in their fifth round of strike action . In an indication of their resolve to hold the line, over 7,000 additional junior doctors voted to continue action, with a near-unanimous 98% in favour, the highest majority so far.
The consultants are following strikes in July and August, in their first wave of such action in nearly 50 years, with thousands of doctors taking part.
The British Medical Association (BMA) reports that it has again written to Health Secretary Steve Barclay to discuss pay, a well as reform of the Doctors' and Dentists' Review Body (DDRB), so as to end the strikes .
The government has refused to discuss even the issue of pay at all. As consultants began their August strike, it was revealed that the government had not met BMA consultants for five months. Specifically, health ministers have not spoken with consultants since March 27, junior doctors since May 12, and senior radiographers since July 4 .
Speaking on August 24 at the beginning of the 2-day strike, Dr Vishal Sharma, BMA consultants committee chair, said: "Our message to the Prime Minister is that we are serious about protecting the consultant workforce and thereby the NHS and patients. ... the Prime Minister has the power to avert any further action at all, by getting around the table and presenting us with a credible offer."
Also in August, the Welsh BMA junior doctors committee unanimously voted to ballot members on industrial action, confirming that if the ballot succeeds, strike action will commence with a full 72-hour walkout of all junior doctors, following the rejection of the Welsh Government's 5% pay offer. At the same time, Scottish junior doctors accepted a 12.4% pay increase .
Doctors are fighting to reverse a steep decline in real terms pay over the past 15 years. Indeed, they are striking for the very survival of the NHS in conditions that are creating an "exodus" from the profession . Doctors aim to achieve full pay restoration, which is crucial for the recruitment and retention of doctors.
The government has been taking a confrontational stance and is attempting to wreck public opinion by attacking the dignity of the profession, despite doctors and health workers being well aware of their value, and turning truth on its head by blaming the strikes for the problems in the NHS.
Health workers see the necessity of healthcare. A modern society requires a thriving health service in order to function. It is not strikes that are preventing treatment, it is the government and the private interests they represent, which are creating an existential crisis for the NHS. Recruitment and retention, which require that pay be determined objectively rather than deliberately eroded away, are crucial for the future of the health service.
Rather than engage meaningfully, the government in July announced a below-inflation 6% increase for 2023-24, along with a £1,250 consolidated payment, as the "final offer", stating that no strike action will alter their decision.
The figure of 6% had been recommended by the DDRB. As has been exposed, pay review bodies such as the DDRB are far from independent, and in some cases their reports are acted upon, in other cases ignored, as suits the aims of the government. The BMA condemned the "derisory" offer as "an insult." For this reason, doctors are also demanding a new mechanism to prevent future declines in real pay, including reforming the DDRB process to ensure independent recommendations for pay increases.
The crisis in the NHS is severe. Hospital waiting lists have doubled from 3.7 million in October 2017 to 7.42 million in July 2023 . Prime Minister Rishi Sunak pledged in January to cut waiting lists, promising faster care, but this promise has proven unattainable on the health service's present direction.
At an NHS England board meeting in Birmingham on July 27, plans were announced to prepare for the extra strain on the NHS in the coming winter. The new measures of the winter plan are, in the words of NHS England, a "new scheme to encourage local teams to 'overachieve' on performance measures with financial incentives provided for these areas." 
The crisis is a consequence of the direction in which the health service has been taken, consistently, by successive governments. This direction can be described as one increasingly distancing decision-making from the people and their communities, and putting the NHS into the service of powerful, competing private interests.
Recent developments include the Health and Care Act 2022, which further distanced decision-making from local communities through the Integrated Care System (ICS). Under this system, decisions are made by unelected and remote Integrated Care Boards and sub-committees under government control. And this year, the Elective Recovery Taskforce published a report aimed at finding ways to maximise private hospital use and encourage private providers to run new Community and Hospital Diagnostic Centres .
In the face of the government's confrontational stance, doctors have been holding the line, to the point that junior doctors and consultants, along with other sections of health workers including nurses, are now presenting a united front in the struggle for the future of the health service.
The united front of consultants, doctors and nurses in taking a stand for the NHS, demonstrates their determination and shows the way forward in terms of speaking in their own name and providing solutions. The government refuses to listen due to the NHS's corporate direction. But open discussion about the future of the NHS and the solution to its present problems is the order of the day.
The government has forced the issue of who decides. The struggle reveals that the solutions to the problems in the NHS lie with the health workers themselves. The fight they are taking up is as much to do with ending their marginalisation as it is immediately about pay, beginning with speaking out, smashing the silence on their working conditions - which are also the patients' conditions - and refusing to be ignored. They are aiming at a new situation where decision-making involves doctors, nurses and all health workers, along with communities and people as a whole, speaking and acting in their own name and as one, without the mechanisms of disempowerment blocking their direct decisions from being realised.
The alternative is new public health authorities independent of disruptive private interests, directed solely at fulfilling the needs of the people for health and social care, and which embody these modern democratic principles where the people decide for themselves.
1. "The struggle for the future of the NHS Junior Doctors Hold Four Further Days of Strike Action, Rejecting Sunak's Final Offer", Workers' Weekly, August 19, 2023
2. "Consultants in England announce prospective September strike dates", BMA, August 7, 2023
3. "Government Has Not Met Senior NHS Consultants For Five Months", Tom Scotson, PoliticsHome, August 24, 2023
4. "72-hour walkout looms", Oba Babs-Osibodu and Peter Fahey, co-chairs of the Welsh BMA junior doctors committee, September 6, 2023
5. "Support the Doctors as the Battle for the NHS Continues", Workers' Weekly, July 26, 2023
6. "NHS sets out plans for winter: Government Continues to Drive NHS Further into Crisis To Pay the Rich", Workers' Weekly August 5, 2023
7. "The Integrated Care System and the Elective Recovery Taskforce: Further Distancing Decisions from the People on Health Care Intensifies the Crisis", Workers' Weekly, August 19, 2023