|Volume 53 Number 27, September 23, 2023
Workers' Weekly Internet Edition: Article Index : ShareThis
Uniting for the Future of the Health Service:
Consultants and Junior Doctors Hold Joint Strike Action
In their latest round of action over pay and working conditions so as to safeguard the future of higher education, university staff across the country are set to strike for five consecutive days from September 25 to 29.
"The dispute centres on low pay and working conditions. Employer body, the Universities and Colleges Employers Association (UCEA), has imposed a pay award for 23/24 worth just 5% for most UCU members, even though they overwhelmingly voted to reject it. UCU is also demanding action on gig-economy employment practices and high workloads," writes the University and College Union (UCU) .
The UCU has agreed to a joint review of sector finances alongside the UCEA. According to research by the union, the higher education sector made more money than ever last year, yet the claim of employees fell to a record low.
Nationwide strike ballots at 143 universities also began on September 19, following the rejection of the 5% offer. This is the third such ballot this year. As the union explains, a successful ballot will renew the strike mandate into 2024 .
The union also points out that lecturers' actions have forced employers to negotiate over workloads and job security for the first time.
Meanwhile, the UCU has ended its marking and assessment boycott, which had been ongoing since April 20.
Covering all marking and assessment at 145 universities, the boycott had been met by up to 100% of pay being deducted from participating staff at a number of institutions. It was pointed out that this disproportionate, punitive, and probably illegal response by management was an aggressive tactic aimed at intimidating workers into backing down. 
The University of Sheffield staff will strike for ten days from September 18-29 in dispute over this pay docking following the boycott.
UCU regional official Julie Kelley said: "The brutal pay docking regime Sheffield's management is enforcing means a staff member with a single unmarked essay could lose a month's wages. Attacking staff like this only adds fuel to the fire and will do nothing to bring this dispute to an end. Sheffield needs to stop the pay docking and call on UCEA to re-enter negotiations." 
In a separate development, the University of Brighton announced in May its plans to cut over a hundred staff members, resulting in a significant reduction in lecturers across various subjects, citing "cost savings" of £17.9m, despite having spent more than £50m on building projects in the past two years. Local UCU members voted to take industrial action, and the university's higher education committee has now voted for the university to be greylisted, which is the union's ultimate sanction. The UCU is asking its members, other trade unions, labour movement organisations and the international academic community to support its members at Brighton by not applying for advertised jobs, not speaking at or organising conferences outside of contract, not accepting new positions as visiting professors or researchers, not accepting invitations to write for academic journals, not accepting new contracts as external examiners for taught courses, and refusing to collaborate on new research projects outside of contract. 
Another example typifies the assault on academic standards, on academic staff and overall the philistinism of the authorities which dictate what goes, without reference to the staff and students concerned. The University of Chichester unilaterally and arbitrarily closed down the Masters by Research (MRes) course on the History of Africa and the African Diaspora, followed a few weeks later by dismissing the Professor of Africa and the African Diaspora, Professor Hakim Adi. The university also dismissed a colleague of Professor Adi, Dr Dion Georgiu. A vigorous campaign has been launched by students and colleagues and by wide sections of concerned people, in the midst of disinformation and high-handedness from the University . A letter to the press from ten MRes graduates points out: "As MRes graduates, spreading this disinformation does a disservice to our discipline, to the culmination of our hard work and the work of Professor Hakim Adi. It also jeopardises our ongoing challenge , to uphold the course and the rights of the students and Professor Hakim Adi to fair treatment." As Professor Adi emphasised in an online press conference recently, what the University of Chichester is seeking to accomplish amounts to an attack on all academia.
These attacks are coming in the context of the government's so-called "crackdown on poor quality university courses", announced on July 17 by Prime Minister Rishi Sunak. As the Financial Times reported: "Universities in England offering courses with poor employment prospects and high student dropout rates will be subjected to stricter regulatory controls under plans to be unveiled on Monday by Prime Minister Rishi Sunak. The government will order the Office for Students, the higher education regulator in England, to do more to limit the number of students that universities can recruit on to certain courses. The prime minister and education secretary GillianKeegan will promise a crackdown on 'rip-off degree courses' which leave graduates with inadequate pay and high debts."  This is a scandalous attack on education as a whole and the rights and dignity of those lecturers and academic staff who are dedicated to their subjects and their importance for the younger generation. According to the government's logic, the point of degree courses is to fit the graduates with the ability to earn large salaries and pay off the debt incurred while at university. The irony of this can be seen in the present struggles, where "inadequate pay and high debts" is the norm for higher education workers, not to mention the graduates.
The struggle of higher education workers, both academic and support staff, is aimed at recognising and realising the value they add to the economy. They produce highly skilled graduates and postgraduates, contribute to society's cultural level, and contribute to scientific and technological advances. It is a fight for the future of higher education. Education is a right that should serve the people, and academics and workers are fighting for their rights and conditions.
It is to the higher education workers' credit that, by holding the line against imposition and intimidation, they have forced negotiations on certain key issues. Such tactics, attempting to block workers from organising in self-defence, themselves reveal that it is an issue of control over the direction society is headed. Through their stand, university workers are contributing to a new outlook where people can think and act in their own name, allowing them to take control over matters that affect their lives and the general interests of society. Workers' Weekly continues to fully support the university staff and wishes them every success in their actions.
1. "Start of university term to be hit with five days of UK-wide strikes," UCU, 6 September 2023
2. "Date set for university strike ballot," UCU, 11 September 2023
3. "University Staff to Strike against Arbitrary Full Pay Docking," Workers' Weekly, June 10, 2023
4. "Ten days of strikes set to hit the University of Sheffield over pay docking row," UCU, 15 September 2023
5. "Start of university term to be hit with five days of UK-wide strikes," UCU, 6 September 2023
6. For full details of the closure of the course, the sacking of Professor Adi, and the campaign to save the MRes in the History of Africa and the African Diaspora, and Professor Hakim Adi's post at the University of Chichester, see the History Matters website:
7. "Rishi Sunak announces crackdown on 'poor quality' university courses", Financial Times, 17 July 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, 2023http://www.rcpbml.org.uk/wwie-23/ww23-23/ww23-23-02.htm
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
The BMA website carried an article by Ben Ireland on September 20, emphasising that BMA branches of practice were co-ordinating a walkout for the first time in NHS history, and reporting on what the consultants are saying.
The article says: "Junior doctors and consultants taking joint industrial action for the first time in NHS history say they feel a greater sense of camaraderie through their combined efforts to fight for fair pay and conditions. ... Both groups of doctors have seen their pay erode substantially and are calling for it to be restored to 2008 levels. Each group has had a sub-inflation pay uplift imposed on them by the government this year, with prime minister Rishi Sunak saying the six per cent for consultants and six per cent plus a lump sum for junior doctors is 'final'.
"Simon Walsh, an emergency medicine consultant picketing outside The Royal London, said: 'We are all here regrettably because the situation has now gotten to the point where government isn't even willing to talk to us, let alone produce a credible offer. Despite supporting each other, none of us want to be on strike. We'd all rather be at work.' Dr Walsh, deputy chair of the BMA's consultants committee, added: 'If the government hadn't entrenched themselves in a ludicrous position where they won't talk to us, perhaps we wouldn't be here.'
"Margarita Kousteni, an ST2 in psychiatry at Maudsley Hospital in south London, said: 'It's encouraging that doctors who have gone through what we've gone through and reached the grades we're aspiring to, are supporting us. They know the hardship we go through and have seen better days in the NHS so can recognise things are getting worse.'
"Mike Andrews, an IMT3 at Royal London, said the lack of government interaction with negotiations meant doctors and consultants are 'hunkering down' for a long-term dispute. He said the recent reballot of junior doctors, in which 98 per cent voted in favour of extending the strike mandate, from a turnout of 71 per cent, shows the government's position has 'far from dissuaded us', adding: 'More and more people are engaged.'"
The article continues: "It has been more than 170 days since health secretary Steve Barclay spoke with the BMA's junior doctors committee and while consultants hailed a 'significant step' of fresh talks with government over the weekend no agreement has been reached. At the time of the survey, it had been a similar length of time since Barclay had spoken to the BMA's consultants committee.
"Dr Walsh said: 'We've been desperate to get round the table, endlessly saying how important it is. We can see that patients understand that the only way to resolve this dispute is through negotiations and listening to each other. Other NHS organisations are saying the same. It's only the government that doesn't want to get round the table.'
"Shane Delamont, a neurology consultant picketing at Kings College Hospital, said joint strike action had brought junior doctors and consultants closer together. 'We've certainly gelled much more than before,' he said. 'Which is a good thing, paradoxically.' He said NHS funding pressures since the David Cameron-led government's first austerity policies had laid the ground for the current industrial action, with doctors losing even more patience with the government's continued lack of support after their enormous efforts during the COVID pandemic. 'I never thought, as a consultant, I would go on strike,' added Dr Delamont. 'It's built up over a number of years. What we are seeing now is the chickens coming home to roost. The anger is unsurprising.'
"Phil Kelly, a consultant physician at Kings, said: 'It's very sad that we've gotten to this position where two parts of our union feel like we have to do this. At the start, some felt this might be inevitable, but it's still sad now we're here. That it has come to this is distressing. 'If someone had have said 15 years ago that it would get to this from where we were, we wouldn't have thought it was possible. This is a dreadful situation, incredibly sad. We all depend on each other to do our jobs, and we are losing brilliant people.' While the dispute is centred on pay, Dr Kelly said that, for consultants, this boiled down to a 'currency of recognition'. 'We are undervalued,' he said, noting how more consultants are retiring sooner, moving overseas, going private or leaving the profession in increasingly numbers. Dr Kelly said many consultants regularly work extra hours to fill gaps left by the workforce crisis, and that this can misconstrue average salaries as well as causing stress and burnout. 'The average contribution is far greater than the pay', he added. 'And the more you say to people that they are worth less, the less they are going to be available.' He stressed the importance of the Review Body on Doctors' and Dentists' Remuneration (DDRB) being truly independent in consultants' negotiations with government - one of BMA consultants' key asks. 'The trust has gone,' he said of the body that a Tory backbencher recently told the i newspaper produced recommendations that are 'basically rigged'."
The article refers to the press release issued by the Department of Health and Social Care on September 19 which proclaims that the government is considering introducing regulations that would require some doctors and nurses to work during strikes, and that "minimum service levels" (MSLs) could be extended so that nurses and doctors could be covered by new regulations.
The article says: "Tuesday's joint action came after health secretary Steve Barclay announced a consultation on minimum staffing levels in hospitals during strike action. In reaction, Phil Banfield, chair of BMA council, said: 'If this government was serious about patient safety, it would not have deliberately run down the health service over the last 10 years, with the terrible, adverse effects that austerity has had on the health of the nation every day.'"
The article continues: "Dr Kelly added: 'To suggest minimum service levels now is sadly political manoeuvring that smacks of designing a way to break the ability to strike. If the role is so critical, pay fairly for it.'
"Dr Andrews said: 'If the government really cared about minimum staffing levels, then they should be negotiating with us so we can get back to work and have safe staffing on non-strike days.'
"Marta Patyjewicz, an FY3 at Royal London, moved from Poland to the UK expecting to have a better work-life balance in the NHS but has found herself on strike within months. While 'both systems are similar', she says the NHS is 'more overwhelming' for doctors because of the problems caused by the workforce crisis. Dr Patyjewicz said many fellow international medical graduates (IMGs), who are often filling gaps left by UK-trained doctors moving overseas, are moving again after a short period because of the conditions they find - which was affecting the NHS' reputation worldwide as well as failing to resolve staffing shortages. 'I live in London and have met lots of people in other professions, like finance, who earn a lot more than doctors,' she added. 'It makes you feel unappreciated.'
"Naresh Buttan, a consultant psychiatrist at Maudsley, moved to the UK from Australia in 2008. In that time consultant pay has eroded by over a third in real terms. 'Since I moved here I've only known pay getting worse,' he said. 'At the same time working conditions have become harder and harder. 'The number of referrals has gone up, conditions are more and more complex and we have been through COVID. I'm 54 and I wonder if I can do another 10 years in the NHS. I'd love to but the way it's going the more I think about quitting. 'It used to be that working for the NHS you knew it would look after you, but now it doesn't feel the same way - which is why these strikes are happening today.'"
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