Decoding the junior doctors’ strike – from patient safety to public support
Almost a year after the first strike over wages and working conditions, doctors in England are going on strike again for six days. (A pay deal has already been reached in Scotland, while doctors in Wales will strike later this month and those in Northern Ireland are currently being put to a vote.)
Although the new Health Secretary, Victoria Atkins, is on slightly better terms with the British Medical Association (BMA), which represents young doctors, than her predecessor, Steve Barclay, doctors and the government are still far apart. As the two sides argue their case, here's some help in interpreting what they have to say.
Claim: The strike could endanger patient safety
Six days of strike action as a sequel to holidays at a time of enormous pressure there are real problems surrounding patient safety”
Matthew Taylor, CEO of the NHS Confederation, December 23
The trainee doctors have timed their strikes for maximum impact during the dispute – as you would expect from any group of workers. But it is at a new level, with 144 hours of uninterrupted service interruptions during what is typically the busiest week of the year. The NHS Confederation, which represents hospital trusts, says that many trusts will be in a “very vulnerable position”.
Emergency care will still be provided, but tens of thousands of procedures will be postponed, including cancer patients and people with vision problems. (Last time, 90,000 appointments and operations were postponed during a three-day strike.) When a hospital faces an unpredictable emergency, this joint letter (pdf) from the BMA and NHS England explains that staff may be asked to return to work. The BMA says it will only agree to such exemptions if all other options have been exhausted.
Health care trust leaders fear such requests would take too long to process, or create differences in the interpretation of what constitutes a major incident. The BMA rejects this, but warns that the derogation process should not simply be used to relieve more routine pressures.
There are claims that deaths increased last year would have been caused by strikesBut there is no hard evidence for a connection. While there is limited research available on last year's action, there is also research on the trainee doctors' strikes in March and April last year in the European Journal of Emergency Medicine found that mortality rates in emergency departments were similar to those on non-strike days. (One author is affiliated with the BMA.) A recent study into a strike by junior doctors in 2016 found no impact on mortality or readmission rates for emergency patients overall – although there were higher readmission rates for black emergency patients.
Meanwhile, although Rishi Sunak has done that before blamed striking NHS workers for record waiting listsHealth Foundation research in October found they were responsible for only a 3% increase. The BMA has argued that this indicates that doctors are being made scapegoats by the government for a much deeper problem.
Claim: Junior doctor wages have fallen severely over the past fifteen years
The wages of junior doctors have been reduced by more than a quarter since 2008.”
Junior doctors so far have received an average pay increase of 8.8%, with another 3% on the table this year. The BMA is asking for 35%, to restore wages to the level of fifteen years ago – though they said that too “We recognize that it would be reasonable to do it in a few years,” meaning the gap between the two parties is a little smaller than it sounds.
There is no doubt that trainee doctors' salaries have fallen significantly in real terms; How much depends on how exactly you calculate it. The BMA arrives at this figure by using the consumer price index (RPI) to measure the impact of inflation on salaries. It says this represents a 26.1% loss in income since 2008. But the Office for National Statistics said in 2018 that RPI is “a very poor measure of headline inflation.”
The Institute for Fiscal Studies considers a measure with the not-so-catchy title of the consumer price index, including owner-occupier housing costs (CPIH), to be more accurate. The IFS says that using CPIH has resulted in a real wage reduction of somewhere between 11% and 16% since 2010.
But not everyone agrees with that analysis of the best figure to use. The Royal Statistical Association said after a 2020 consultation with its members that “CPIH is a macroeconomic indicator good for measuring the overall performance of the economy, while RPI is intended to reflect changes in the cost of living.” This is in line with the position of the BMA.
The figure also depends, of course, on which year you use as a base: although the change is more serious compared to 2008, most similar measures are compared to 2010, when the coalition government came to power and after the financial crisis. But it's worth noting that doctors have fared worse than many other professions in the austerity era. as this graph makes clear.
Claim: The public supports the junior doctors
The public knows that the only way to have a healthcare system that takes care of them is to have enough doctors. And they can completely understand (that the salary of doctors in training) is simply not enough”
Dr. Vivek Trivedi, co-leader of the British Medical Association, December 20
This is quite easy to answer: support for doctors in training remains high, according to the most recent polls. In September, Found Ipsos that 53% of the public support doctors – less than ambulance crews and nurses, but more than consultants, and more than striking workers in any other sector. That has fallen by only one percentage point the same research in April last year.
A YouGov poll in September it emerged that voters blamed the government more than the BMA, by a margin of 45% to 21%. A Christmas poll, also by Ipsos, puts NHS staff at the top of 'nice list' – rated higher than teachers, the England women's football team and David Attenborough. Of course, this could all change as the strikes continue. But claims thatFor example: “with every new strike the reputation of (prospective doctors) continues to plummet” has so far been far off the mark.
Claim: Junior doctors refuse to conduct interviews; The government refuses to make an offer
They made the decision to walk away from the discussions we had, which were live.”
The Minister of Health, Victoria AtkinsDecember 13th
I mean even recently the secretary of The state has said they are making a final offer. Well, then give it and let's settle the dispute”
Dr. Rob Laurenson, co-leader of the British Medical AssociationDecember 30
Both sides describe the failure of the talks in terms that present themselves as willing to negotiate and the other side as unyielding – and both are right to some extent. After five weeks of negotiations Things went wrong at the beginning of Decemberthe BMA said the government's 3% offer was not credible. But Victoria Atkins claimed that “we had not made a firm offer in any way.”
Now Atkins is urging the BMA to “come back to the table.” But that apparently broad offer is dependent on canceling the strike, which the doctors are not willing to do.
Matthew Taylor of the NHS Confederation summed up the situation before Christmas: “It appears the BMA will not engage unless the Government agrees to provide some additional funding; the government will not enter into talks until the BMA has called off the strikes.” He suggested that while both sides feared that giving in would reveal weakness, “from the perspective of the public, patients or other people who work in the NHS, whoever moved first, I think, will get a lot of credit for that”.
In summary, the talks appear to have failed because of the fundamental rift that still exists between the two sides, and not because one is more unreasonable than the other. Until some progress is made on that underlying issue, the dispute is likely to continue.