The confirmation that resident doctors will strike over Christmas was entirely predictable, as Roy Lilley has noted in his NHS-related daily email today.
An 83.2 per cent vote to continue action, on a solid turnout, signals confidence and discipline.
But what is also clear is that this is not just a labour dispute, as Wes Streeting is trying to claim, or a disgrace, as Keir Starmer would have it. This is a dispute about who is responsible for a system already stretched close to breaking point.
Doctors are very clear that it is not them, and with good reason.
They are equally clear that the failure is on the part of successive politicians, all of them sharing the same austerity culture.
The public has no difficulty deciding who to side with in this case: doctors are not the problem, and are the ones seeking the solution to it.
The public blames politicians who are now trying to pin the blame on doctors for an NHS crisis of Labour's own making, which attempt is backfiring as a result.
Wes Streeting has compounded the problem. He has chosen belligerence over negotiation, framing a pay dispute as a test of authority and repeatedly warning of NHS collapse, winter crisis and patient harm. Christmas was supposed to concentrate minds. It has not. Instead, each supposed “final” position he has suggested has quietly expanded, revealing successive weakness on his part rather than strength. The doctors know they have him on the run.
This is ultimately a credibility failure. Exaggerated threats, shifting red lines and hostile briefings may win headlines, but they corrode trust. Once trust is lost, negotiations become endurance contests rather than problem-solving exercises. That is where this dispute now sits, and the BMA has outmanoeuvred the government as a result.
The NHS will almost certainly muddle through the strikes. Trusts are well rehearsed. Elective work will be cancelled, rotas simplified, and Christmas capacity reduced as it always is. If the apocalyptic scenario does not materialise, as is likely, Streeting's authority weakens even further, and for all the rhetoric, there is no clear indication as yet that the UK is suffering a serious flu crisis this year; it may be nothing more than normal, but just earlier than usual.
Doctors are, admittedly, consciously trading public goodwill for bargaining power, judging pay erosion to be the greater threat. But this dispute is no longer really about Christmas or even pay. It is about who runs the NHS, how fragile it has become after years of neglect, and how quickly Number Ten realises this needs to be resolved through respect, negotiation and competence and not confrontation.
The problems are that:
- No.10 can't sack Wes Streeting right now, even though he is hopelessly out of his depth and has grossly mismanaged this dispute by making it personal.
- No.10 has also made it personal, which was a gross error of judgment on their part.
- Labour has, as a result, nowhere to go but lose, as they are bound to do.
What a mess.
And we, and doctors, are paying the price for yet another government that has no clue how to negotiate anything.
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All Wes Streeting has done is shine a light on the gross inadequacies of the political class. He has no real world experience, embarks on naked self-promotion and is nothing more than the current frontrunner in the political class’s latest race for the keys to Number 10, boosted by his mates in the client media (which is just another branch of the political class). His close association with the private health care sector must call into question his approach to the doctors and the government’s plans for the NHS. The political class is so out of touch with the general public and this is becoming ever more apparent to the public with time. Personally I have not witnessed any loss of public goodwill towards doctors and the NHS although I do appreciate that NHS staff face rising hostility from some patients but that is different because other professions, like my own, also feel under threat from certain members of the public (often fuelled by right-wing media and politicians). Today’s politicians appear oblivious to the growing public dissatisfaction with them and the policies they pursue and spend more time concentrating on focus groups and lobbyists. This is the outcome of a highly careerist political system where personal ambition triumphs over principles and competence. It would be laughable if it were not so serious.
Much to agree with
The way Streeting is treating these doctors in training is despicable. You would think he was being asked to pay their wage demands with his own money. You would think “Don’t pay the danegeld” was public policy rather than a quote from a poem published in 1911 containing wisdom for the ages. You would think that the BMA was a socialist trade union rather than one that stands up for its members and you would think trainees in any profession should not be striking when asked not to by the people we elected.
The only way to get rid of Streeting in any kind of electoral timescale alas is to see him punted upwards to the office of Prime Minister. The future does look bleak and I see little reason for hope.
Maybe we need an extremely articulate, experienced, competent and principled ‘junior doctor’ to make it known that he will stand against Streeting as an independent MP at the next election — ie, do a Martin Bell!
And guess what: Unlike our political class, there is no shortage of articulate, experienced, competent and principled medics.
And perhaps we can get the greens (or other like minded parties) to agree not to contest. It’s really about getting Streeting out and to make an example……..
🙂
I would rather not divide the opposition though: he is already very liklel;y to lose hios seat. He only just held it last time.
On the topic of ‘doing a Martin Bell’ ….. Richard, how would you fancy getting yourself a white suit and suggesting that you’d reluctantly stand against Rachel from Accounts in Leeds West and Pudsey until there is a proper discussion?
This was initially suggested slightly tongue in cheek — but it might at least provide you high profile platform to discuss an alternative to the neoliberal nonsense and to explain to viewers that there are completely different choices available — rather than a constant stream of the ‘there is no money’ variety?
But I might win, and I do not wish to be an MP, so standing would be dishonest.
Sorry for taking the subject off at a tangent. But.
All this talk of Streeting for Number 10 has five hundred and twenty eight problems.
Back in the day he would just find a safe seat. Currently LINO needs to rent time on an electron microscope to read their poll ratings.
I, like most of the readers of this blog were sad that he scrapped through last time.
How can Wes spoil 2029 for us all ?
Getting No. 10 involved too early is always a mistake. They are the last chance to climb down if things need changing…. but they have allowed themselves to become too closely aligned with Streeting.
Of course, internal politics protects Streeting but they don’t have to sack him – they could sack Rachel Reeves and “promote” Streeting to Chancellor! But does No. 10 actually want him to fail so that his leadership credentials are damaged?
At the risk of dissent, the one area where the BMA is failing is about “pay restoration” – using RPI and a particular point in the past does give a false picture and I think many folk look at their claim and feel instinctively that it is too much, too fast (when they look at their pay over the same period). Where the public really supports them is that without more resources the NHS is clearly struggling. Everyone is either a patient or knows a patient; is an employee or knows an employee. Wes Streeting can say what he likes….. the public knows better.
Interestingly, as the BMA points out, doctors’ student loans are indexed to RPI, so the state is content to use RPI when it is protecting the real value of money owed to it, yet when doctors highlight that their pay has not kept pace with rising costs, RPI is suddenly judged inappropriate and CPI is preferred.
Good point…. and doctors are in that “earnings window” where they will eventually pay off the loan…. but not quickly – thereby incurring very high interest costs. When comparing the financial position or doctors “today” vs “back in the day” student loan costs need to be included.
Agreed
This applies to almost all graduate level public service workers (nurses and teachers, for example).
I have no idea why the teachers’ unions are so pathetic that they accept such pay erosion – but they seem to. However, assuming that teachers are already so badly paid that they will never pay off their loan, the impact of losing 9% of their salary above the min. 20 odd K threshold means that they should have that as a minimum.
I fully get the doctors’ point — I don’t see why it doesn’t apply across the entire public sector.
Not crowing, and by no means saying that either the S.N.H.S, nor indeed the Scottish Government are perfect, far from it, but certainly over the Xmas period there are no strikes in our Health Service. Just saying.
🙂
When I think of all the unemployed doctors and of all those sitting in pain on waiting lists I know who I blame.
All we have to do is make sure that we remind Streeting that he is in this position because his leader and his chancellor have decided to ‘accept things as they found them’ when they took power.
We need to remind this government what it has said over and over again. It has essentially talked itself out of a job. I mean, is there anything left to say?
As for there not being much of a blow back – well, the public may well not be taking it out on the doctors yet – but have you seen how Farage is polling? Ouch! Wakey wakey!
Stymied’s Labour are terra-forming this country for fascism – Britain’s best kept secret. Once Farage gets in, and more official links are made with Putin’s Russia, there will be a war in mainland Europe.
My advice: if you have kids, encourage them to go and and live in Australia or Mauritius or anywhere whilst they are young enough to make a contribution to their new home. There are dark shadows on the horizon towards the East, getting larger.
[…] By Richard Murphy, Emeritus Professor of Accounting Practice at Sheffield University Management School and a director of Tax Research LLP. Originally published at Funding the Future […]
One fact that I think is missing from the MSM coverage of this dispute is to fully explain the specialty training posts. According to MSM these went from 2000 to 4000. The BMA press release says 1000 to 4000.
I suspect this is more political big numbers. If specialty training posts should be at, say, ten thousand then this is just in the better than nothing league.
Richard can you or your medical correspondent shine a light on this ?
Google summarises the issues as follows and this seems a fair summary from what else I hear and read:
____
Problems with specialty training post availability, especially in the UK, stem from a massive mismatch: far more doctors applying than available spots due to poor workforce planning, leading to intense competition (e.g., 30k+ applicants for ~10k places), leaving many qualified doctors jobless or forced abroad, with concerns about system flaws like insufficient consultant supervision and financial barriers making entry harder, despite some government promises for expansion.
Key Problems
** Shortage of Posts**: The core issue is insufficient creation of training slots to match the growing number of graduates, meaning bottlenecks form after foundation training.
** Increased Competition**: Applications have surged (e.g., 23k in 2019 to nearly 60k in 2024), while posts grew minimally, drastically increasing competition ratios (e.g., from 1.9 to 4.7 overall in the UK).
** Career Stalling**: Doctors are left in limbo (“FY2s”) with no guaranteed employment or training, leading to stress and potential career abandonment or emigration.
** Systemic Flaws**: Issues like inadequate consultant SPA (Supporting Professional Activities) time to supervise trainees, financial pressures, and non-clinical selection criteria create an uneven playing field.
** Medical School Expansion**: Expanding medical school places without matching postgraduate training slots worsens the unemployment crisis for new doctors.
Impact
** Doctor Unemployment**: Many doctors completing foundation training cannot find a specialty training post.
** Brain Drain**: Talented UK doctors may leave for countries like Australia, or abandon medicine for other careers.
** Bottlenecking**: Creates extreme pressure, even for roles like Locally Employed Doctor (LED) positions, as doctors try to build portfolios.
Proposed Solutions & Demands
Significant, urgent expansion of training posts (beyond promised numbers like 1,000).
Pausing medical school expansion until training capacity catches up.
Addressing systemic issues in selection and workload.
Who’s Involved?
** BMA (British Medical Association)**: Actively campaigning for more posts and highlighting the crisis.
** NHS & Government**: Facing pressure to implement workforce planning and fund more positions.
______
I shouldd add, this is a govenment created crisis: they have trained the doctors they thought they needed and now refuse to give these highly trained people the jobs they want and society dmemands. You could not make this up.
Indeed, the doctors are right to take action.
I spoke to my doctor daughter in Australia this morning where she’s working for a year post F2 and applying for a training place to return to.
Her husband, who’s 31, is also a doctor at the same stage and has just heard that he won’t even get an interview for a training post, as due to changes in the way it’s calculated, he has fallen 1 point below the qualifying threshhold despite having been well above it before. His only way to remedy this is to do an MA, PhD or teaching qualification, all of which will cost thousands. He has a degree in Pharmacology, a degree in Medicine, worked as a health care assistant through Med school, including through Covid, has a good track record and references, is extremely dilligent and has around £100,000 of student debt……
My daughter has had to go through a stressful process just to obtain a place to take the exam that will determine whether she might get an interview…..yes! just an interview, not even a place.
The hoops they have to jump through!
Fortunately they are both robust and determined but why oh why should they have to be so?
They deal with life and death situations on a daily basis and have a huge amount of responsibility – they are not greedy! they need to be supported!
Tbis is beyond absurd
Are they staying in Australia then?
I would not blame them.
Surely, this is a Tory government-created crisis. I cannot believe that the entire crisis over insufficient training places for doctors has blown up since 4th July 2024. And yes, I don’t think student tuition fees should be indexed by RPI, and that is something that Reeves has had two opportunities to fix and has done nothing about it.
Nye Bevan was right when he talked about having to stuff the doctors’ mouths with gold.
Oh come on, that wasn 75+ years ago.
Shall we talk about now?
It never ceases to amaze at the rank stupidity of our politicians and their venality.
They are meant to managing our country to the benefit of its citizens and is failing miserably.
Indisputable. stop poaching other medics from africa and asia. indisputabable we are short of medics. indisputable employ all those who have trained in the nhs. indisputable this is driving medics to work in private hospitals. draining availablity of care for the needy and making care more available for the well off. But specialists in nhs earn about £150 while Gps £70k . Salaries are graduated as with lecturers. Where there is need as with doctors ,pay the going rate or fail the patients
I am not sure all of this is right.