- Interview by
- Taj Ali
This time last year, junior doctors warned the Government they would go on strike unless steps were taken to reverse the dramatic 26 percent real terms pay cut they have suffered since 2008 and the resultant recruitment and retention crisis. They were ignored.
In January, junior doctors voted by 98 percent to go on strike, going on to stage nineteen days of industrial action since March. And this week, they have voted again by 98 percent for further strikes, extending the possibility of walkouts continuing well into 2024. Doctors are angry — and their determination to restore their pay after fifteen years of erosion shows no sign of abating.
NHS consultants have also joined the strike wave, staging four days of action, with at least five more planned in the coming weeks. And now, for the first time in the history of the NHS, junior doctors and consultants will coordinate industrial action.
Tribune sat down with co-chair of the British Medical Association (BMA) Junior Doctors Committee, Dr Robert Laurenson, to discuss the latest escalation in industrial action and why doctors will continue to fight as long as they have to — for themselves, for their patients and for the future of the NHS.
The decision to coordinate industrial action between consultants and junior doctors is a major escalation. What has brought the BMA to this point?
It’s been clear to both consultants and junior doctors that Mr Sunak has been imposing decisions without empowering his Secretary of State for Health to negotiate properly and has refused permission to meet with us to discuss pay. So we have no option but to coordinate and escalate our action to bring the Government to the table to discuss fifteen years of pay erosion that both consultants and junior doctors have faced.
It’s interesting you mention the Prime Minister’s role in this. In January, The Observer reported that Health Secretary Steve Barclay had privately urged trade unions to help him make the case to the Treasury and No 10 for extra money for nurses, ambulance workers and other NHS staff. Who is actually in control of negotiations here?
We have been told that the decisions are coming directly from No 10. Mr Sunak is taking on all this responsibility and setting his red lines. It was his unilateral decision to impose yet another deal, which we have not consented to. He should be held accountable for the outcomes: a failing healthcare system and further strike action.
You’d think with the announcement of further escalation, there would be a degree of reflection, perhaps an effort to prevent another round of strikes. But Steve Barclay has come out very quickly and said the pay award is final. They are adamant that they will not reopen negotiations, particularly as other groups of workers accepted their imposed pay deal. Do you think you can shift the Government on this?
In October, we will hold a rally of striking consultants and junior doctors during Conservative Party Conference. They will have to explain to the people they are looking to persuade to let them run the country why consultants and junior doctors are leaving the country, leaving the profession and taking strike action. We encourage people to join us at 1 pm on 3 October at St. Peter’s Square in Manchester to ask the Prime Minister why he’s blocking talks and why he won’t sit down and build a healthy relationship with doctors. A sick population is an unproductive population and an unproductive population is a sick economy.
The Government says they’re not willing to discuss pay, but the door is always open for discussions. Have you had any discussions with the Government since the previous round of strike action?
Before our last round of action, they invited us in for an informal talk about non-pay-related issues. When we sat down and said, ‘Okay, well, what would you like to talk about?’ They turned around and said, ‘We’re not allowed to say.’
Was that with the Health Secretary?
No, it was civil servants — people who are not empowered or given a mandate to talk about non-pay-related things. It was a pointless meeting. The cynic in me thinks they were just playing political games because I believe they leaked the occurrence of that meeting to selected media.
When I spoke to your co-chair a few months back, he mentioned how long it had taken to get to the point of negotiations. He mentioned a meeting in April where the Health Secretary said he had no mandate to negotiate. It did appear, however, that there was some progress in May where the issue of pay was discussed, but nothing has come out of that. The negotiation process in Scotland seems to have been much smoother.
Those negotiations in May have proven to be a sham. They had the pay review body report, which they refused to share with us during negotiations. They offered us even less than the pay review body recommendations. So those negotiations were not an effort to come to a resolution. It was an effort to undercut the pay review body. It was a complete sham. And it goes to show how disrespectful they were in that they weren’t interested in coming to a negotiated agreement. They were only interested in being pennywise and pound-foolish. Presiding over a broken NHS has a dramatic impact on the economy.
You don’t believe in pay review bodies, do you?
The BMA has not had confidence in the pay review bodies for the last four years. We don’t submit evidence to the independent pay review board because we don’t believe in their independence. The Prime Minister selects the chair of the body of the review board, so they’re not actually independent. They used to be independent. And in fact, in the 1970s, they once recommended a 30 percent uplift. So there is precedent for it. What I find fascinating is how all of the allegedly independent pay review bodies came to almost exactly the same conclusion for every single public sector industry, no matter how different our circumstances are. I think that goes to show that this was not an independent process.
We will likely have a Labour Government as early as next year. The BMA could be in negotiations with them. The Labour Party have not backed your pay demands. In recent months, they’ve also talked about greater private sector involvement in the NHS. In Wales, the BMA is in dispute with a Labour-run administration after being offered 5 percent. What’s your take on what you’ve been hearing from the Labour Party?
That 5 percent offer from the Welsh Government was after they committed to full pay restoration. So that was a betrayal. And I think all doctors need to be cognizant that it doesn’t matter what people say — it matters what is written down in black and white. The message from the BMA is that we’re here to represent doctors to ensure that we can protect the profession and deliver high-quality health care. It doesn’t matter if it’s Labour in Wales, the SNP in Scotland, or whether it’s whatever party is in power next year. And the last thing to say is that privatisation is not going to resolve our issues. If the employment of doctors is outsourced to private companies, we would have to fight those private companies over pay too.
Shadow Health Secretary Wes Streeting has pledged to use the private sector to bring down waiting lists. Politicians and commentators are increasingly saying you can’t solve the NHS by simply pouring more money into it. It needs reform and innovative solutions.
We need to recognise that the NHS was in a good place just over a decade ago, and people were very happy with how it was working. Of course, there are always issues and things that need to be changed. And so when people say that the NHS needs reform, I don’t think anyone can disagree because it is not working at the moment. But it cannot be a public-private partnership where the public are excluded from conversations.
Junior doctors have voted once again by 98 percent for further strike action on a 71 percent turnout. More junior doctors voted in this ballot than the initial one. That’s an extraordinary result. Many unions often struggle with engagement, particularly during long-running disputes.
The BMA has undergone a grassroots revolution, and ordinary doctors have taken up their free time to spread the message and build networks. The BMA and doctors have never been more interlinked. I have access to about 40,000 people at the end of my phone. I read all the messages from doctors and what people have to say and I respond. And it’s not just me. All of our reps are constantly engaging and communicating. We tried to be extremely transparent throughout the negotiation process, telling people what was being said because, at the end of the day, this is their pay that’s being negotiated.
Doctors believe in the BMA. They have trust and faith, which is why our mandate has been so strong. But it’s also because doctors do not trust this government. This is a government that imposed the public sector wage freeze, that imposed the contract on us. They’ve reneged on an agreement in our multi-year pay deal. And then they’ve demonstrated contempt for health unions and the BMA in their approach to the negotiations.
Given other union memberships have accepted the Government’s offer, many would argue that puts the BMA in a weaker position. Surely, they will respond that everyone else has accepted the deal and that you’re the odd ones out?
Unfortunately, this is, again, the kind of broad brushstrokes and lack of nuance and detail that Mr Sunak has. We are all in different industries, sectors, and professions with different pay and conditions that have been eroded from different points. The 2016 junior doctors dispute was so bitter. It left a scar on our profession. And our profession feels like we lost that dispute badly. So doctors feel not only a sense of injustice that needs to be rectified because of how the contract imposition went down, but we are also people who see behind the curtain in terms of access to high-quality healthcare.
Many doctors are now beginning to understand and realise that our backs really are up against the wall regarding the future of our profession and the future of high-quality healthcare. It is absolutely unacceptable for people to wait two years for an outpatient appointment. The waiting times to see GPs in many areas across the country are unacceptable. And the basic economics of it is a mismatch in supply and demand. We don’t want to be working in those circumstances. But, most importantly, we don’t want to be living in those circumstances. We are human too. We are subject to disease, sickness and ill health too. And, as people who know what happens behind the curtain, we don’t want to be sick. It is not a good time to be sick in this country because of the last fifteen years of erosion that’s occurred.
If you had a message for the Prime Minister, what would it be?
It would be to sit down with us. We can help him with four of his five priorities. We can help him reduce inflation, which his government has said is being fuelled by long-term sickness. We can help him grow the economy. We can help them reduce debt. And we can help him reduce the waiting list. There are many ways for us to work together to build the country back up. We believe in a high-skilled, high-wage economy. So let’s do it together in partnership. Don’t treat us with such contempt — or the strikes will never end.