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Low Pay Keeps the Doctors Away

Vivek Trivedi
Robert Laurenson

50,000 junior doctors are on strike today over a 26% cut to their real pay since 2008. This is a fight for the future of the NHS — a fight they won't back down from anytime soon.

Junior doctors are on strike to demand pay restoration after seeing their pay cut by more than a quarter since 2008. (Carl Court/Getty Images)

Interview by
Taj Ali

Underpaid, overworked, and struggling to hold up a health service in collapse, junior doctors have had enough. Since 2008, they have faced a 26 percent cut in real terms to their pay packet. Junior doctors have told Tribune about having nightmares about work, how patients are dying in under-resourced hospitals and how every bone in their bodies aches after gruelling shifts. They have highlighted the indignity patients face as trolleys pile up in overcrowded accident and emergency corridors as patients wait for hours in pain to be seen by them. 

The profession are united in their anger and have been unafraid to call numerous waves of strike action this year (28 days in total) to demand better for themselves, their patients and the health service. Doctors initially called for negotiations in August last year. They repeated that call in January after voting by 98 percent for strikes and again in March before their first wave of strike action. The Government eventually agreed to pay talks in May, which was later described by the BMA’s junior doctors committee as a sham. After insisting for months that they would not re-open negotiations, the Government came back round to the table five weeks ago. 

The latest offer, an additional three percent alongside the six percent and £1,250 imposed earlier in the year, has been described by the BMA as inadequate and a further round of strikes have been called. The union maintain that their campaign is about pay restoration and that the current offer is simply not good enough. 

Tribune sat down with the co-chairs of the British Medical Association (BMA) Junior Doctors Committee, Dr Vivek Trivedi and Dr Robert Laurenson, to discuss the latest developments in the dispute. 

TA | It looked as though we were seeing some progress in negotiations a few weeks ago. Why have junior doctors called further strike action? 

RL | We’ve been in dispute for fourteen months now. We had a round of negotiations in May, which turned out to be in bad faith because the government had the pay review body report in their pockets and they didn’t release it. They tried to undercut it and those talks broke down. Then the pay review body published their recommendation, which the government accepted, but it was still below inflation and constituted further pay erosion, which goes against the grain of our pay restoration campaign, which is why we continued action. 

Even though the prime minister said that pay was off the table, we ended up talking about pay in the latest round of negotiations and we had an agreed deadline on this round of negotiations because our members were concerned that we might be being played for time. 

TA | So just to clarify, you gave the health department negotiators advanced warning that there was a deadline for this latest round of negotiations. Was that made clear to the Government? 

RL | Actually, it was an agreement. It was an agreement by both parties. And one of the reasons we made it clear was because we had a prescheduled junior doctors committee meeting on the 5 December. At that meeting, the committee unanimously voted for further strike action because the deal of 3 percent was completely inadequate. 

VT | So even the Department of Health thought before we’d agreed on the specific date that talks would take between four to five weeks or so and that’s why that 5 December deadline fit not just for us, it fit for their time frame as well. The talks were productive, they were constructive, and I think both sides agree that the tone was better. But ultimately, when it came to that deadline day, that average three percent uplift was unequally spread and would have still seen large cohorts of our doctors face a pay cut this year. So not only did it not start to redress the erosion that’s happened previously, it would have been a further pay cut this year, and obviously that would be unacceptable to doctors. And that’s why our committee unanimously voted to reject that offer and to call for further strike action, which the government knew was a possibility and a probability before in advance of that meeting. Which then makes it all the more confusing why, if they had a further offer to put forward, as we’re hearing now, why it wasn’t put forward by that deadline. 

TA | Did you feel you were being deliberately stalled in light of the new minimum service levels legislation which could weaken your leverage power if you take further strike action later down the line? 

VT | That’s always a consideration and definitely was a concern that we were hearing from our members, especially when, despite the change in nature of the most recent talks, doctors are still scarred from how the government’s treated us, not just over the past few months, but over the past few years. And so it’s difficult to brush all of that away, even immediately after things start to progress. And whilst that was a consideration for us, there was no reason for us to not engage in these talks as positively as we could have. We didn’t hamper anything. We basically explored the talks and wanted them to flourish to their fullest possible potential. We didn’t call for strike action before our deadline and waited until the final day presented to our committee what we’d had. And that’s when the decision was made. 

TA | My initial understanding of the most recent negotiations was that pay was not going to be discussed. But now it appears those talks were quite positive and the government made a concession, offering an additional three percent. That three percent alongside the previous six percent and £1250 does seem like a compromise from their side. The Health Secretary says you’ve walked away from negotiations. What’s your response to that? 

RL | Just to be clear, we did not walk away from negotiations. It never makes sense for us to walk away from negotiations. We call strike action to get a settlement. What’s happened is their self-imposed boundaries have pushed us out of negotiations because they failed to reach an agreement with us through our agreed timeline. So it’s a little bit like siblings grabbing the other one’s hand and hitting them and saying, stop hitting yourself. It’s their decision, their boundary that’s pushed us out. And we’re very happy to come back in, but they need to invite us in. 

VT | We have no preconditions and would meet them at the table. They are not willing to meet us at the table unless we cancel strike action. That’s very clear. 

TA | We’ve seen other groups of workers put forward pay claims and settle on significantly less than they sought to get. Looking at Scotland, junior doctors have accepted 17 and a half percent over two years. The Scottish Government has also committed to further pay rises to move in the direction of pay restoration. That’s not 35 percent but it’s movement in that direction at a slower pace. The Labour Shadow Health Secretary Wes Streeting has said pay restoration would be a journey not an event. What sort of compromise would you be willing to make in order to reach a settlement? 

RL | So the Scottish deal also includes three years inflationary lock to prevent further pay erosion, which is a pretty big deal. And they’ve got three years of further negotiations to get to pay restoration as well. The government in Westminster literally doesn’t have that constitutional lifeline. There has to be an election in the next 13 months, and that’s not our condition, that’s the law of the land. The comments by Mr. Streeting, I think, are actually fairly reasonable. I think he’s listening. And the idea of it being a journey, not an event, I think shows signs of a potential partner who wants to work with us in good faith. Of course, we’d need to see what the outcome was, or the product was of that journey, but at least we could be on one. Whereas with this government, it feels like they don’t understand the nuance of the context of the situation we’re in and they’re just slapping down arbitrary numbers on the table without much thought behind it. 

VT | In terms of other sectors settling disputes, because especially more recently, we hear a lot from the government saying, ‘oh, your other colleagues in the medical profession have settled disputes,’ but just to reiterate, that’s not the case. Offers have been put to their memberships. Consultants have been re-balloted and SAS (speciality and specialist) doctors’ ballot have got active mandates for strike action. So it’s premature and I think, to be honest, is unlikely that those disputes will be settled. 

TA | The Government, and the Labour Party talk about fiscal responsibility. If we look at what your junior doctor colleagues have been offered by the Labour-run Welsh Government, it’s 5 percent — even lower than what you’ve been offered in England. Wes Streeting came out and the other week and said NHS trusts use the winter crisis as an excuse for more cash. The prevailing narrative from our political class appears to more money won’t solve the NHS crisis. What do you make of that? 

RL | I have some very nuanced thoughts about this. With regards to the NHS asking for more money in winter, I can understand why politicians would be cynical of very senior managers in the NHS making those claims because of how the NHS decides to spend money. That being said, it is clear to me that there are huge investments that need to be made in things like workforce and in things like estates. However, you look at the government’s position on paying physician associates 35 percent more than a doctor, how can that be justified as fiscally responsible when you’re getting less bang for your buck? 

TA | Just on that point, there appears to be massive uproar within the BMA around Government plans to increase the number physician associates within the NHS to plug gaps in the NHS workforce. My understanding is physician associates are NHS staff who are not doctors and don’t have medical degrees but are increasingly doing roles that doctors have traditionally done. Why are BMA members unhappy about this and how much of that is related to the current dispute? 

RL | It definitely runs in parallel to the dispute. It definitely feels very unfair to our members who are highly skilled, highly educated and highly talented, who have gone through many extensive years of training and education and postgraduate examinations to work in conditions forced upon them to rotate around the country, not being able to set down routes to have to find that someone else has come through a shortcut route with fewer skills, less education, lower standards, no regulation, no accountability for their own decisions to get paid more than people who have dedicated the prime of their lives to helping other people. 

These underhand corporate tactics are used against us in order to actually create division among workers. It’s my belief that physician associates and the people they work with are being exploited by the fact that they’re not being invested in, and they’re not being valued, and they’re not being upskilled to become doctors. And we need to be careful to recognise that the physician associate as a concept is a divisionary tactic in of itself, to divide workers by creating a second tier and by undervaluing people. So we need to be championing the ability for more graduate entry, medical school places to be opened up and fully funded for, so that we can have more doctors for tomorrow. 

VT | Going back to the question on fiscal responsibility, we know that we don’t have enough doctors to look after people, and we know that those people are getting more and more unwell. As a result, they’re unable to work, they’re unable to provide for the economy. In fact, a huge amount of income to the government is being lost because of that. It’s fiscally irresponsible not to have an appropriate workforce that’s able to deliver that. That’s not even just the BMA saying that; there are other institutions which have suggested that the lost revenue from rising long-term sicknesses is as high as 70 billion pounds plus over the next ten to fifteen years. Investing in health is a fiscal multiplier. 

This year we’ve heard countless times from Rishi Sunak and other people within his government that they cannot afford to give pay uplifts of x percent because it will lead to a wage spiral inflation. That concept was refuted by basically any credible economist, but they still stuck to it. This makes me doubt whether people in government are the right people to make fiscal decisions. It’s fiscally irresponsible not to invest in your workforce if they’re the ones that are going to be bringing in more revenue in the long run. 

TA | What is the mood like amongst junior doctors? Often, with long-running dispute, fatigue and disillusionment can set in. What have you been hearing from the members? 

RL | For quite a long time, doctors have been sold the pipe dream that things will get better tomorrow, and they’ve woken up to the fact that they’ve been lied to for many years. The beginning of the industrial campaign was a new experience, which, as with all new experiences, gives people a lot of energy and over time, it’s a bit of a roller coaster effect. You have your ups and downs and you’ve got those big swings in people’s emotional states. And that volatility in people’s emotional states can lead to panic or fear of missing out or fatigue or burnout in their morale and their hope for a better future. But doctors have shown themselves to be incredibly resilient, particularly coming from a background of little industrial experience in industrial disputes. And there’s now a collective belief and understanding that this is not an exercise in instant gratification. This is a necessary dispute and campaign that needs a victory in order to defend the profession. 

TA | I recall nurses and doctors standing with striking railway workers at King’s Cross and Euston last year. RMT General Secretary Mick Lynch has spoken at two of your rallies and the BMA council made a solidarity donation to the RMT union. With many disputes now settled, are you still getting support from the wider trade union movement? 

VT | Just from personal experience, we had members from UNISON and other unions join us on the picket lines yesterday. And we frequently have conversations with other unions at regional levels, even at local levels, in workplaces, and with our other colleagues in hospitals who are members of the Royal College of Nursing, Unison, Unite and other unions. 

Workers know that, especially more recently, we’re all effectively being treated the same way. We’re all being taken advantage of because, especially in the public sector, workers have given and expended goodwill for so long that our employers will just continue to take advantage in the hopes that will go on forever. But that isn’t sustainable. And workers know that. They are the backbone of any profession, and actually knowing their worth and standing up for it is the only way for that profession to thrive. Otherwise, workers will move to other places. And I don’t think that is a future that anybody wants. We should all be aiming for a future where people are respected and recognised for the efforts and time that people put into whatever they do. 

RL | We’ve been really lucky to have people like Mick Lynch come and speak to our members and our consultant colleagues as well. The balance of play is always between employer and employee. And I think people who think of themselves as better than other types of workers fundamentally miss the point and they are being distracted by pride or some other illogical, irrational emotion. We need to recognise that actually, the balance of power is always in favour of the employer until you have a legal mandate to withdraw your labour, because it’s only at that point that you can actually demonstrate how much value you bring. So I think it’s really important that other sectors, other unions, other workers, they don’t focus in on the fact that we’ve not settled for similar amounts or less. 

I think everyone should be looking at principles and logical bases and justifications for pay disputes and claims. And I think pay restoration is such a powerful argument that I’d encourage all other workers to fight for pay restoration. Nurses deserve it. People in retail definitely deserve it. Firefighters, teachers, everyone deserves pay restoration. And if we think about pay restoration in terms of what it means for other people, go back to 2008, it probably means fewer billionaires, it probably means better wealth distribution. And actually, at the end of the day, it probably means the restoration of our public services and everything that makes our country great, which is why it’s a scary message for this government and it’s why they’re putting up such a big fight against us. 

About the Author

Dr Vivek Trivedi is co-chair of the British Medical Association (BMA) Junior Doctors Committee.

Doctor Rob Laurenson is the co-chair of the British Medical Association's junior doctors committee.

About the Interviewer

Taj Ali is the editor of Tribune.