What do the resident doctors really think they will achieve with another round of strikes over their pay? They can’t really believe the public will stay with them on this, given they were awarded a 22 per cent raise over two years just last summer.
The British Medical Association is arguing that doctors’ pay has been eroded by 29 per cent in real terms since 2008, and that they won’t accept anything less. The union this week announced that resident (formerly junior) doctors will walk out for five consecutive days from 7am on 25 July.
The way ministers are framing the decision to strike again underlines that they believe public opinion has finally curdled. Health Secretary Wes Streeting has described the industrial action as “unreasonable”, and warned that “we all know that the NHS is still hanging by a thread, and that the BMA is threatening to pull it”.
Now, he has offered to look at making doctors’ pensions “slightly less generous” so that they can have higher pay now. It’s a smart move because it highlights another perk of the job for doctors, which is their pension arrangements, and makes the BMA look even more unreasonable if it refuses to entertain the possibility while continuing striking.
square DR JONATHAN ILIFF I’m a doctor and the BMA doesn’t speak for me
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The BMA has always overplayed its hand in negotiations over pay: whether in the 2015 junior doctor walkouts that collapsed after leaked messages revealed members of its junior doctor committee admitting privately that the dispute was about money, not safety, as they had publicly claimed; or in the 1970s, where it ended up being nicknamed the “British Money Association”. Or indeed in the bizarre language many of its members in the late 1940s used to compare the NHS and its founder Nye Bevan with Nazi Germany and Hitler.
The common themes in the BMA’s disputes are always an organising committee in the union that is far more militant than the membership (and in the case of junior doctor strikes, even the wider BMA), and a membership that feels disrespected and taken for granted by politicians.
Resident doctors will still trust the arguments of their union more than they will the rebuttals by ministers. They also spend a great deal of time with other doctors – partly because they work such long hours that they don’t have much space to socialise with anyone else, partly because medicine tends to run in families and across marriages, and partly because, frankly, it’s difficult for a civilian to get a word in edgeways in a conversation between a group of urologists.
This means that doctors are more likely not to notice the disapproval of non-medics, or to assume that they just don’t understand the arguments in favour of the pay rise. Initially, as public opinion turns against them, they might not appreciate what’s happening, before adopting a persecution complex, and then eventually understanding that their union may have done them a disservice once again.
This is the argument adopted by Sir Robert Winston, who has resigned from the BMA in protest at this latest round of strikes. His worry was that the strikes would affect the “sacred” doctor-patient relationship, and that his colleagues in the union “provide such a poor example to the many young people who aspire to become doctors of the future”.
Doubtless his warnings will be dismissed as those of an older doctor – Winston is 84 and has been a member of the BMA since 1964 – who has forgotten the importance of backing junior colleagues. He will likely get little satisfaction in a few months’ time from pointing out that he did try to warn those colleagues about the direction they were taking.
All that said, you can see the method in this particular stance taken by the BMA. They have watched this new government fall into a pattern of being adamant that it has the right policy and won’t change course, holding firm to that argument for some months as its political capital drains away, and then U-turning at the last minute when it becomes politically expedient to do so.
This has happened on benefits and grooming gangs: why not doctors’ pay too? The pay rise that ministers agreed last summer shortly after the new government was formed will also be a small factor in the BMA’s thinking, but less so than the wider pattern of holding out and then caving.
While the doctors’ pay demand might be unreasonable, they are also banking on ministers needing them politically as the means to drive down waiting lists and restore public faith in the NHS in time for the next election.
But what’s missing here is that public opinion isn’t currently moving towards the doctors, whereas ministers previously caved on other matters because they were taking a hammering. Once again, the BMA may discover that the public doesn’t always think the doctor knows best.
Isabel Hardman is assistant editor of The Spectator magazine
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