The recent junior doctor strike was significant, not just for doctors, but for all NHS workers. We spoke to a colleague and union rep about his experiences and reflections. If you have taken part in the strike, feel free to send us your own impressions and comments. Regarding the wider NHS pay round we refer you to this previous article on the role of the current government.
I went to medical school in the northwest of England and then came down to London almost three years ago to start my official doctor training (the foundation years) Now I’m about to start surgical training. Currently, I’m a local representative of the BMA for the junior doctors.
During the strike in 2015 I was still a student, but I did go to the pickets. I definitely understood the gravity of it at the time. It was the first doctor strike in years, I think since the 70s or 80s. It definitely wasn’t like the strikes in the last couple of years. There were a lot fewer people on the pickets. It didn’t seem as politically oriented. It was very siloed and junior doctor specific, not too much solidarity from the rest of the workforce. I remember as well that there were several strikes, several rounds, and towards the end there was a lot of dissatisfaction and a lot of drop out from the doctors. It kind of all fizzled out, which is very different this time. A lot of what motivated the current strike action was based on reflection from those years.
Doctor’s Vote
There’s a group within the BMA, they’re called Doctors Vote. Right. They’re effectively like a campaign group, a bit like Momentum within the Labour Party (although they wouldn’t like that comparison). They were basically campaigning on a pay restoration policy. Focusing on what happened in 2015 and the question of what we could do differently this time. I think one of their assessments was that there wasn’t enough preparation and planning, and they also they felt like the BMA wasn’t run by the members enough. It was run too much by a very small group of members and there wasn’t enough grassroots involvement.
Their pitch to the membership was if you vote for us within the BMA, we will deliver a strike mandate and we will try to get this pay restoration mandate. I’m not actually a member, partly because I don’t agree with a lot of what they have been doing recently. As far as I understand, they basically formed on Reddit, on a Reddit page called All Junior Doctors. On that page there was a lot of anger about various other issues that they felt that the BMA were not addressing. I think they formed fairly organically within that Reddit forum. So they had a few good organisers, who maybe had been involved with stuff before in the BMA, and they decided to form this network and this organization. It has now morphed into more of an official grouping. You can become a rep for them and that’s a separate thing from being a BMA representative. There is a Doctor’s Vote representative, the point of which is to spread their ideas and their policies within the BMA. They have various processes of how they decide about things. They themselves have a committee as well.
There is another group in the BMA which I’m part of which is called the Broad Left, which is a left wing group alliance, like Doctors’ Vote, but going for policies that are left-adjacent within the BMA. One policy of the Broad Left was to promote the BMA joining the TUC. Sadly we had a majority on this vote but it required a set majority which we didn’t achieve.
At the moment we’re organising a lot on Palestine.
Originally we were one of the only groups arguing for a pay increase and to achieve that through a strike but with the growth of Doctors’ Vote, the Broad Left is now sidelined. Doctors vote and other members of the BMA have a valid criticism of the Broad Left which is something like: “Nice ideas, but not really doing anything.” or if they are being more hostile, “bad ideas and they don’t do anything”. However, Doctors’ Vote managed to grow help from the Broad Left. A lot of broad left members are historical members of the BMA who’ve been in positions of leadership, this is often where the criticism comes from.
My problem with Doctors’ Vote is that obviously they were a single issue campaign initially. There are a lot of other things that were driving the anger, but they decided to focus on the pay restoration as a key issue. Once they got in to positions of leadership they were extremely effective and I have admired their success. They managed to get us out with a huge strike mandate. I mean, one of the highest I can remember. The original one was I think it was like 98% approval. And I think something like 77% of the junior doctors that could vote did vote. Only the RMT or CWU would get that kind of turnout.
I think some of the discontent from the rest of the membership is just that they have formed a bit of a clique. I don’t want to say that they have totally, because they still involve quite a lot of the members in the decision making, but there is definitely a very specific group of people that are now pushing the ideas about what decisions should be made and what policies are next up. I find that a bit too totalising, not totalitarian, just totalising.
They communicate mainly through WhatsApp. One of the big factors we’ve had in this strike wave is using WhatsApp. I think almost every single doctor in the country is in a WhatsApp group, specifically just for the strike, for each of the hospitals. And then these are then fed into bigger WhatsApp groups where they send out notifications whenever anything happens to do with the strikes or when a new strike is announced or a deal is being organised with the government. Everything goes out through these WhatsApp channels. Everybody knows basically straight away what’s going on. Which is, I think, a fantastic organising method.
The current strikes
When it comes to the current strikes, you have to break it down into the different regions of the UK. So the only region now that’s still in an industrial dispute with the government is England. Wales and Scotland have both now been offered deals. Northern Ireland is actually still in dispute as well.
I think this wave of strikes with the doctors has been quite different from the previous one. There has been a lot more solidarity. I think most junior doctors have been on board with the strikes and even, to my surprise, a lot of consultants as well, who historically have been less likely to support or strike themselves. I think this makes sense from a material perspective because consultants are almost management in a way and so have a bit of a more vested interested in the general running of clinical services.
The strikes are about the principle of pay restoration, which is that we should be paid the same as we were in 2010, which equates to about a 35% increase. Almost everyone was out, really. I barely saw anybody go in and I was on the picket lines every time.
The people who I saw go in for the first two days had such an awful time. They basically went in to work and all the consultants who were there to cover the gaps just said: “Well, you can get on with the jobs now.” Which is a terrible day for a junior doctor. So most of those people who had to cover for the strikers just decided: “I’m not going to do that.” They came out on strike. Since then I think the commitment has been waning. We have some statistics from east London, in some Trusts only 50% of junior doctors were on strike, whereas in my Trust, for example, it was still something like 80 or 90%. So regionally, there’s been a lot of variation.
There are agreements about how to determine what levels of staffing there should be during industrial action. The principle of the BMA was that we will withdraw all of our labour, so you have to assume that we are going to withdraw every junior doctor and you have to plan accordingly. So then the gaps will be filled by the consultants and those other types of doctor as well, called specialist doctors. They then would pay them usually very good rates, in order to get them there – to the point where actually the cost of the strikes for the government has been more than it would have been to pay us our demanded pay increase. I think it’s 2 billion or something. They’ve already paid more than that through cancelled surgeries or even just through payments for locum doctors.
There was only one place where the BMA agreed to the derogation, and the doctors went in during the strike and what they found was the staffing levels were fine. And so they just went back out on strike again.
It’s slightly difficult to say how the strike impacted on day-to-day work in the hospital, because I’ve been on strike every day. So, I’ve never actually been in the hospital when it’s happening. The biggest impact was on theatres. So a lot of operations are cancelled. And also clinics as well, which is what most of the consultants do. I think in terms of the day to day running of, for example, A&E or the wards actually that wasn’t much different from normal days. And in some cases people have said that things actually ran a little bit better because the consultants are so experienced. Unlike the junior doctor they can just say: “This person can go home. We don’t need to do this test and stuff.” They are quicker in their judgement. So I think in terms of safety it actually wasn’t any different. In terms of whether you got your appointment cancelled or your operation cancelled, that’s were the strike definitely had an impact. The BMA has been pretty clear on that. It’s not necessarily our intention to cause that problem, but that is where the money is for the hospital. It’s not in acute care.
When it comes to management’s response that varies from Trust to Trust. I worked in two hospitals during the time that the strikes were going on. In both hospitals I found that the management were really supportive, which is surprising. But they encouraged us to strike if we wanted to. They said: “If that’s what you want to do, you’re welcome to do it. We will support you in doing that, in the sense that we will try to fill the gaps.” I think they wanted to develop a sort of relationship between us as the doctors and them as management, where they’re saying that this is not a local issue. This is a national issue. And I think the BMA were quite happy to go along with that as well, because it is true, really. On this particular issue of pay it’s not the Trusts that are causing the issue. They’re not determining the pay of individual doctors. That’s determined at the national level. Yeah. So us striking is not a vote against management or about how the Trust is run. So I think it really was a good move from them to decide: “Okay, we agree with that. We’re going to support them in doing this the best we can.” I found that almost everybody agreed with us. For example, I didn’t meet a single nurse that was angry. In general there was a lot of solidarity from the nurses, but once the nurses settled their pay dispute and we continued, there was a bit of discontent like: “Well, we’ve settled now. Why do you think you’re better than us?” I don’t think we are better than nurses. I think nurses should be paid infinitely more and, if anything, the same, to be honest. I understand why they were miffed and there a lot of complex reasons why the RCN didn’t hold out on their strikes, chiefly nurses have a smaller pool of capital to dip into to sustain a strike.
I think on a national level things were a bit different. There was the narrative of the BMA that I agree with, which is that we don’t have a choice at this point. We’ve tried very hard to argue for our pay to be increased. We have this body that recommends to the government how much of a pay increase we should have each year (DDRB). They’ve given a pay increase that the government disagreed with. So the government didn’t even do what their own independent body wanted. So therefore we’ve explored all the routes we can. This is the final route we have. It’s industrial action. That’s what we can do. I think at the national level, the management of the NHS, they were pitching the strike more as a sort of equal battle. There’s the government on one side, there’s a junior doctors on this side, and they’re both equally to blame in this situation. I think in some cases they were saying that the doctors are really the ones who are more to blame because they’ve decided to strike.
When it comes to the organisation of the strike and whether it brought people together, well, a lot of it was organised online, through WhatsApp, in terms of information, for example, when is the strike going to be, how are we going to have the strikes, etc.. But right at the beginning, there was one sort of thing that I think was critical, which is that we had huge demonstrations across the UK, one in Manchester, I think Birmingham, Newcastle and London. There was one particularly big one where we bussed in loads of people from the rest of the country, and it was massive. I remember seeing people that I went to medical school with who live far up in Cumbria or north of England. Afterwards it was so cool because everyone just hung out. Everyone. We basically just filled the streets around Westminster. It was just full of striking doctors. Yeah, it was a really powerful moment. I think. Sometimes local pickets were called off in order to allow people to go to the demos. And sometimes pickets were called off from the top, because they thought people were tired. But we had no problems just organising our pickets anyway.
On the pickets themselves, things were much more variable. I think if you had some sort of political alignment, if you call yourself a socialist or you’re in the Labor Party or Green Party, you’re probably much more likely to turn up to the picket. You understand the utility of a picket and the symbolism of it. At our hospital we had figures like 40, 50 doctors on the picket, which is quite a lot of. It’s not all of them, but quite significant. We had consultants visiting who gave us food and drinks. Or just random people, or patients, they all came and said that they supported us. Just fantastic. I only had a few people that wanted an argument or said something nasty. In general the pickets were more of a show of force, rather than a space for collective debate about the strike itself. The striking colleagues enjoyed it, played music, chatted about random stuff, and a little bit about the strike. There was some exchange about the strike, about ideas and organising, but mostly from people who already have a background in organising. This has been my criticism of the whole strike system, which is that we didn’t capitalise on the initial enthusiasm and try and think about how we could make these pickets themselves actually useful politically and also just organising-wise collectively. At our pickets I’ve tried my best to get other union members to come along. We had the RMT, CWU, PCS, RCN, Unison, GMB, all public service unions. We also bring patients along too. Sometimes they will reach out to me and they’ll say: “I want to come and say something.” We had a RMT guy come and speak, he almost died a year ago and went to ICU at our hospital. So he came and did a speech and it was amazing, I mean, everyone was crying.
A fellow rep and I organised some teach-outs of the Royal London Hospital, they were quite cool. We had various organisations come and chat to us, other unions. There were groups like Docs not Cops, they came to talk. There were various local issue and national issues, but we also had union talks. So, what is a union? How can you be involved in the union? What do you want out of the union? We did get quite a lot of attendance. And people enjoyed them. We did some around housing, as well, but that dropped off. Less people started coming. I think the problem is because it’s a single issue strike. There were also quite a lot of people who were striking, but they wanted to just use that day for something other than a strike, they wanted a day off (and fair play to them).
The strike mobilised more people into national structures, such as Doctors’ Vote, but not into local branch structures. The problem with the BMA is that we don’t actually have a branch structure, really. There are structures on an area level rather than for local hospitals (called divisions). So if you’re a doctor living in a particular area, but you work somewhere else, you’ll actually be within your area branch, not your workplace branch. A lot of those doctors who attend are older doctors. A lot of them are retired, retired members of the union. These meetings are not advertised very well. Most members don’t even know they exist. So we didn’t see an increase in branch attendance because of the strike. We did try to do it personally. What I tried to do is have an alternative structure, basically just meetings with people who were coming to the pickets and local members. And effectively, that is just a branch meeting. And because I am the union rep, I can funnel some of what is said at these meetings into the meetings we have with management. Around 20 to 30 people come to these meetings, during the middle of the day, that’s not bad. I would tempt them with pizza. And these were on non-strike days. This also happened at other hospitals, but maybe not quite to the same organised level how we were doing it. These meetings happen once a month now, this is a regular thing now that we do.
I think Doctors’ Vote does a lot of good, but one of my main critiques is that the grassroots involvement in the strike has been limited. There’s been surveys sent out, there’s been questionnaires sent out, which is good, but there wasn’t really an engagement with what’s happening on the ground. What are your members saying? Are they saying they’re tired? They don’t want to strike? They want to continue?
People were way more militant than I expected. I was actually becoming the moderate one in some senses, because I was saying: “Well, I think people are a bit tired. Maybe we should have a bit more of a break. They need to save money, etc..” And some of the members were coming to me and saying: “We just need an indefinite strike. Let’s just do it now. These three day, four day, five day strikes, they don’t work.”
One of the good things about being a BMA rep at a local level is that you do actually have quite a lot of independence. I very rarely have to talk to anyone higher up, to get anything done. I just do it. I just do it myself locally.
That’s another thing that I found really good about the recent strike wave, but also in the BMA specifically. People who I know and who are probably Tories, or definitely not left wing at all, they’re really pro-union now because of the strike. They’ve come out believing unions are good and useful, which I think beforehand people didn’t think, especially about the BMA. It had a really bad reputation for just being a waste of time. People used to join the BMA because they wanted to move up the career ladder into management. The perception of the BMA as a fighting union has changed. If you look at the offer from Labour we just received, it shows the fight we put up has worked.
Relationships between doctors and other workers
I think the relationships between doctors improved through the strike. I think it gave us a cause, a reason to organise together. It gave us a reason to think about each other’s lives and how we all chose to do this profession, and it’s a good profession. We talked about how we’ve been treated and how things have changed a lot. I think the younger you are, the earlier into your career you are, that’s where the most militancy is. During F1, F2, in the early stages of specialty training. That’s where the most solidarity and union unity was. I think it’s because of two things. One is that you are earlier into your career. So your commitments to management or your commitments to higher level planning is not as developed. You are just a worker. You’re doing what you’re told. You have some level of independence, but it’s quite small. You don’t really make any management decisions or clinical service decisions. As you go up the chain, you get more senior you start being involved with thinking about the hospital as a whole, I’m thinking about patient care as a whole. I think it probably changes how you view a strike or how you view certain issues around pay, and also you get a bit jaded, as well. You get a bit worn down by the system. The other thing is that junior doctors who are now coming in have been screwed over a lot more than the doctors who are now consultants, and also some of the ones who are about to be consultants. Most consultants now will have come through medical school when they didn’t have to pay for their fees. So they don’t have any student debt whatsoever. My student debt is about £85,000 and it will never be paid off, but I still pay a significant amount every month to that loan. That’s a factor that a lot of consultants and most senior doctors don’t have. Consultants have lost a lot of their pay, too, but over time, they will have invested in things. They’ve probably got a house for example.
I don’t want to create this division, but there is a slight division, it’s just a material division. I think materially speaking, junior doctors have less to lose and more to gain, and that’s basically why they’re more committed. Also the recent student experience creates a bit of a bond. You’ve just been a student and had all the issues of being a student and also the camaraderie of being a student as well. And it does extend on a little bit. Part of the issue with our training is that we rotate every four months initially, and then later every six months. That can be between wards or between whole hospitals or sometimes even whole regions. So any possibility of developing relationships or solidarity beyond doctors or even within doctors is very difficult. That’s why I think it’s nice that this issue is so universal and that you can organise around it and everyone gets the idea. And they want to work with you straight away.
About the question whether there were missed chances of linking up strikes of junior doctors, nurses, paramedics and so on, I mean it would be pretty devastating for health care if all of them did strike at the same time. I think the various unions did not want this optic. They wanted to present the idea that: “We’ve been pushed to this position. This is the final straw. We don’t want to cause trouble. We just want our money.”
We support the nurses. But if we were to strike with them, it would look too bad. But it’s also a legacy of Thatcherism and the various governments since then. They have gotten rid of all of our ability to have any type of solidarity strike or even coordinated strikes. Now it looks like a professional group is fighting for their own interests, whereas it could be more like: “We are all health workers. We all have bills to pay”. I don’t think this is the Doctors’ Vote position or the BMA leadership position. It’s kind of the opposite. They want us to make a distinction between us and the rest, the nurses. “They can do what they want and we support them in doing what they want to do. But it’s not coordinated.” It also goes back to the fact that the BMA is not just a union, it’s also an association. They do like golf meetups and stuff.
Doctors do have a bit of a superiority complex just in general. I think we should just recognize our importance as a worker, instead. We provide a skill that barely anyone else can provide, really, which is evident from our strikes. But I think all healthcare workers can say the same thing. I personally think we should link up. The better everyone’s pay and conditions are in the NHS, the better it is for everybody. Including the workers and everyone else who uses the NHS.
I didn’t experience the impact of the nurses’ strikes, as in the hospital where I was working the nurses didn’t reach their strike mandate. I don’t actually know what that was like on the ground. I did go along to pickets at other hospitals though, to show support.
When it comes to day-to-day work there is quite a bit of overlap between the work of doctors and nurses, which would support such a joined struggle. I’m a surgeon, so I have a lot of interaction with the nurses, members of the team. At our hospital there is a quite unique atmosphere of working together closely. I’m friends with lots of therapists, nurses, midwives. I don’t think that really happens in a lot of the hospitals. In a day to day situation you do a ward round where doctors go around all the patients. I usually talk to the individual nurse on that day, about most of the patients. They tell me what’s been going on. I tell them what we like to do today. I talk to therapists about who we’d like them to see. I mean, a lot of the time doctors are just giving orders. That’s true. I talk to the HCAs, as well, because a lot of the time they have these small interactions with patients that bring things out that you didn’t know and you didn’t see. I think we do have a huge overlap, but you’re right, doctors will sort of artificially, deliberately, but also organically remove themselves.
I think sometimes there’s a misunderstanding about doctors that we’re disappearing because we don’t care or we just want to go do something else. But a lot of the time, especially for the lower level of doctors, our daily tasks have to be done on a computer. You need quite a bit of concentration because you’re writing notes and you’re prescribing medications that need to be done correctly. So often we need to isolate ourselves for a little bit so that we can get all that stuff done. But when it comes to communication, doctors too often rely on written or digital communication – they should actually listen and talk to the nurses, then it is also more likely that the work gets done.
My general problem with healthcare workers is that there’s too much animosity between people. I think most of the reason for that is it’s a high stress environment. There’s a lot of responsibility for everybody and especially nurses and basically anyone that isn’t a doctor. There’s such a low threshold for a mistake that could cost you your pin. I think this is something doctors need to know, how easy it is for a nurse to be struck off or have an investigation. I think we should all try to be a bit more understanding with each other. Doctors need to do that separately more than anybody. That would help with solidarity between us. It can go both ways: if we support each other when strikes are happening, maybe we’ll work together better when we’re working and vice versa.
The current moment
Labour have just been elected and to be fair to them they have put their money where their mouth is and offered us a deal very quickly. However, in order to have the deal, our leadership had to agree to endorse the deal and put it as a vote to our members. It is definitely not full pay restoration and it doesn’t even commit to the principle of this full pay restoration (unlike the Scottish and Welsh deals). However, it also contains some non-pay aspects such as a commitment to look into changing the rotational nature of our training (where we have to move around the country a lot to progress in our career). In contrast to the other deals we had been offered before, this deal also applies to locally employed doctors (doctors who are not in a formal training post), which includes many internationally trained doctors who work in the NHS.
I won’t say my opinion on this deal for now because our members are voting on it currently. All I will say is that the deal is good but clearly not pay restoration, which was our intended goal at the start of these strikes.
On a final note, I have seen that the current TUC president Matt Wrack has set out a new campaign for pay restoration for all public sector workers. I think this shows the influence we have had in the wider union movement. We may feel we are separate from other unions but thanks to our new found militancy we hopefully are helping other workers find their worth. We will see what happens with vote on this deal but I believe a fire has been lit amongst junior doctors that can’t be so easily put out.
