Easter 2023 is likely to be remembered for a long time in the NHS. Straight after a four-day bank holiday weekend, with many senior doctors already on leave, the BMA called junior doctor members in England out on a 96-hour total strike, without exempting emergency cover other than for major incidents. Their aim? A 35 per cent pay increase for junior doctors. Not a ‘pay rise’, they are careful to say, but ‘pay restoration’ – clawing back what they calculate has been lost during 15 years of below-inflation pay rises for junior doctors.
It is certainly a high-stakes gamble. Especially when public sector finances are immensely stretched, and everyone is in the midst of a cost-of-living crisis. In recent months, many other professions have also taken part in strike action. However, other lower-paid public sector workers are asking for, and settling for, significantly less ambitious pay awards than junior doctors. Rail workers agreed to a nine per cent pay deal, and the Royal College of Nursing is encouraging their members to approve a five per cent deal with some one-off extras. Criminal barristers agreed to a 15 per cent pay deal to end their strike.
Against this backdrop, the BMA’s demands for a vastly bigger pay increase and the more extreme action they are taking seem increasingly jarring. Yes, there are some factors that have meant real-term losses for junior doctors exceed some other groups, but real-term losses for nurses are not far behind.
BMA junior doctor members voted overwhelmingly to support strike action, giving a very strong mandate for the BMA to act. However, the details of the current strikes subsequently agreed by BMA leaders were not in the original ballot.
There is much understandable frustration and anger amongst junior doctors over pay and working conditions. Many juniors are choosing to work outside the NHS or outside the UK, compounding the challenges for those who are left.
Something needs doing, but is this it?
There is no doubt that leadership is required, both from the BMA and the government. Few would suggest that junior doctors shouldn’t get a fair pay deal, and that working conditions and morale shouldn’t be addressed through systems change. There are huge challenges in the NHS, leading Amanda Pritchard, the Chief Executive of NHS England, to describe the NHS as ‘under extreme pressure “like nothing I have ever experienced” in her 25 years in the health service’.
The BMA surveyed thousands of junior doctors in late 2022. 99 per cent were worried about the effects of the rising cost of living, and 79 per cent often thought about leaving the NHS. When asked why they were thinking of leaving:
85 per cent said ‘Level of current pay’
83 per cent said ‘Deteriorating working conditions’
83 per cent said ‘Pay erosion since 2008/9’
70 per cent said ‘Worsening personal wellbeing’
61 per cent said ‘Worsening culture of workplace’
Ultimately, the survey revealed a deep dissatisfaction with working in the NHS with which many of us are familiar. And whilst pay was a significant issue for many, working conditions clearly play a significant role in the disquiet too.
So, is a 35 per cent wage increase for junior doctors the answer? And is it credible, affordable, or reasonable? Some may say it’s merely an initial bargaining position; but as the whole campaign hinges around ‘full pay restoration’, anything less would sound like capitulation. I have not heard any other union calculating or advocating for ‘full pay restoration’ for bus drivers, teachers, nurses, or physios – only the BMA, for doctors. Even the BMA’s own calculations suggest that granting their request would cost a billion pounds. Does anyone seriously think that if any government decided to invest an extra billion into the NHS now, that it should all go on paying junior doctors?
I’ve also been struck by the dichotomy in BMA rhetoric. Much of their coverage talks about the challenges of the day-to-day lives of real junior doctors – the understaffed rotas, the exhaustion, the weight of responsibility, and the huge debts racked up at medical school. These struggles are real, and we need to listen and understand. It has always been hard to be a junior doctor, and there are multiple reasons why it’s particularly hard now.
However, the BMA’s campaign goal focuses on ‘full pay restoration’ in England as the key to solving the other issues by improving recruitment and retention. That seems simplistic, to say the least. Pay is certainly one important issue that needs addressing. Junior doctors are a highly mobile workforce, and their employers must factor in their ability to ‘up sticks and move’ into private healthcare or overseas if pay and conditions are significantly worse in the NHS than elsewhere. But implying a binary choice between doing nothing or raising pay by 35 per cent seriously strains credulity.
Polling released at the onset of the strike indicates that 54 per cent of the public support the strikes, and that 49 per cent believe that junior doctors are not paid enough. But the survey doesn’t ask whether the BMA’s detailed demands are reasonable. Furthermore, less than a third were able to identify what a first-year junior doctor is actually paid.
What’s going on at the BMA?
Most of the public has little idea of the transformation that has occurred in the BMA leadership over the last year. Much as when the hard-left Momentum movement infiltrated the Labour Party some years ago, a similar group of militant junior doctors has organised and mobilised, essentially taking over the leadership of the BMA from within through democratic means. Many of the BMA Council have come to power through this movement. This helps to explain the significant increase in the militancy of BMA demands since this change of leadership.
Strong action by BMA junior doctors is publicly supported by BMA consultants, despite the impact on seniors of this week’s crippling strikes. But this is easier to understand when we realise that BMA consultants are also in their own pay and pension negotiations and are looking for significant improvements in their terms and conditions. If the government does not meet the BMA’s demands for restoring consultants’ pay and reforming the current pay review body, the BMA will ballot consultants in England for strike action from 15 May. This means that it is ultimately in the interests of BMA consultants to support hard-line action by juniors. It lays the ground for their own upcoming requests and establishes the BMA as a tough union to negotiate with. There is also a strong feeling amongst some BMA members that they did not push hard enough when junior doctors last took industrial action in 2015-2016 over the imposition of a new contract. This has contributed to a further hardening of attitudes amongst BMA leaders.
How should Christian juniors respond?
Christian junior doctors will find themselves in a very difficult position and ultimately will come to different conclusions about participation in the current strike action. They will be under no illusions that something needs to change, or that action needs to be taken. And yet they may understandably feel that the BMA’s demands are unrealistic or have concerns about the impact on patient care. Our 1st Incision podcast recently hosted an excellent discussion by two CMF juniors who teased out the various dilemmas very helpfully.
Employers and employees have mutual responsibilities to each other. Christians may often need to use legal and peaceful means of bringing about positive change within society. Industrial action may well form part of this package. However, when we do so, we must carefully consider the complex factors at work.
Ross Hendry, Chief Executive of CARE, previously worked for the trade union, Unison. He provides a helpful general framework for Christians to discern their response to different disputes, using seven questions:
- Does this action facilitate or impede our calling to work (for the Lord) in the long as well as the short term?
- What is the desired goal and who is served by it?
- How does my action demonstrate a love for my neighbour above a love for myself?
- Who is harmed and who is influenced by my actions?
- Am I acting or supporting actions simply to fit in?
- Will these actions cause me or others to sin?
- How is God honoured through these actions?
Each of these questions is highly applicable to the current junior doctors’ dispute, and whilst they do not give us an easy conclusion, they will help any Christian junior doctor think through how and in what spirit to act in the current campaign.
How can we pray? What else can we do?
If you’re a Christian junior doctor, please continue to give careful consideration and prayer to your ongoing response. Whether you have decided to take part or not is a matter of conscience, but so often the manner in which we decide, and how we communicate this to others, is crucial to how we act as ambassadors for Jesus in the workplace.
All of us can be praying for Christian juniors, that they would ‘act justly…love mercy…walk humbly’ and take opportunities for thoughtful discussion with others about the difficult and complex situation that juniors are seeking to resolve. Ask them how they are, let them know you’re praying for them, and ask how you can pray more specifically for them and their colleagues.
If you know a Christian junior who is not already part of CMF, please encourage them to join up, either as a full member or as a free Friend. Our mission to unite and equip Christian doctors and nurses to live and speak for Jesus has never been more needed!
Pray for patients whose care has been disrupted and who will face further frustration and suffering as a result of this week’s action. Pray that the current conflicts will lead to longer-term solutions that will make our overstretched NHS fit for purpose for the coming years.
Pray for all other healthcare workers who are affected by this week’s strikes. The knock-on effects and mental health strains on colleagues will be massive, as appointments are rearranged, people work outside their usual roles and core competencies to cover gaps, and staff in all roles seek to respond to patients’ stresses and suffering.
Pray for those in Government who are considering the BMA’s requests. Pray that they would act constructively, seek a fair resolution, and address the wider challenges within NHS workplaces as well as direct questions of pay. Pray that they would listen attentively, sifting through what BMA leaders are saying to hear the real voices of juniors and that they would be both courageous and creative.
Pray for those in NHS leadership – for great wisdom in planning around the strikes, to preserve as many NHS services as possible, to protect patients, and to support other staff groups who are under ever greater strain as a result of the strikes.
Pray for BMA leaders and negotiators, that they would make reasonable demands and seek constructive dialogue. Pray that they would avoid further, damaging escalation of the current dispute and that any who are seeking to capitalise cynically on the current situation to further their own ends would be humbled.
What are you worth?
Ultimately, much of the current situation comes down to questions of value and worth. The BMA’s campaign, so closely focused on ‘pay restoration’, implies that ‘you are worth what you are currently paid’. Quite simply, less pay = less worth.
The closely related questions of poor working conditions and workplace culture also have a huge impact on how people feel valued by those in authority – as revealed in the BMA’s recent survey.
Of course, for Christians in the NHS, these issues of pay and conditions are very important – for them and for others. There are often genuine questions of justice and fairness bound up in the complexities.
However, the ultimate question of ‘what are you worth?’ looks very different when we realise we are made in God’s image, called to be his disciples, saved by his grace, and tasked to be his hands and feet to serve a broken world. He may call us to negotiate on behalf of colleagues, to advocate for patients, or to build bridges with those of opposing views when others seem content to burn those bridges.
We’ve just gone through Easter when Christians all over the world remember the death and resurrection of Jesus. His incredible sacrifice is not only the act that transforms our eternities, but the one that shows us our true value.
We might well imagine that when asked what each of us is truly worth, Jesus stretched out his arms wide upon the cross, and said, ‘This much.’
Further Resources from CMF:
The following articles are from the last round of junior doctor strikes in 2015/16: