Offline: Should doctors strike?

Abstract

If you think Liz Truss had a tough first few weeks as the UK's Prime Minister, spare a thought for Dr Sarah Clarke, the new President of England's Royal College of Physicians (RCP). She assumes her role as trainee doctors consider taking industrial action over pay. Clarke gave an interview to The Times newspaper last month in which, when asked about the threat of industrial action, she said: “I don't agree that strike action is the right route to go because you're talking about patients here and you are talking about impacting on patient care.” Trainees, including the College's own fellows and members, erupted with anger. Clarke was “tone deaf” to the “economic hardships” of younger colleagues. “Doesn't care, no empathy.” “Not my President.” “Pack your bags and go.” The British Medical Association (BMA) published an excoriating letter, calling on her to apologise and to join colleagues “as they take a stand against the continued erosion of the NHS, its workforce, and the pay and conditions of doctors”. Clarke issued a statement making clear that she supported the right of doctors to strike—“the fact that patient safety is already compromised by staffing levels may be a reason to take action for some”, she said. She later offered “a heartfelt apology” for her earlier remarks. Although Clarke suggested she had been misrepresented in The Times article, she admitted that her interview was “not the start I would have wished for my presidency”. Industrial action by trainee doctors in England is highly likely. Their central argument is that the income of a trainee is now 26% less in real terms than it was in 2008. Liz Truss and her new Secretary of State for Health and Social Care, Thérèse Coffey, failed to respond to a BMA call to commit to full pay restoration. A ballot of trainees will take place in January, 2023. The BMA has established a strike fund. But industrial action is fraught with danger. Trainees last went on strike in 2016. Health care was significantly disrupted. The UK Government did not buckle. And while a majority of the public originally backed industrial action, support fell as strikes continued. It took a further 3 years of protracted negotiations before the dispute was finally settled. The conditions for success today are even less propitious. Britain's economy remains weak. The National Health Service (NHS) faces a workforce recruitment and retention crisis. A perilous economic growth strategy being implemented by the current government will leave scarce resources for trainee salaries. If industrial action does take place, a dangerous confrontation between the government and doctors is certain. The strategy for trainees must therefore be to build a united profession. Division will only stiffen the resistance of ministers. The rift between the BMA and RCP must be healed quickly. Despite Clarke's Times interview, she is a strong supporter of trainees, writing in the RCP's October Commentary that she will make sure the College “understands and raises the issues that matter to them in our influencing work. They are medicine's future and I look forward to working with them.” The role of the Royal Colleges will be key to the success of any strike. It will not be enough for presidents to say they support fair pay for trainees. They must explicitly back strike action. The UK Government must be given no room for misunderstanding the seriousness of the profession's resolve. Ministers should also understand that this dispute is only partly about money. It is also, and more importantly, about valuing the contribution that trainees make to patient care. There is no other profession today where new graduates are treated as badly as doctors. Trainees are seen as mere cogs in the machine of the NHS. Their feelings of disillusionment, even despair, are real. The government may claim that a doctor's duty of care to patients overrides their legal right to strike. Deploying such an argument would be a grave political error. Industrial action by doctors is rare. As one senior medical leader said to me: “when doctors strike it should be seen as a critical incident warning of system failure”. The NHS cannot thrive when trainees are burnt out, demotivated, and taken for granted. The threat of industrial action should be seen as a signal of a health service under intolerable stress. Ministers have an opportunity to avert a preventable calamity. They should seize it.