Dr Noshaba Khiljee is a Consultant Nephrologist and Physician at Dartford and Gravesham NHS Trust and was a parliamentary candidate in 2019.
The British Medical Association has announced that trainee doctors in England will have a complete walk out for 72 hours from 13-16 March in the ongoing dispute over pay.
The union said trainee doctors, who account for more than 40 per cent of the medical workforce, were “demoralised, angry and no longer willing to work for wages that have seen a real term decline of over 26 per cent in the past 15 years.”
The Conservatives rightfully clamped down on strikes following the 2015 election. But in the recent trainee doctor ballot, 98 per cent of trainees voted in favour of action, with nearly 40,000 doctors voting on a turnout of 77 per cent, soaring over the thresholds set in the Trade Union Act 2016.
The co-chairs of the BMA junior doctors’ committee stated that trainees had been left with “no option” after talks with the Government did not secure a resolution.
A strike will be difficult for ministers – but much worse for patients. A study published in the British Medical Journal after the strikes in 2016 found they:
“…had a ‘significant’ impact on the provision of healthcare, with thousands of appointments cancelled, and significantly fewer admissions and A&E attendances than expected.”
Compared to the weeks preceding and following the strikes, there were over nine per cent fewer admissions, nearly seven per cent fewer A&E attendances, and six per cent fewer outpatient appointments than expected; hospitals cancelled nearly 300,000 outpatient appointments, 52 per cent higher than expected.
The number of recorded deaths didn’t change significantly, and wasn’t higher than expected. But the study did not take into account whether patients health worsened as a result of delayed appointments and procedures.
Ultimately, the industrial action by trainee doctors had a significant impact. So, having learnt the lessons from 2016, is it right to strike? I don’t think so.
We are still trying to catch up following the pandemic. According to research from The King’s Fund, by March 2022 there were more than 300,000 people waiting more than a year for routine planned care, compared to only 1,600 people in February 2020.
In 2019, NHS trainee doctors had accepted a new contract which gave them an 8.2 per cent pay rise over four years in return for finally ending a four year-long dispute with ministers; 82 per cent) of those who voted on the new terms and conditions agreed to accept them.
Under the deal, the 39,000 doctors agreed to:
- a pay rise averaging two per cent for each of the next four years, starting in 2020.
- new limits on how much weekend working they do.
- new limits on the number of long shifts, of up to 13 hours, they can do in a row.
I and many others hoped that, after years of austerity, there would be space for a re-think on public sector pay, especially issues such as Annual Allowance Pension Taxation, which is severely affecting senior doctors.
But Rishi Sunak’s 2020 Budget was the start of a new era. The pandemic had a crippling effect on the national finances; the war in Ukraine then exposed the steep costs of relying on energy imports.
Ministers didn’t get every call right: the rush to buy PPE supplies as quickly as possible resulted in much that was unusable, wasting vast sums of money.
But it was an unprecedented situation – working in a hospital, I saw first-hand how people had to make difficult decisions under immense pressure. We were bound to get some things wrong.
Nonetheless, I did not feel the initial one per cent pay rise offered to NHS workers in 2021 was right. Many felt it was a slap in their face, considering they put their lives at risk day in and day out whilst others had the furlough scheme to pull them through the lockdown.
This was subsequently raised to three per cent, backdated to April, but maybe a better deal at a later stage could have been offered. After all, weren’t we all in it together?
This may have been the point when NHS workers felt enough is enough. Their good deeds had not been fully appreciated. All the clapping in the world wasn’t going to pay their bills or support them through the cost-of-living crisis.
The first-ever strike by NHS nurses has strong public support. According to a new YouGov poll, 66 per cent say they support it, with 45 per cent saying they strongly support it. Another poll found that 47 per cent were supportive of upcoming strike action by trainee doctors, compared to just 27 per cent opposed.
At the time of writing, the trainee doctors strike is going ahead, and many thousands of elective procedures and clinic appointments will be cancelled. Unlike almost all the strikes in 2016, emergency cover will also not be provided.
In my hospital, we have to cancel all our elective procedure and planned clinics. Emergency work and ring-fenced urgent procedures, such as cancer care, will take precedence.
As consultants we will be redeployed to provide the necessary cover on the wards and the emergency settings. In my case, working over three departments, I will be required to provide cover on the Acute Medical Unit, and High Dependency Unit, as well as help with the inpatient renal department.
On my day off work, I may even be asked to come in and help due to staff shortages.
Consultants may have to be resident out of normal working hours and then off the next day. Thus, when the trainee doctors return, their own senior team may not be available. Cancelled clinic lists and elective procedures will create further delays, potentially of 12 to 18 months.
Most importantly, we have been asked under strict instructions not to enquire if trainee doctors will be on strike, as it may interpreted as pressurising them not to. Therefore, we are not able to fully plan for our workforce quotas.
Locum agencies will profit by hyper-inflating their rates, with available doctors going to the highest-bidding NHS trust!
I have worked in NHS hospitals for more than 20 years, and I believe it’s true value is reflected by its clinical workforce. They are unhappy with years of pay erosion, and paying additional taxes for saving a pension.
Without clinical staff always going the extra (unpaid) mile things would have deteriorated faster, and sooner. This has always been considered an unspoken part of the job. However, it is clear to me that the workforce is exhausted and fed up – to the extent that some literally don’t care about the NHS anymore.
However, because of the significant impact on patients, striking should be an action of last resort, and I don’t believe we are at that point yet.
Instead, we should be working together to get the change we need, focusing on the local level. We shouldn’t take on extra work if the renumeration undervalues us. If shifts overrun, we should seek financial compensation.
There would be an impact on waiting lists and appointments, but not to the extent of an all-out strike, and would encourage negotiations at a local level. The Government has given trusts a lot of money to catch up with the Covid backlog, and trusts have great discretion in how it is spent.
Bringing down waiting lists is one of Sunak’s five pledges. The Government saw a surprise £5.4bn surplus in its finances in January 2023, despite substantial spending to help with energy bills and EU payments. This creates room for manoeuvre.
Striking should be an action of the absolute last resort by the workforce and their unions.
But to avoid it, the Government must also recognise the impact austerity and the pandemic has had on demoralised healthcare workers and engage with public sector pay claims.
Dr Noshaba Khiljee is a Consultant Nephrologist and Physician at Dartford and Gravesham NHS Trust and was a parliamentary candidate in 2019.
The British Medical Association has announced that trainee doctors in England will have a complete walk out for 72 hours from 13-16 March in the ongoing dispute over pay.
The union said trainee doctors, who account for more than 40 per cent of the medical workforce, were “demoralised, angry and no longer willing to work for wages that have seen a real term decline of over 26 per cent in the past 15 years.”
The Conservatives rightfully clamped down on strikes following the 2015 election. But in the recent trainee doctor ballot, 98 per cent of trainees voted in favour of action, with nearly 40,000 doctors voting on a turnout of 77 per cent, soaring over the thresholds set in the Trade Union Act 2016.
The co-chairs of the BMA junior doctors’ committee stated that trainees had been left with “no option” after talks with the Government did not secure a resolution.
A strike will be difficult for ministers – but much worse for patients. A study published in the British Medical Journal after the strikes in 2016 found they:
“…had a ‘significant’ impact on the provision of healthcare, with thousands of appointments cancelled, and significantly fewer admissions and A&E attendances than expected.”
Compared to the weeks preceding and following the strikes, there were over nine per cent fewer admissions, nearly seven per cent fewer A&E attendances, and six per cent fewer outpatient appointments than expected; hospitals cancelled nearly 300,000 outpatient appointments, 52 per cent higher than expected.
The number of recorded deaths didn’t change significantly, and wasn’t higher than expected. But the study did not take into account whether patients health worsened as a result of delayed appointments and procedures.
Ultimately, the industrial action by trainee doctors had a significant impact. So, having learnt the lessons from 2016, is it right to strike? I don’t think so.
We are still trying to catch up following the pandemic. According to research from The King’s Fund, by March 2022 there were more than 300,000 people waiting more than a year for routine planned care, compared to only 1,600 people in February 2020.
In 2019, NHS trainee doctors had accepted a new contract which gave them an 8.2 per cent pay rise over four years in return for finally ending a four year-long dispute with ministers; 82 per cent) of those who voted on the new terms and conditions agreed to accept them.
Under the deal, the 39,000 doctors agreed to:
I and many others hoped that, after years of austerity, there would be space for a re-think on public sector pay, especially issues such as Annual Allowance Pension Taxation, which is severely affecting senior doctors.
But Rishi Sunak’s 2020 Budget was the start of a new era. The pandemic had a crippling effect on the national finances; the war in Ukraine then exposed the steep costs of relying on energy imports.
Ministers didn’t get every call right: the rush to buy PPE supplies as quickly as possible resulted in much that was unusable, wasting vast sums of money.
But it was an unprecedented situation – working in a hospital, I saw first-hand how people had to make difficult decisions under immense pressure. We were bound to get some things wrong.
Nonetheless, I did not feel the initial one per cent pay rise offered to NHS workers in 2021 was right. Many felt it was a slap in their face, considering they put their lives at risk day in and day out whilst others had the furlough scheme to pull them through the lockdown.
This was subsequently raised to three per cent, backdated to April, but maybe a better deal at a later stage could have been offered. After all, weren’t we all in it together?
This may have been the point when NHS workers felt enough is enough. Their good deeds had not been fully appreciated. All the clapping in the world wasn’t going to pay their bills or support them through the cost-of-living crisis.
The first-ever strike by NHS nurses has strong public support. According to a new YouGov poll, 66 per cent say they support it, with 45 per cent saying they strongly support it. Another poll found that 47 per cent were supportive of upcoming strike action by trainee doctors, compared to just 27 per cent opposed.
At the time of writing, the trainee doctors strike is going ahead, and many thousands of elective procedures and clinic appointments will be cancelled. Unlike almost all the strikes in 2016, emergency cover will also not be provided.
In my hospital, we have to cancel all our elective procedure and planned clinics. Emergency work and ring-fenced urgent procedures, such as cancer care, will take precedence.
As consultants we will be redeployed to provide the necessary cover on the wards and the emergency settings. In my case, working over three departments, I will be required to provide cover on the Acute Medical Unit, and High Dependency Unit, as well as help with the inpatient renal department.
On my day off work, I may even be asked to come in and help due to staff shortages.
Consultants may have to be resident out of normal working hours and then off the next day. Thus, when the trainee doctors return, their own senior team may not be available. Cancelled clinic lists and elective procedures will create further delays, potentially of 12 to 18 months.
Most importantly, we have been asked under strict instructions not to enquire if trainee doctors will be on strike, as it may interpreted as pressurising them not to. Therefore, we are not able to fully plan for our workforce quotas.
Locum agencies will profit by hyper-inflating their rates, with available doctors going to the highest-bidding NHS trust!
I have worked in NHS hospitals for more than 20 years, and I believe it’s true value is reflected by its clinical workforce. They are unhappy with years of pay erosion, and paying additional taxes for saving a pension.
Without clinical staff always going the extra (unpaid) mile things would have deteriorated faster, and sooner. This has always been considered an unspoken part of the job. However, it is clear to me that the workforce is exhausted and fed up – to the extent that some literally don’t care about the NHS anymore.
However, because of the significant impact on patients, striking should be an action of last resort, and I don’t believe we are at that point yet.
Instead, we should be working together to get the change we need, focusing on the local level. We shouldn’t take on extra work if the renumeration undervalues us. If shifts overrun, we should seek financial compensation.
There would be an impact on waiting lists and appointments, but not to the extent of an all-out strike, and would encourage negotiations at a local level. The Government has given trusts a lot of money to catch up with the Covid backlog, and trusts have great discretion in how it is spent.
Bringing down waiting lists is one of Sunak’s five pledges. The Government saw a surprise £5.4bn surplus in its finances in January 2023, despite substantial spending to help with energy bills and EU payments. This creates room for manoeuvre.
Striking should be an action of the absolute last resort by the workforce and their unions.
But to avoid it, the Government must also recognise the impact austerity and the pandemic has had on demoralised healthcare workers and engage with public sector pay claims.