What’s the story behind the four-day hospital consultants’ strike?

Hospital consultants in England are in the middle of their most serious industrial action in the history of the National Health Service, a 96-hour stoppage. During this time, NHS wards, operating theatres and clinics are functioning at the level of service usually seen on Christmas Day.

Most outpatient appointments and elective surgeries, such as hip and knee replacements and cataract removals, are postponed, perhaps for months. Emergency treatment seems still to be available, but urgent care won’t be. Inevitably, and even with goodwill and the best efforts of all those involved, this must harm the health of some patients.

The public is still being told to dial 999 in life-threatening emergencies, and to use NHS 111 and the NHS website for everything else. Ambulance services and pharmacies are operating as normal, and the junior doctors and nurses are back at work. However, there are no staff that are able to cover for consultant doctors or surgeons.

The present action ends at 7am on Saturday. Another strike is scheduled to take place on 24 and 25 August.

What do the consultants want?

Unlike the junior doctors with their outlandish 35 per cent pay demand, the consultants are wise enough not to stick an absurd-looking figure in their claim. But they basically want the same as their colleagues, a “catch up” to make up for their loss of earnings over the past decade or so.

In their letter to the health secretary Steve Barclay, they asked him “to begin the process of addressing our decline in pay and ... to make an independent assessment of what doctors should be paid, considering historical pay erosion”.

Also, like everyone else in the NHS, they want the government to improve staffing levels for the sake of patient safety, and to boost recruitment and retention.

Is their strike solid?

Yes – even though the consultants are losing substantial amounts of pay. More than 24,000 consultants in England voted in the BMA’s ballot (a turnout of 71 per cent), with 20,741 (86 per cent) voting for industrial action.

What about public opinion?

That’s less solid. Interestingly, pollsters Ipsos Mori asked a sample of the public some questions, having informed them of the kind of money the consultants make – from about £90,000 to £120,000, plus other payments for out-of-hours work. The information prompted a small fall in support for the strike action among those who were made aware of the doctors’ average salaries.

Almost half (49 per cent) said they would oppose consultant doctors going on strike (26 per cent support, net support minus 23 per cent). A similar proportion (47 per cent) thought consultants were paid too much. Predictably, these relatively well-rewarded professionals are viewed much less favourably than nurses and junior doctors.

What has the government said?

Barclay said: “I am disappointed the BMA is going ahead with this week’s strike, given the average consultant’s NHS earnings are expected to increase to £134,000 a year. My door is always open to discuss non-pay issues, but this pay award is final so I urge the BMA to end their strikes immediately.”

The consultants have been offered 6 per cent, in line with the independent pay review body’s recommendation, as well has having had the tax cap on their pension pots removed and the NHS long-term staff and training plan published.

And the opposition?

Ever alert, the shadow health and social care secretary, Wes Streeting, tweeted that “the Health Secretary hasn’t met the Consultants since their strike ballot result and hasn’t replied to the BMA’s letter. In the face of the worst NHS strikes in history, the Health Secretary has been asleep at the wheel and the Prime Minister is nowhere to be seen.”

As is standard practice, Streeting refuses to say what he’d do if he were in power now, beyond getting people “round the table”.

What will it do to Rishi Sunak’s chances of meeting his pledge to reduce waiting lists?

Good and bad news from the prime minister’s point of view. The strikes are certainly unhelpful. As Keir Starmer pointed out at prime minister’s questions, waiting lists have risen from 7.2 million at the start of the year, when Sunak outlined his “five priorities”, to 7.4 million now, so he’s actually going backwards.

More than 600,000 appointments, procedures and operations have already been lost in various strike actions since last November, and some 100,000 appointments were lost during the junior doctors’ five-day stoppage last week.

However, such strikes also hand Sunak a handy alibi, as he can blame the unions if he misses his target, even if he was likely to miss it anyway. At all events, the severity of the annual NHS winter crisis, perhaps with an added Covid complication, will also prove a critical factor in whether Sunak is able to claim success.

If there are strikes by health workers going on at the end of the year, then the public will probably blame the government, as has been the case recently.

This is unprecedented, isn’t it?

Pretty much, but the history is interesting. The consultants joined in with a day of action in 2012, but that was merely a gesture of solidarity. Their only recognisable industrial action took place in unusual circumstances in 1975. At that time, nurses and other hospital workers objected to looking after the consultants’ lucrative private patients, who were cared for on NHS wards in so-called “pay beds”.

The cabinet minister in the Labour government who was responsible at the time, Barbara Castle, tended to sympathise with the nurses and sought to phase out the practice. In response, the BMA consultants, in genteel fashion, withdrew “goodwill activities” for a few months. The dispute eventually petered out and the government quietly gave in. Who knows if history will repeat itself?