NHS strikes: What ails UK health service? Doctors’ protests or budget cuts?

London, United Kingdom – Thousands of doctors across England have started a three-day strike for the eighth time since March, demanding better pay and working conditions.

Consultants and junior doctors – who form 80 percent of hospital doctors – began the 72-hour strike at 7am (06:00 GMT) on Monday, as the ruling Conservative Party has convened for its annual meeting in Manchester.

The publicly-funded National Health Service (NHS) has warned that the strike will cripple nonemergency services.

It will mark the second joint strike by consultants and junior doctors in less than a month, forcing hospitals to reschedule outpatient appointments and nonurgent operations. Nearly a million hospital appointments have been rescheduled since the strike action, including nurses, began in December.

Here’s what you need to know about the strike:

Why are the doctors striking?

Doctors say the raises in their salaries have not been keeping up with high inflation amid a cost of living crisis in the UK.

The health sector has suffered from staff shortages due to years of funding cuts. This means medical professionals are forced to work longer hours, unsupported, and unable to take breaks. A recent survey by The British Medical Journal found that one in three medical students plan to leave the NHS within two years of graduating.

Add to this, a lack of resources, such as hospital beds and medical equipment, and doctors are left feeling “undervalued and burnt out”, says Dr Kiran Rahim, a junior doctor and a paediatric registrar in a London hospital. She has been providing critical medical care and treatment for sick children since she qualified just over a decade ago.

She says junior doctors have had a real terms (RPI) pay cut of 26.1% since 2008.

Consultant’s starting basic full-time annual salary is 88,300 pounds sterling ($107,328) and for a junior doctor who has just graduated from medical school it’s around 29,384 pounds sterling ($35,716).

A survey by the British Medical Association (BMA) the trade union representing doctors in the UK, has said nearly half of junior doctors were struggling to pay their rent or mortgage during the cost of living crisis, and half had difficulty paying their energy bills.

Dr Rahim was hoping, by this point in the year, to be able to continue doing a job that she loves, instead of going on her strike.

“I want to see the government work with doctors to bring an end to industrial action, but that has repeatedly not happened. Our goodwill has been exploited enough and we’re just done. Formal resolution with the BMA needs to happen.”

Is the government’s pay offer to doctors enough?

Last year junior doctors were offered an “insulting” pay rise of two percent, “well below inflation”, stated the British Medical Association (BMA), the trade union representing doctors in the UK.

All this culminated in strike action in March this year, with junior doctors demanding a 35 percent pay remuneration, and consultants asking for 12 percent.

Now the government has offered 6 percent and 8.8 percent to consultants and junior doctors respectively.

Using annual consumer price index (CPI) forecasts, a six percent rise would only amount to one percent if the rate of inflation is factored in.

Doctors have rejected the offer.

Professor Phil Banfield, BMA council chair, says doctors are willing to end strikes if the government makes “a credible offer”.

“We don’t want to be on strike, we don’t want to have to protest at party conferences, but we do want doctors to be recognised as the highly skilled practitioners of medicine that they are. We want to be serving our patients.”

Why have wages stagnated for years?

It’s not just doctors’ pay, there’s been wage stagnation across the UK economy since the 2008 global financial crisis.

The UK’s coalition government led by the Conservatives introduced a series of austerity measures after coming to power in 2010 as a way to respond to the crisis, including a slow down in NHS spending. But this left the NHS budget short by $28.6bn.

Add to this, “soaring inflation, high energy costs, the structural changes and impact of Brexit and an ageing population, you’ve got the perfect storm,” says Professor Nora Colton, director of the Global Business School for Health (GBSH) at University College of London (UCL).

How is the NHS budget spent?

Figures for 2021-22 show the government spent 193.8 billion pounds sterling ($236bn) on daily running costs. Nearly 40 percent of the annual budget was spent on staffing, including doctors’ wages.

What do NHS budget cuts mean?

It’s not just doctors’ salaries, there have been cuts in services across the country, including hospital and A&E (accidents and emergencies) closures.

The Royal College of Emergency Medicine found that long A&E waits – due to a shortage of staff and a lack of hospital beds – contributed to 23,000 excess deaths in 2022.

“It’s not that simple”, states Professor Colton, “there are all sorts of systemic issues at play. There were reports that ambulances couldn’t release people into A&E because there weren’t enough bed spaces. There weren’t enough bed spaces because people weren’t being released into social care. People weren’t released into social care, because of funding cuts – it’s very complex.

“It’s not easy to say it’s because of budget cuts, it’s just the overall inability to take a systemic approach to health care.”

How does the UK compare to other health systems?

NHS is one of the oldest publicly-funded healthcare systems in the world and is comparatively well funded when contrasted with other well-off nations, but its health outcomes are below average.

The King’s Fund analysis of data from the Organisation for Economic Cooperation and Development (OECD) shows the UK ranked sixth on the list for health expenditure as a percentage of GDP in 2022.

“The UK spends 10 percent of its GDP on health, yet health outcomes are lower than in other countries. That’s because of health inequality, social inequality, it all exacerbates health outcomes,” explains Colton from UCL.

“Pouring more money into hospital care isn’t going to fix things, to do that we need to make sure that primary care, diagnostics and prevention are invested in.”

Does the NHS need more money?

Professor Colton believes the NHS model can be saved, if “courageous politicians and visionary leaders” take action.

“It’s not just about money, it’s about investing in the right places – into infrastructure, innovation and technology. If we don’t start pivoting to the future towards preventative and diagnostic care, the complex problems the NHS is facing will not get solved.

“We need a better understanding of how everything functions together, in a properly funded care model and workforce.”

Colton believes doctors should have better working conditions and be financially compensated for their work, “but from a government economic perspective a salary increase is seen as driving forward wage inflation”.

How long will strike action continue?

Consultants have a legal mandate to keep striking until the end of December and junior doctors until late February.