Consultants in England are preparing to strike for two days from 6.59am on 25 November, with only emergency cover provided. More than three-quarters of those who took part in the British Medical Association’s ballot voted for action. The government wants to retain experienced doctors while squeezing their pay and exhausting them at work. Those doctors have a means of resisting which no ministerial appeal to professional duty can abolish: they can withdraw their labour.
This year’s pay award was 3.5 percent. It hasn’t settled a dispute over years of lost purchasing power and deteriorating working conditions. Dr Helen Neary and Dr Shanu Datta, co-chairs of the BMA’s consultants committee, described the position:
“Not only is our pay still a quarter down in real terms on what it was 17 years ago, having fallen more steeply than the rest of the economy, but we are also not being given time to dedicate our all to the NHS and patients, with quality and improvement being traded for the treadmill of target-chasing, driving colleagues to burnout through excessive workloads.”
Consultants’ responsibilities also make their working conditions a matter for the whole service. They provide frontline care, organise services, and train and supervise the doctors who’ll follow them. Driving an experienced consultant out of the NHS means losing more than the appointments that person would have carried out. It weakens the service’s ability to develop its next generation of staff. Training takes time from the very people whose working day is already being squeezed.
The BMA’s complaint about target-chasing belongs here. If a doctor’s time is consumed by meeting immediate demands, less remains for supervision, service improvement and careful preparation. Work postponed today returns as a problem tomorrow. Ministers can demand better performance as often as they like; another demand doesn’t create another hour in the working day. The same government which wants credit for shorter waiting lists is wearing down the staff on whom that achievement depends. According to the BMA, even that much-advertised progress is now stalling.
Professional responsibility gives the employer a particular advantage in healthcare. Staff know that leaving work undone can hurt somebody. The temptation for management is to treat that concern as a resource it can draw on indefinitely, filling the gap between what a service needs and what it’s been given. Each individual doctor then faces a burden which should have been resolved through staffing and resources. The BMA’s account of burnout shows where this leads. A sense of duty can keep someone working through exhaustion; it can’t make exhaustion harmless.
Employers depend on the treatment and recovery of workers, and on the care of their families. Public provision meets needs which individual wages often couldn’t cover. Yet financing that provision draws society’s resources into a common service and opens a struggle over how much of the bill capital will bear. The capitalist class benefits from a functioning NHS while resisting claims on its wealth to sustain it. Holding down NHS pay shifts part of that burden onto the people doing the work.
Britain’s imperialist state approaches that struggle with definite commitments. It protects capitalist property and maintains the power through which British capital pursues its interests abroad. Healthcare competes for resources within that political order. A spending limit handed down to the NHS therefore carries class decisions made before a consultant enters a negotiating room. Treating the limit as unquestionable merely reserves the argument for how much staff and patients will lose.
Consultants last struck in 2023 and have been in dispute again since last year. The committee co-chairs explained how the present confrontation developed:
“Since we entered into dispute over 18 months ago we have engaged in good faith with the government, proposing practical solutions, but time and time again ministers have kicked the can down the road. Unfortunately, that road has now run out and we have been forced to announce strikes.”
Good faith hasn’t supplied the union with the power to obtain a settlement. Organisation and the credible withdrawal of labour give it a different means of pressing its demands. The BMA says the action could be avoided if health secretary Yvette Cooper committed to formal negotiations on pay and working conditions. Emergency cover will continue during the strike. The doctors’ responsibilities to patients haven’t disappeared; neither have the government’s responsibilities as their employer.
Under socialism, the working class would control the resources from which healthcare is provided. Planning would have to account for the training, staffing and working time needed to deliver it, including the time required to maintain and improve the service. Shortages would still require real choices. But capitalist property and imperial commitments would no longer stand above those choices as claims which workers must accommodate before their own needs can be considered.
The BMA says the government has four weeks to avert the strike. Consultants have already spent more than 18 months putting their concerns and proposals to ministers. What the government is about to lose is the assurance that they’ll carry on while ministers put them off.
