Resident Doctors: Industrial Action

Statement

The following Statement was made in the House of Commons on Thursday 10 July.

“With your permission, Madam Deputy Speaker, I will make a Statement on planned industrial action by resident doctors.

Today’s waiting list figures show that, after 14 years of decline, the NHS is finally moving in the right direction. Since July, we have cut waiting lists by 260,000. We promised to deliver an extra 2 million appointments in our first year, and have more than doubled that figure, delivering 4.6 million more appointments. For the first time in 17 years, waiting lists fell in the month of May, and they now stand at their lowest level in more than two years. That is what can happen when NHS staff and a Labour Government work together. We have put the NHS on the road to recovery, but we all know that it is still hanging by a thread, and that the BMA is threatening to pull that thread.

On Tuesday this week, I met the co-chairs of the BMA’s resident doctors committee to discuss the results of its ballot for industrial action. In that meeting, and in a letter I sent yesterday, I offered to meet the BMA’s full resident doctors committee and work with it to improve its members’ working lives. Since the start of this year, I have offered repeatedly to meet the entire committee, but it still has not taken up my offer. Instead of agreeing to talk, the BMA responded by announcing five days of strike action. Its planned strike action will run from 7 am on Friday 25 July to 7 am on Wednesday 30 July. These strikes are unnecessary, given this Government’s willingness and eagerness to work together to improve resident doctors’ working conditions. Following a 28.9% pay rise thanks to the actions of this Government, the BMA’s threatened industrial action is entirely unreasonable. I am asking it again today to pause, call off the strikes, and instead work with the Government to rebuild its members’ working conditions and rebuild our NHS.

Before this Government came into office, a toxic combination of Conservative mismanagement and strikes was crippling the NHS. The cost to the NHS ran to £1.7 billion in just one year; patients saw 1.5 million operations and appointments cancelled, and people’s lives were ruined. Phoebe suffers from a genetic condition: neurofibromatosis, which causes non-cancerous tumours on the outside of her body. Her first operation at Great Ormond Street Hospital was cancelled twice—at first due to strikes, and then because there was not the capacity to treat her. Phoebe loves going to school, and it is an absolute tragedy that her education was set back. She was prevented from doing what she loves because the NHS was not there for her when she needed it, but this year, when Phoebe’s family contacted Great Ormond Street in March, her surgery was scheduled less than two weeks later. Compared with what she went through two years ago, the difference was night and day.

That is the difference a Labour Government make, and it is why this Government were absolutely right to end the strikes when we came into office. I am so proud of what we have achieved together with NHS staff. In the words of one NHS leader I spoke to recently, there is light at the end of the tunnel and for the first time it is not an oncoming train. That has been possible only because of the deal this Government negotiated.

When we agreed that deal to end the strikes last year, resident doctors did not just receive a 22% pay rise, the Government gave a genuine commitment to build a new partnership with those we now call resident doctors, based on mutual respect. I have personally ensured that that commitment was followed through. A new exception reporting process has been agreed with resident doctors in principle, so that doctors are paid for the work they are asked to do. A review of rotational training is under way and almost complete to reduce disruption to resident doctors’ lives. We promised to tackle GP unemployment, and we have delivered with an extra 1,900 GPs on the front line who were otherwise facing unemployment. I am determined to go further to tackle doctor unemployment.

When I say to resident doctors that I want to tackle the bottlenecks they face, and the unfair competition for specialty training places, and to create more training places, they can judge me not just by my words but by my actions. When the pay review body recommended a 5.4% average pay rise for resident doctors this year, we accepted that and funded it in full. Those are not grounds for industrial action. Indeed, in the history of British trade unions, it is completely unprecedented for a pay rise of 28.9% to be met with strikes. The BMA itself described this pay rise as ‘generous’.

Thanks to this Government, the average annual earnings per first-year resident doctor last year were £43,275. That is significantly more, in a resident doctor’s first year, than the average full-time worker in this country, and it is set to increase further with this year’s pay award. For resident doctors in their second year out of medical school, their average annual earnings rose to £52,300 last year. In core training years, resident doctors earned an average of £67,000. Specialty registrars earned on average almost £75,000. There is no question but that these are highly trained, highly skilled medics who work hard for their money, but to threaten strikes in these circumstances is unreasonable and unnecessary, so it is no wonder that the BMA has lost the public’s support.

At the beginning of this dispute, resident doctors faced a Conservative Government cutting their pay and refusing to talk to them. A clear majority supported action as a result. In February 2023, 56% of the public backed junior doctor strikes. Today, that support has collapsed. Just one in five people believes that the BMA is doing the right thing. Patients are begging resident doctors not to walk out on them, and I hope the BMA is listening, because many resident doctors are.

For the first time since the BMA’s campaign began, a majority of BMA resident doctors did not vote for strike action. They can see that the Government have changed and our approach has changed, yet the BMA’s tactics have not. Resident doctors have received the highest pay award in the public sector, both this year and last year, so renegotiating this year’s pay award would be deeply unfair to all other public servants. Such a deal would be paid for by their future earnings and, with the greatest respect to resident doctors, there are people working in our public services who are feeling the pinch more than they are.

Even if it would not be unfair on public sector workers, it is unaffordable. It should be apparent to anyone that the public finances this Government inherited are not awash with cash, so I will not and cannot negotiate on this year’s pay award, and I am not going to lead resident doctors up the garden path by making promises unless I know I can keep them. As I have said in person, in writing, in private and in public, I am willing and ready to get around the table and work together to improve the working conditions of resident doctors. There is so much more that we can do together. I do not just hear the complaints that resident doctors have about their placements, rotations and bottlenecks—I agree with them. I know the NHS has been a bad employer, and I am determined to change it. My offer to talk comes with no preconditions attached. I will also say this to resident doctors directly: consider very carefully the consequences of your actions.

I just say to resident doctors, and it is important that the House knows what we are saying to them, that they should carefully consider the consequences of their actions. Five days of strike action mean patients and their families receiving the phone call they are currently dreading, being told that the operation or appointment they have been waiting for—often for far too long—is being cancelled and delayed. I know how I would feel if that happened to a member of my family, and I ask them to consider how they would feel if that happened to a member of theirs. While they are out on the picket line, protesting the 28.9% pay increase they have had, their friends and colleagues and other NHS staff—many of whom are paid less and receive less than them—will be inside, picking up the pieces and working in harder conditions to cover for the consequences of resident doctors’ actions.

In conclusion, the strikes are not only unnecessary and unreasonable but unfair. They are unfair on patients, unfair on other NHS staff, and unfair to the future of the NHS, which is in jeopardy. The tragedy is that they will never have had a Secretary of State as sympathetic to their legitimate complaints as this one. If they want to know what the alternative is, its Members are not sat here. They have not even bothered to show up today, and that party does not even believe in the NHS. The grass is not greener on the other side. I ask them not to squander this opportunity. At this stage, we can still come out of this dispute with a win for the BMA’s members, a win for the NHS and a win for patients, but if the BMA continues down the path of strike action, it will lose its campaign, resident doctors will be worse off, and the heaviest price of all will be paid by patients. I commend this Statement to the House”.

23:12:00

My Lords, I begin by paying tribute to those conscientious resident doctors who have decided not to take industrial action so that they can continue their vital work and care of their patients. From these Benches, we find it deeply regrettable that a minority has decided to take this unjustifiable action of launching another round of industrial action. This action will undoubtably lead to greater waiting lists, more cancellations of appointments and a worse outcome for patients. Even the pro-government Independent newspaper has predicted that tens of thousands of patients face cancellations. Can the Minister tell the House what remedial action the Government will take to protect patients and offset as far as possible the negative impacts of these strikes and their impact on patients? I hope the Minister will recognise that I try as much as possible to be constructive in these debates. Unfortunately, when the Government last year offered resident doctors a 28.9% pay rise to end the last round of strikes without attaching any conditions on productivity or on future promises on industrial action, many of those who have studied—and those who have not studied—behavioural economics, game theory or negotiation strategy predicted that the BMA would again call for strikes to extract even more money from taxpayers without improvements in patient care. It reminds me of a conversation I had with the Secretary of State for Health when we were in government. He had what he thought was a very constructive conversation with a BMA committee, which agreed that some of the working practices needed to be modernised—we were still working on 1948 models. When he asked a BMA representative for advice on implementing the agreed changes, the response was, “How much more are you going to pay us?” The then Health Secretary said, “But I thought you agreed that these practices need to be changed”. “Yes”, the BMA representative replied, “but how much more money are you going to pay us?” I have huge respect for trade unions and, along with friendly societies and mutuals, their wonderful history in civil society. Thanks to my father’s membership of the Transport and General Workers’ Union—I told the noble Lord, Lord Woodley, about this earlier on—my mother was able to get an appointment at the independent Manor House Hospital. The trade unions had a wonderful history in civil society of helping working people. But in this case it is clear that those who are on strike are more interested in producer interests than in improving patient care. It reminds me of the doctor who tweeted that the NHS is about doctors and nurses but was then asked, “What about patients?” The current Secretary of State was warned about the risk of incentivising the BMA to call more strikes when he agreed the pay rise last year. My right honourable friend the shadow Secretary of State for Health was very clear when he said that simply caving in to the BMA was the wrong course of action, especially given that there were no conditions attached to that last pay rise. Unfortunately, that prediction came true. We on these Benches welcome the Government’s indication that they will stand firm on the current dispute; this is surely the right course of action. Since 2022, the BMA has spearheaded more than 11 strikes in the current industrial action. One of the BMA’s leaders even went as far as saying that resident doctors are “excited to go again”. However, we should not tar all BMA members with the same brush; we should recognise that less than 50% of those eligible to vote did so. We should recognise that most doctors realise that further industrial action is not fair on patients or taxpayers, as indicated by the brave decision of the noble Lord, Lord Winston, to resign from the BMA. Can the Minister tell us whether there has been any impact study on the forthcoming Employment Rights Bill, which we debated earlier and which will lower the strike ballot threshold? Do the Government recognise that this might make even more strikes by the BMA more likely? After resident doctors were awarded a 28.9% pay rise last year, they were offered another 5.4% pay rise this year. This is not only above inflation; it is also the largest pay rise in the public sector. As the Health Secretary himself has said, these are most certainly not the conditions for industrial action. I applaud the Secretary of State for indicating his intention to remain firm in the face of this action. We on these Benches will support him in that endeavour, but I hope that he will stick to his thus far tough stance and not allow the BMA to get the better of the Government. However, there have been some reports that the Secretary of State is considering asking for the action to end now, with the promise of more pay rises in future. It would be unfair of me to ask the Minister to comment on reports in the press but, if this does turn out to be the case, can we implore the Government both to avoid the temptation of unconditional pay rises and to ensure that any future pay rises are tied to modernising the way in which doctors work, so that all patients can get a better service? I would welcome any assurances that the Minister can give at this stage.

My Lords, in the interests of her husband’s care, my noble friend Lady Walmsley has not been able to stay until this late hour; she sends her apologies to the House. I will speak on behalf of these Benches. We are disappointed that the BMA is planning to call a five-day strike on the votes of a minority of its members. We welcome the constructive approach of the Secretary of State. We believe that more attention should be paid by the BMA to the effect on patients and on other NHS staff, some of whom are paid much less well than resident doctors but will have to do their best to minimise the damage. Resident doctors had a 29% pay increase last year. Another increase of that size, if it were granted, would be extremely damaging for the national economy. Many other public service workers who are less well paid than resident doctors have not received such pay rises. Under these circumstances, we believe the BMA’s demand to be unreasonable, unfair to patients and other workers, and, potentially, hugely damaging to the important work of the Government to restore the standards of care in the NHS. Public sympathy is not with the residents doctors at this time. Nor do they have the support of consultants, who will, of course, do their duty and step up to the mark to protect patients even though they are not in support of this strike. Like all public sector workers, doctors need—and normally deserve—the support and trust of the public. It is unwise for them to jeopardise that support and trust by taking unnecessary action. A strike is unnecessary because the Secretary of State has made it absolutely clear that he accepts that there is a good deal more to be done to improve the lives and working conditions of resident doctors. He has shown many times that he is eager to meet them in order to work out how to make those improvements. I urge the BMA leadership to take him up on that offer. We on these Benches accept that many NHS staff have worked under unbearable strain for too long. There are issues around placements, rotations, lack of team support, backlogs preventing specialist training, the physical state of hospitals, and the stresses of not being able to deliver good care. In that context, I have a particular question for the Minister. One of the areas that the Secretary of State mentioned in his response to a question in another place from my honourable friend Alison Bennett MP, about the reality of working conditions, was this issue of corridor care. We know that this is a result of the effect on the flow of patients through the hospital caused by delayed discharge from the wards of patients who are fit to go home but for whom the appropriate social care or physical adaptations are not available. While we wait impatiently for the Casey review on social care, what are the Government doing about delayed discharges? Will the Minister ensure that local authorities have the resources to fund necessary adaptations to help people live safely at home? If I was a doctor or nurse in A&E, committed to delivering good-quality care, I would find having to deliver poor-quality care extremely distressing. This is surely critical to the morale of the NHS, affecting recruitment and retention even more than the pay issue. I can assure the Minister of our support if something effective were to be done about it.

My Lords, I thank those noble Lords who have stayed for this very important debate at this late hour. I thank the noble Lords, Lord Kamall and Lord Stoneham, for their comments and their support for the approach that our Secretary of State has taken. I emphasise that, since taking office, this Government have prioritised improving industrial relations with resident doctors. The Secretary of State met with them in the first week of taking office and agreed a fair pay deal, which sought to reset the relationship between government and the profession. While the majority of resident doctors did not vote for strikes, it is disappointing that the British Medical Association’s resident doctors committee has rushed to announce strike action that will significantly impact patients and set back the progress that we are making with the NHS. Resident doctors will receive the highest pay award of the entire public sector this year and will have received an average 28.9% pay rise compared with three years ago. Increasing this further would be unfair, not least to other public servants. The Secretary of State met the BMA on 8 July and wrote to it on 9 July, and expects to meet it this week to discuss how strike action can be avoided. He has made clear to the BMA that while we cannot go further on headline pay than we already have this year, he remains committed to his offer to work with it, including meeting its entire committee, to resolve the legitimate issues that resident doctors face around their working conditions. I have not heard the rumours that the noble Lord, Lord Kamall, mentioned. They certainly have not come up in any conversations that I have been involved in. As the Secretary of State explained in the other place, significant progress has been made to start to rebuild the NHS. Waiting lists have been cut by 260,000. We promised to deliver an extra 2 million appointments in our first year and have more than doubled that figure, delivering 4.6 million more appointments. For the first time in 17 years, waiting lists fell in the month of May and now stand at their lowest level for more than two years. This is what can happen when NHS staff and a Labour Government work together. We have put the NHS on the road to recovery, but we have to be honest: the BMA is threatening this progress. Strike action can, of course, have serious consequences for patients and should only ever be a last resort. The Secretary of State spoke in the other place of the case of Phoebe, who suffers from a genetic condition. Her operation at Great Ormond Street Hospital was cancelled twice, first due to strikes and then because there was not the capacity to treat her. Strikes are unfair on patients, unfair on other NHS staff and unfair to the future of the NHS, which we know is in jeopardy. Following a 28.9% pay rise, thanks to the action of this Government, the BMA’s threatened industrial action is entirely unreasonable; I put that on record here tonight. Along with the other noble Lords, we are of course urging the British Medical Association resident doctors committee to abandon this rush to strike and, instead, to work constructively with this Government to improve their working conditions and rebuild the NHS. We believe there is a lot of scope, as the noble Lord, Lord Stoneham, said. Their working conditions have been appalling over the last decade. There has been enormous sympathy for the conditions that they have been in. The noble Lord, Lord Kamall, quite rightly raised the issue of how patients will be protected and how negative impacts will be offset. We want to work constructively with all the unions to avoid disrupting services for patients. We acknowledge that unions have the right to go on strike, but there will be robust contingency plans in place to minimise disruption. Employers will seek, across the board, to mitigate impact and to look at ways of rearranging elective care and maintaining, in particular, urgent action. I have every confidence that the Secretary of State will stay firm and will work towards establishing better relationships and better conditions. I cannot possibly comment, as the noble Lord suggested, on rumours and speculation. It would just not be the right thing to do at this point in time. I thank the noble Lord, Lord Stoneham, for his support and his recognition of the work that has been undertaken. On corridor care, I think every single Member in the Chamber who I have heard speak on this issue recognises the dire situation that we have with social care at this moment in time. To fix the NHS would be impossible without fixing social care; it is absolutely imperative that we move forward. We have confidence in the noble Baroness, Lady Casey, and her review—in particular, her ability to reach out and work cross-party with all the different agencies, pulling them together. We need to take action immediately—the noble Lord is absolutely right—so over the next three years we will focus on the neighbourhood approach, which is one of the three pillars of the 10-year plan. We will target, particularly, those who have been most let down by the current system. That, of course, includes older people with frailties and those in care homes. Social care professionals will work alongside NHS staff in local teams, supporting recovery, rehabilitation and independence—that is absolutely critical to their ability to move out of the acute sector. We will enable professionals to take on more health-related responsibilities—for example, taking blood pressure checks, around rehabilitation and, again, working on prevention to reduce avoidable hospital admissions. We are looking, importantly, to improve pay, terms and conditions through the fair pay agreement. In the longer term, the creation of a national care service, guided by the review by the noble Baroness, Lady Casey, will support deeper integration between health and care. This will build on the whole theme of moving services out of hospital into the community. Importantly, those closer links—and even integration—of health and social care will work with local authorities and the voluntary and community sector. I think we all know examples of excellent practice in this space. The issue we have is that there is no consistency, and that is where we see problems. Those areas that have built supportive networks in their communities have done a tremendous job in making sure that patients do not end up in hospital unnecessarily, but also by introducing step-up and step-down facilities that will make a difference. There are many aspects of this to consider, but I hope the Government’s strength of feeling and dismay at the decision to strike has come across loud and clear. I know we will all be looking to the Secretary of State, with his calm and clear exposition of his intention to meet the union and work out a way of getting through this situation to protect patients and the future of the NHS, and to make sure that we can get on with the reforms we have promised through the 10-year plan, which offer an exciting future for health in this country—when we are allowed to get on with it.

23:30:00

My Lords, I endorse the comments of my noble friend Lord Kamall about recognition of those doctors who have decided not to take action. There can be no way that doctors abandoning patients is compatible with the Hippocratic oath they have taken. For 17 years as chancellor of a university, I have listened to doctors on qualification saying that they are taking their Hippocratic oath and that they will give priority to patients and do no harm. Taking five days of industrial action does a great deal of harm to the patients and, of course, to others in the profession who have to pick up the load—the nurses, the consultants and others. I endorse the great disappointment expressed by the noble Lord, Lord Stoneham, that the report by the noble Baroness, Lady Casey, is going to be so slow in arriving, given that it is so essential to the next steps in the health service. I wonder whether the Minister could come back on the point I made to her last week about resident doctors taking industrial action and then signing on as locums at a premium rate in another health authority or hospital, whether in the NHS or otherwise. Resident doctors are doing the profession enormous harm. Extraordinarily, we still have incredibly high entry standards for doctors. It remains one of the most popular and sought-after professions for school leavers. I take with a pinch of salt this idea that they are all leaving. Lots of doctors go on rotation to America or Australia and to get experience around the world, but I still think that, thank goodness, they regard working in Britain as a worthwhile activity and profession. But the damage these resident doctors are going to do to that trust and respect is enormous.

I thank the noble Baroness for her comments and the background. I shall particularly pick up on the issue of moonlighting, which she has raised before. As a point of reference, during the industrial action in 2022-24, it was picked up. There were isolated and anecdotal incidents of this behaviour. It is difficult to get accurate information, and with the current systems in place there is no clear or easy way to monitor the practice. However, resident doctors moonlighting while on strike is clearly unacceptable and in clear breach of the GMC code of practice. As I have said before, it is up to the employers to take any reports of this very seriously, and I am sure they will. I echo the noble Baroness’s comments about the medical profession in this country. We have some extraordinary people working in the whole of the NHS, not just the doctors. It is a phenomenal organisation, and we believe it is our absolute duty to do everything we can to protect it and preserve it for the future, and to keep it true to its principles of delivering care free at the point of delivery and reaching everyone that needs it.

My Lords, I gave prior notice to the Minister that I want to ask a couple of questions about the Leng review into physician and anaesthetist associates which was published today, dealing with issues of high relevance to the concerns and the levels of dissatisfaction among resident doctors. Indeed, the review directly addresses some of the training issues for resident doctors which are set out in this Statement and which the Government say they are seeking to tackle, particularly rotational training and the lack of training places. I have two questions. First, when and by what mechanism will Parliament, and particularly your Lordships’ House, have the chance to discuss the Leng report, given the high level of engagement on the statutory instrument that created the GMC registration of PAs and AAs in February 2024 and the level of expertise in your Lordships’ House? Secondly, and this reflects many questions with which I am being bombarded by those concerned with these issues, some of the main recommendations of Professor Leng include the renaming of physician associates and anaesthetist associates as assistants. Professor Leng says they should not be seeing undifferentiated patients except within clearly defined national clinical protocols; they should get at least two years’ experience in secondary care when newly qualified before taking roles in primary care or mental health trusts; and there should be a named doctor as a line manager, which puts into question people operating as so-called locum physician associates. Presumably, at least the first of these, the naming question, would require a new statutory instrument. Others may or may not. Can the Minister give me and all the other interested people some idea of how the Government are planning to take this forward?

The noble Baroness is certainly up to date as the report was published only this morning. If I am honest, asking such detailed questions at this stage is possibly slightly premature. We have committed to bringing in an implementation plan, which will be published in the autumn. The government-commissioned work has been very detailed. Professor Gillian Leng led the review, and the report sets out 18 recommendations that will give much-needed certainty and clarity to staff and patients. The Government are accepting these recommendations in full. By doing this, the Government have demonstrated their commitment to evidence-based policy informed by expert clinical advice, listening to patients and professionals. I look forward to the implementation plan coming forward to make sure that we get some clarity. One of the most dangerous things is the lack of clarity that has surrounded these positions. The debate had, quite frankly, become polarised and in some cases toxic. That is not in anyone’s interest. Of course, there will be conversations between all interested parties following the report’s publication today and I look forward to discussions. I am sure it will come back to this place at the appropriate time.

My Lords, the Secretary of State said that resident doctors “should start to experience an improvement in their working conditions on everything from the availability of nutritious food and drink”—[Official Report, Commons, 10/7/25; col. 1150.] to other items. I would be interested to know: how exactly are the Government intending to achieve nutritious food and drink for these resident doctors?

I do not want to take that lightly, but resident doctors work extraordinary hours and put themselves on the line every time they go into work. Making sure that their employers provide them with the support they need is a fundamental job that they should all do, and I suspect that in some cases that has not been the case. There are so many other ways that all medical staff need supporting. Unfortunately, many medical staff meet violence in the workplace and meet discrimination and all sorts of challenges, and they need to feel that they have support. Making sure that they have access to nutritious food is fundamental and important, and I think we all know, looking back over the last decade, that the conditions that we have expected those wonderful professionals to work in have simply not been good enough. We will do everything we can to ensure that whatever aspect is causing concern is picked up and taken very seriously.

House adjourned at 11.40 pm.