Britain’s Junior Doctors’ Strike Is About Putting an End to Austerity

More than a decade of cuts under the Conservatives has left Britain’s National Health Service dangerously understaffed and underfunded. After years of pay cuts, junior doctors are fighting back to protect patients and the NHS.

On the first of their four-day nationwide industrial action, striking junior doctors rally in Trafalgar Square on April 11, 2023, in London, England. (Richard Baker / In Pictures via Getty Images)

Junior doctors like me working in England’s National Health Service (NHS) have made the agonizing decision to strike this week for a simple reason: the worsening of conditions within Britain’s state-run health care provider has meant that professionals and patients alike are not safe. Both are suffering as a result of incessant, relentless real-term pay cuts for junior doctors.

Like the 98 percent of doctors who voted for strike action, I will also be striking — for my colleagues, for my patients, and to save a wounded NHS. Our pleas to the government are simple: pay restoration is rational, not radical.

The NHS ought to be celebrated. It’s a national treasure, deeply woven into the fabric of British society. Even Margaret Thatcher, who once described the NHS as a “monolith of socialism,” left the institution mostly intact during her eleven years at the helm of the Conservative Party, during which she embarked on an attack on public services and trade unions.

Wisely, she knew all too well that the “the NHS is the closest thing the English people have to a religion.” Seventy-five years after the creation of the NHS, that faith is being tested. For more than a decade, the relevant stakeholders, which include the Department of Health and Social Care, Health Education England, and NHS England/Improvement, have failed to implement a strategy to plan for changes in the supply of labor. This has caused the NHS to sleepwalk into the greatest disaster in its history: the largest medical staffing crisis the institution has ever faced, as outlined by a recent cross-party parliamentary report.

Shamefully, the UK has a doctor-to-patient ratio of just two doctors per one thousand people — dangerously low compared to other European countries. Britain also spends just £2,989 ($3,741) per head on health care, the second-lowest of all the G7 countries. Such low spending would be dangerous at the best of times. But with the NHS waiting list at a historic high of 7.21 million people, this shortfall in funding is slowly crippling the service. There is a close connection, often ignored in discussions of the ongoing dispute, between doctors’ pay and the staff shortages within the NHS.

Junior Doctor Pay in Nosedive

New analysis by the British Medical Association (BMA) demonstrates that junior doctors in England have, from 2008/9 to 2021/22, faced a real-term pay cut of 26.1 percent. A junior doctor qualifying in 2009 earned £47,500 ($59,455) in today’s money while paying £1,000 ($1,251) per year in tuition fees. Today’s graduates will have to work for five years to earn the equivalent while paying off a total of £100,000 of tuition fee debt, making ends meet in the context of a cost-of-living crisis caused by an inflation rate of 10.4 percent.

To put this in context, consider three doctors with ten years, seven years, and one year of experience in an operating room where an appendix is being removed — one of thousands of similar operations that takes place every day in England. For the procedure, which lasts about an hour, they would earn £28, £24.46, and £14.09, respectively — a total of just £66.55 for a potentially lifesaving operation. It is clear that, in the context of a decade of cuts to the NHS’s budget, the low pay of junior doctors suppresses the costs of urgent medical treatment.

Junior doctors are now often asked to perform the role of two doctors at any given moment. Burnout and workplace stress are hitting a record high, with 62 percent of doctors experiencing the results of harrowing work pressures. Patients also suffer the costs of burnout, with doctors being more than twice as likely to make a medical error. Both professionals and patients are suffering as a result of the government’s chronic negligence of health care for the past decade. The toll of managing a chronically underfunded, understaffed health care system still reeling from the COVID-19 pandemic is manifesting among junior doctors in the worst possible way.

“Drexit”: an International Failure

Worsening conditions in the NHS have led many doctors to leave England to work in countries with health care systems that provide better compensation and conditions. The UK provided Australia with 13 percent of its general practitioners and 22 percent of its specialists in 2011. There was a 17 percent increase in the number of British doctors working in Australia and New Zealand between 2014 and 2016. This mass migration of medics has led the UK, one of the world’s richest countries, to suffer from a “brain drain,” a phenomenon usually associated with developing nations.

The truth is that the UK is failing to retain and attract the “best and brightest” on the international stage. The NHS is competing with international health care systems for the global medical labor market. Unable to win this competition, the UK is seeing an exodus of talented clinicians, academics, and health leaders to other countries that are providing more lucrative work with the bonus of a more comfortable lifestyle.

Pay and work conditions are not the only factors, but they are certainly the most powerful by a large margin, compelling many doctors to leave their jobs in the NHS and move overseas to perform the same job in a new health care system. Due to government negligence, the UK is simply not keeping up, and this should worry us all.

The migration of thousands of doctors from the NHS — what health care professionals have colloquially come to call “Drexit” — has had disasterous long-term effects on the service. According to one study from 2021, 89.7 percent of doctors who left the NHS did so because of pay dissatisfaction, with the overwhelming majority of them reporting being satisfied with their overseas pay. Another issue pointed out by this same study is that burnout played a role in motivating doctors to leave the NHS. This burnout was resolved when they entered training programs overseas in 89.2 percent of cases.

With medicine in the UK becoming a comparatively unappealing and unattractive prospect, can we blame doctors for seeking better prospects elsewhere? Right now, it’s a no-brainer — and that fact is unacceptable for any government to run away from.

The Danger Is Not a Four-Day Strike but Years of Government Negligence

The decision to strike is not an easy one, but the British public should be reassured that junior doctor strikes are both safe and legal. In an international study, a systematic review found no evidence whatsoever that junior doctor strikes cause any impact on hospital patient deaths.

We do acknowledge the disruption caused by the four-day strike to outpatient procedures, and we sympathize with our affected patients. However, I implore you to ask, what is more chaotic: a four-day strike by doctors fighting for a better, safer NHS, or thirteen years of NHS mismanagement leading to innumerable delays and dangers to patients? This mess lies at the door of successive Conservative governments.

During the winter, Britons saw a revolving door of injustice, with patients languishing in corridors desperately pleading for a bed that would have once existed were it not for relentless cuts to the NHS budget. Seeing the heart-wrenching statistics that emergency room delays cause up to five hundred deaths a week came as no surprise to health care workers like me — that’s how horrific the situation has become.

Of 125 hospital trusts in England, only three hit the standard of treating 85 percent of patients within two months of an urgent referral — a number dangerously below the target due to chronic staff shortages. The operations being canceled due to the junior doctor strikes pale in comparison to the three hundred thousand operations canceled in the past three years due to chronic staff shortages.

Rational, Not Radical, Pay Restoration

The truth that even Britain’s secretary of state for health and social care, Steve Barclay, cannot escape is that the junior doctor pay demand makes economic sense as well as common sense. NHS spending on locum tenens agencies rose by 20 percent last year: a symptom of the chronic medical staffing crisis. In total, an abominable £500 million was wasted paying these “middleman” agencies. The NHS spends £3 billion to plug the gap, whereas fixing the long-term doctor shortage with a fair pay restoration would cost only £1.03 billion. It would be reckless of the government and Barclay to dismiss this.

Doctors and their patients ought to stand united against the perils of government incompetence that have led us to the chronic staffing crisis years in the making. That is the real danger. A win for doctors is a win for our patients — repairing what we have lost from our beloved NHS. Finally, to those ministers clapping at us throughout the pandemic: I implore you to put your hands in your pockets to reinstate our pay and protect our patients instead.