Kate Andrews Kate Andrews

A stand-off between Labour and the BMA is coming

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Junior doctors will be staging yet another walkout in the week running up to the election: five days in total, from 27 June to 1 July. It is the 11th walkout since March last year, as the union insists they will not settle for less than a 35 per cent pay raise.

The dates are no coincidence: there is no moment more politically fueled than the run-up to polling day. This gives more weight to the government’s argument that these strikes have always been political in nature, and certainly resulting in political consequence: the NHS waiting list rose by roughly 500,000 after Rishi Sunak pledged to get the waitlist falling, due in part to hundreds of thousands of delayed appointments and operations thanks to the strikes. 

This next strike will put at the front of the public’s mind how strained the relationship is between the Tory party and the British Medical Association (BMA) – one that polling suggests has garnered more sympathy for the doctors than for ministers. But this strike is not just aimed at the Tories. It is sending a message to Labour, too: with the expectation that Wes Streeting could be taking over in the Department for Health and Social Care rather soon, the union wants to make clear now that its pay expectations remain unchanged.

This is perhaps the greatest challenge for the shadow health secretary, were he to find himself in charge. And that’s saying something: Streeting has already had plenty of battles with the BMA (and GPs, and the left of his own party) as he has ramped up his rhetoric of ‘reform’ for the NHS, repeatedly promising to use more of the private and independent sector, while insisting that more money for the NHS will only come if efficiency and productivity improves, too. 

But pay could prove the trickiest one yet, not least because Labour seems to have spent all the money it says it will raise with new taxes, and that doesn’t include a 35 per cent pay bump for doctors. Streeting isn’t pretending otherwise: ‘I want to be really upfront with junior doctors this side of the election,’ he said on ITV this morning, ‘the 35 per cent pay claim they’ve put in, I’m just not going to be able to afford that on day one of a Labour government.’

This is not going to be a popular view in the medical community, which is increasingly willing to admit that they understand the link between these strikes and patients waiting longer for care. Comments from Professor Philip Banfield, the chair of the BMA Council, were put to Streeting on the Today programme this morning. ‘It’s quite a challenge for Labour,’ the union representative said. ‘Remember the junior doctors remain in dispute with government. This needs to be sorted out before the waiting list can be progressed.’ Streeting’s response was not to offer up more cash right away, but insisted that the way to get more money for public services and pay is to go for growth. It’s consistent with Labour’s position right now – to be extremely cautious about its spending plans – but it is certainly not the answer the BMA is looking for.

The risk for Streeting is that these strikes continue under a Labour government – that he finds it just as hard to reduce the NHS waiting list as the Tories have done. Labour likes to claim that the wait list could rise further under the Tories – by calculating how much it has risen under Sunak already – to 10 million by 2029. But estimates from the Institute for Fiscal Studies show a drop is coming, one that is likely to benefit whoever is in charge, so long as that trajectory isn’t made intentionally worse by patients made unable to attend their appointments.

Streeting has a lot to accomplish. He and Starmer have given themselves five years to once again meet NHS waiting targets, to deliver 40,000 more GP appointments every week (offered out of hours and on the weekends, too) and to incorporate pragmatic use of the private and independent sectors to get patients faster access to high-quality care.  There is a very real chance that were Labour to win power, most of its first term in parliament would be spent still missing targets, overseeing a sky-high waiting list. Reform would need to start on day one to create the change it hopes to see in five years’ time. That’s going to be a hard enough task, without the added (and increasingly likely) complication of a government still in dispute with its workforce.