Britain's NHS strike: Doctors want more pay

Aditya Nambiar knew he wanted to work for Britain's National Health Service even before he began his medical studies in 2012. But the junior doctor, who now works in the southern city of Brighton, has seen many things in the past few years that have saddened him: long lines for emergency care, short-staffed hospitals and a lack of beds.

"You go away from a shift thinking you could have done loads of good things, but you come away just thinking you've done absolutely nothing good to those people because their basic human needs haven't been met. This is really horrible," the 29-year-old told DW by phone from his northern English hometown, Scarborough.

That's part of the reason why he personally supports a strike being held by early-career public sector doctors in England since Wednesday morning. Emergency care continues, but many appointments will be delayed. Nambiar doesn't believe it will endanger patients in any way, since senior doctors will still be on hand.

'We would much rather be at work'

The big motivation for this strike is pay. The planned six days of labor action, set to be the longest in the NHS' 75-year history, is aimed at securing a 35% wage increase for England's 75,000 junior doctors as the cost of living booms across the United Kingdom. According to The Guardian newspaper, junior doctors have already received an average 8.8% pay increase, with a further 3% possible this year.

The walkout is one of a flurry staged by NHS workers across the four devolved services of England, Northern Ireland, Scotland and Wales in the past year. They used to be a very unusual occurrence: nurses from the Royal College of Nursing went on strike for the very first time in the union's 107-year history in late 2022. The trend underlines the serious strain on what, for many Brits, is a highly valued but increasingly frustrating public service.

On leave to study for exams when he spoke to DW, Nambiar wasn't taking part himself this time. He did strike last year, however, and would do it again, he stressed.

Amid high inflation, the union organizing the strike, the British Medical Association, said junior doctors' real-terms pay has decreased by one-quarter since 2008.

"A crippling cost-of-living crisis, burnout, and well below inflation pay rises risk driving hard-working doctors out of their profession at a time when we need them more than ever," the union said in a written statement on Wednesday. Speaking from the picket lines in London, BMA member and striking doctor Rob Laurenson told broadcaster ITV he and his colleagues "would much rather be at work."

Industrial action with a price tag

The length and timing of this particular strike have not escaped criticism and negative press coverage. "January is typically the busiest time of the year for the NHS, and these strikes will have a serious impact on patients across the country," Health Secretary Victoria Atkins said in a written statement on Wednesday, urging the BMA to call them off.

Some 1.2 million appointments have already been moved since NHS industrial action began last year, Atkins said. In early November, NHS England estimated that more than 40 days of industrial action so far in 2023 had already cost around £1 billion (€1.15 billion/$1.2 billion). Speaking with local media, NHS officials and several charities expressed concern in the run-up to this week's strike, which should end Tuesday.

A once groundbreaking system under pressure

Despite the strikes, the NHS and its workers have a special place in the hearts of many Brits. Founded in 1948 in the wake of World War II, it was one of the world's first comprehensive health care systems to be offered to everyone, rich or poor, largely free of charge at the point of care.

While other European countries fund their health systems through specific insurance payments and the United States mainly through private contributions, the NHS is funded out of the general tax pot.

However, as the British population has grown and aged, the NHS has also gotten more expensive to fund.

When it was set up, it cost the government about 3.5% of the country's gross domestic product each year. In 2019, the government spent 7% of its GDP on the NHS, according to official statistics. On top of this comes individual expenditure on services not comprehensively covered by the NHS, like dentistry and eye care.

'A decade of underinvestment'

By any measure, the last 10 years have been difficult for the NHS. An investment boom in the early 2000s ended after the 2008 financial crash. In the 2010s, the center-right Conservative government imposed austerity measures, and the rate of spending growth trailed far behind the increase in costs.

While the government argued that belt-tightening was necessary, many experts warned it negatively affected performance and left the service poorly prepared for the COVID-19 pandemic.

"The NHS has endured a decade of underinvestment compared to the historic average," the executives of three major health foundations wrote last year in an open letter addressed to the major political parties.

"As a result, the health service has insufficient resources to do its job: fewer hospital beds than almost all similar countries, outdated equipment, dilapidated buildings and failing IT," the heads of the Nuffield Trust, the King's Fund and the Health Foundation wrote.

One study published in the Journal of Epidemiology and Community Health in late 2022 even linked approximately 335,000 additional deaths between 2012 and 2019 to austerity policies.

Pandemic pandemonium

And then came the COVID pandemic. Nambiar was already a junior doctor in early 2020. "It just was very emotionally taxing. It's hard as a junior doctor because I felt like I wasn't able to contribute enough in that situation," he said.

The onus fell mainly on senior doctors and on nurses, particularly in intensive care, he explained. But he did his best to help things run smoothly. "I was just really tired and burnt out, which I think a lot of my colleagues were at the end. We felt undervalued," he said.

He is also unhappy with the way the government handled the pandemic, with Britain being hit particularly hard by many measures compared to similar countries. Former Prime Minister Boris Johnson was eventually fined over a birthday celebration held in Downing Street in June 2020 that caused widespread public outrage. In December 2023, he apologized to COVID-19 victims, admitting some mistakes were made.

"Obviously seeing a Conservative government not really take any real heed from the medical professionals that were giving them advice on how to manage the pandemic… it was just another strike against them in terms of losing confidence in what they were doing for us," said Nambiar.

What next?

The last two years have seen a spike in industrial action in general in the UK, which is normally less prone to walkouts than France or Germany. In fact, according to Nambiar, this strike is partly inspired by successful outcomes in wage negotiations seen already in the NHS and the rail sector.

With general elections expected this year, health care is likely to be an important issue. In December, 69% of respondents to a YouGov survey answered that NHS services were "bad" compared to 21% who said they were "good."

After close to 14 years of Conservative rule under five different governments, the winds of change are in the air. Approval for the government led by Prime Minister Rishi Sunak is low. The center-left opposition Labour Party is polling at 43% compared to 25% for the Conservatives, according to news outlet Politico.

In May, Labour leader Keir Starmer said he would invest in the NHS if voted into power, but was criticized for a lack of clarity about spending plans. With the British economy sluggish, the next government will not have much breathing room for additional investment.

When it comes to this week's strike, Nambiar is well aware that his £42,000 (€48,600 or $53,200) basic salary (not including extra pay for weekend, early and late shifts) is far above the national average. He is not expecting a 35% pay rise — at least not immediately.

But he hopes the strike pressures the government to spend more. "We want guarantees about working conditions and we also want guarantees about investment in the NHS," he said.

Edited by: Michaela Cavanagh