Decoding the junior doctors’ strike – from patient safety to public support

Good morning. It is never a good time to be seriously ill, but this week is worse than most. The NHS is in the grip of its customary winter crisis, which typically peaks in early January. More than 125,000 posts are vacant, and about 6.5m people are on waiting lists for routine appointments, more than a million of them for more than one procedure.

Today, junior doctors in England go out on strike again, for six days. (A pay deal has already been reached in Scotland, while doctors in Wales are due to strike later this month and those in Northern Ireland are currently being balloted.) Almost a year after the first strike over pay and conditions, the dispute still appears a distance from being resolved.

As the strikes rumble on, both sides have lines that they stick to – and in the heat of the debate, it can be hard to know what information you can trust. Today’s newsletter factchecks the claims and counterclaims. Try not to catch anything while you read it, and here are the headlines.

Five big stories

In depth: As both sides stick to their guns, what is the reality behind their claims?

As this email is sent, junior doctors are starting a strike that will continue until 7am on 9 January – and while the new health secretary, Victoria Atkins (pictured above), is on slightly better terms with the British Medical Association (BMA), which represents junior doctors, than her predecessor, Steve Barclay, the two sides are still a long way apart. Andrew Gregory’s Q+A has all the details. As you hear those two sides give media interviews this morning, here’s some help with interpreting what they have to say.

Claim: The strike could put patient safety at risk

Six days of strike action following bank holidays at a time of enormous pressure, there are real issues around patient safety”

NHS Confederation chief executive, Matthew Taylor, 23 December

The junior doctors have timed their strikes for maximum impact throughout the dispute – as you would expect any group of workers to do. But this one is at a new level, with 144 hours of uninterrupted stoppages during what is typically the most pressurised week of the year. The NHS Confederation, which represents hospital trusts, says that many trusts will be in a “highly vulnerable position”.

Emergency care will still be provided – but tens of thousands of procedures will be postponed, with cancer patients and people with sight problems among those affected. (A three-day strike last time saw 90,000 appointments and operations delayed.) If a hospital finds itself facing an unpredictable emergency, this joint letter (pdf) from the BMA and NHS England explains that staff can be requested to return to work. The BMA says that it will only agree to such exemptions if all other avenues have been exhausted.

In this story, Denis Campbell reports that health trust leaders fear such requests could take too long to consider, or spark differences in interpretation of what constitutes a major incident. The BMA rejects that but warns that the derogation process should not be used simply to ease more routine pressures.

There have been claims that a rise in excess deaths last year could have been caused by strikes, but there is no hard evidence of a link. While there is limited research available on last year’s action, a study of junior doctors’ strikes in March and April last year in the European Journal of Emergency Medicine found that mortality rates in emergency departments were similar to non-strike days. (One author is affiliated to the BMA.) A recent study looking at a 2016 junior doctors’ strike found no impact on mortality or readmission rates for emergency patients overall – although there were higher readmission rates for black emergency patients.

Meanwhile, although Rishi Sunak has previously blamed striking NHS workers for record waiting lists, research by the Health Foundation in October found they were responsible for just a 3% increase. The BMA has argued that this suggests doctors are being scapegoated by the government for a far deeper problem.

Claim: Junior doctors’ pay has been severely eroded over the last 15 years

Junior doctors’ pay has been cut by more than a quarter since 2008”

BMA website

So far, junior doctors have received an average 8.8% pay increase, with an additional 3% on the table this year. The BMA is asking for 35%, to restore pay to where they say it was 15 years ago – although they have also said “we recognise it would be reasonable to do it over a few years”, meaning that the gap between the two sides is a bit smaller than it sounds.

There is no doubt that junior doctors’ pay has fallen significantly in real terms; exactly how much depends on how you calculate it. The BMA arrives at its figure by using the retail prices index (RPI) to measure the impact of inflation on salaries. It says that this gives a 26.1% loss of earnings since 2008. But the Office for National Statistics said in 2018 that RPI is “a very poor measure of general inflation”.

The Institute for Fiscal Studies views a measure with the not-so-catchy title of consumer prices index including owner occupiers’ housing costs (CPIH) as more accurate. The IFS says that using CPIH gives a real terms pay cut of somewhere between 11% and 16% since 2010.

But not everyone agrees with that analysis of the best figure to use. The Royal Statistical Society said after a 2020 consultation with its members that “CPIH is a macroeconomic indicator that is good for gauging the general performance of the economy, while RPI is intended to reflect changes in the cost of living”. That aligns with the BMA’s position.

The figure also depends on which year you use as the baseline, of course: while the change is more severe against 2008, most similar measures are compared with 2010, when the coalition government came into power and after the financial crisis. But it’s worth noting that doctors have fared worse in the austerity era than many other occupations, as this chart makes clear.

Claim: The public support the junior doctors

The public know the only way to have a healthcare system that looks after them is to have enough doctors. And they can completely appreciate [that junior doctors’ pay] is just not enough”

Dr Vivek Trivedi, co-leader of the British Medical Association, 20 December

This is pretty simple to answer: support for the junior doctors remains strong, according to the most recent polling. In September, Ipsos found that 53% of the public back the doctors – less than ambulance workers and nurses, but more than consultants, and more than striking workers in any other sector. That has dropped just one percentage point against the same survey in April last year.

A YouGov poll in September found that voters blamed the government more than the BMA by a margin of 45% to 21%. A Christmas poll, also by Ipsos, put NHS staff at the top of the “nice list” – rating above teachers, the England Women’s Football Team and David Attenborough. Of course, all of this could change as the strikes wear on. But claims that, for example, “with every new walkout, [junior doctors’] reputation plummets further” are wide of the mark so far.

Claim: Junior doctors are refusing to hold talks; the government is refusing to make an offer

They have taken the decision to walk away from the discussions we were having, which were live”

The health secretary, Victoria Atkins, 13 December

I mean even recently the secretary of state has said they have a final offer to give. Well then give it and let’s solve the dispute”

Dr Rob Laurenson, co-leader of the British Medical Association, 30 December

Both sides are casting the failure of talks in terms that present themselves as willing to negotiate and the other side as intransigent – and both are right, up to a point. After five weeks of negotiations broke down at the beginning of December, the BMA said that the government’s 3% offer was not credible. But Victoria Atkins claimed that “we had not in any way made a final offer”.

Now Atkins is urging the BMA to “come back to the table”. But that apparently broad offer is contingent on cancelling the strike, which the doctors are not prepared to do.

Matthew Taylor of the NHS Confederation summarised the situation before Christmas: “It appears that the BMA won’t enter talks unless the government commits to some extra money; the government won’t go into talks until the BMA calls off the strikes.” He suggested that while both sides feared that relenting would reveal weakness, “from the perspective of the public, patients, or other people who work in the NHS, anyone who moved first, I think, will get a great deal of credit for that”.

In summary: the talks appear to have broken down because of the fundamental gap that remains between the two sides, rather than because either is more unreasonable than the other. Until some progress is made on that underlying point, the dispute is likely to continue.

What else we’ve been reading

After all 379 people aboard a blazing Japan Airlines jet (above) survived its collision with a coast guard plane, Justin McCurry has a report on how their remarkable escape unfolded. Archie

For those looking for new music, Ben Beaumont-Thomas and Laura Snapes have compiled a brilliant list of fresh new acts to sink your teeth into. Nimo

The FTSE100 has celebrated its 40th birthday. Nils Prately chronicles its rapid rise and its subsequent stagnation. Nimo

As you try to make sense of the Home Office’s triumphant announcement that it has cleared the asylum backlog, Diane Taylor’s expertise is very helpful. Her unpicking of the detail presents a much less glorious picture. Archie

Rachel Bloom’s parodic style in her musical sitcom Crazy Ex-Girlfriend won her awards and acclaim. Now she’s taking her talent to the stage, in a one-woman off-Broadway production that forces Bloom and the audience to relive the pandemic. Emily Gould’s New York magazine interview unpacks why her subject (pictured above) is revisiting such a traumatic period, night after night. Nimo

Sport

Darts | Sixteen-year-old Luke Littler (above left) has become the youngest ever player to reach the decider of the World Darts Championship, securing his place in the final with a 6-2 win over former champion Rob Cross. Commentator Rod Studd compared Littler with “Usain Bolt running 9.6, easing up at the end”. He will face world No 1 Luke Humphries, who beat Scott Williams 6-0.

Football | A defiant performance from goalkeeper Alphonse Areola helped West Ham to a 0-0 draw against Brighton. In a game where both sides were depleted by injury, Brighton created the better opportunities but could not find a way to score.

Football | Wayne Rooney has been sacked by Birmingham City after 83 days. Rooney lost nine of his 15 matches and supporters turned on the former England and Manchester United captain during Monday’s 3-0 defeat by Leeds.

The front pages

The Guardian leads with “Israel assassinates senior Hama leader in Lebanon” and the Daily Telegraph has that too: “Israel kills top Hamas leader in Beirut”. “Curb the NHS fat cats on £300,000” – the Daily Mail thinks it has found the problem with the health service. “Million cancellations for patients in doctors’ strike” says the Times while the Daily Express has “Six-day junior doctors’ strike ‘act of cruelty’”. “Why STILL no justice?” asks the Daily Mirror, about the Post Office prosecutions scandal. “We escaped from hell” – the Metro leads on the Tokyo plane crash, which many papers have that as their front page picture. The Financial Times’ top story has been coming for a while now: “Tesla loses crown as world’s top electric car maker to China’s BYD”. The splash in the i is “2024 mortgage price war begins as lenders slash interest rates”.

Today in Focus

Cartoon of the day | Martin Rowson on Rishi Sunak

The Upside

A bit of good news to remind you that the world’s not all bad

Over the last century the number of tigers in Thailand had plummeted due to widespread poaching and habitat destruction. By 2007, there were only 46 tigers in the Thungyai-Huai Kha Khaeng wildlife sanctuaries and, despite significant conservation efforts, scientists had not detected cubs born in the area a number of years. The situation has finally taken a turn, after hidden cameras revealed a rare sighting of a mother and her cubs (pictured above), indicating that the species is breeding. The cameras also detected 120 tigers during an exercise that concluded in April 2023, which is up from 100 the previous year.

Sign up here for a weekly roundup of The Upside, sent to you every Sunday

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And finally, the Guardian’s puzzles are here to keep you entertained throughout the day – with plenty more on the Guardian’s Puzzles app for iOS and Android. Until tomorrow.

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