I believe firmly in the importance of unions – in standing up for workers’ rights, ensuring fair pay and securing decent working conditions. Those principles matter, and they always have.
Yet I am increasingly concerned that the proposed strike action being driven by the British Medical Association (BMA) may not be in the best interests of doctors, our patients or the wider public. There is a growing sense that the conversations taking place behind closed doors are not being conducted with the transparency or balance that these times demand.
It feels, instead, as though a vocal minority may be steering the direction of travel. Resident doctors have only just voted to end their dispute after three years of strike action, which caused hundreds of thousands of appointments to be cancelled. It’s not fair to patients to inflict yet more uncertainty on them.
I would absolutely welcome better pay. But I think it is also important to acknowledge that, as consultants in the NHS, we sit within some of the highest-earning groups in the country. That reality cannot be entirely ignored when considering how this dispute is perceived, both within the profession and by the public.
The BMA says average consultant pay is 26 per cent lower in real terms than it was 17 years ago, but that was in 2009, in the wake of the financial crash. Since then, huge swathes of society have seen their pay stagnate.
There are clearly multiple problems within the NHS, and there is no point pretending that the system is working seamlessly. Waiting times for outpatient appointments remain a concern, accessing primary care and specialist services is difficult for many patients, bottlenecks affect inpatient flow, and delays in discharge are frequently driven by limited social care provision. All of that is real, and I would not wish to minimise it.
Moreover, NHS consultants have been squeezed by management, which is eager to get every pound it can out of them. Managers are micromanaging the job and undermining consultants’ sense of autonomy. It is causing immense anger, and I am sure this is one of the factors driving the move towards strike action.
But the context is important.
We recently had a visiting resident doctor from a war zone in another part of the world, who reflected on their experience of the NHS. They noted that, while it may feel unacceptable to provide care in a corridor, those same patients still had access to the best available antibiotics. Their corridor consultations were being delivered by specialists who simply did not exist in their home country. It was a striking observation, and one that has stayed with me.
We may reflect on how difficult it can be to secure an urgent review for minor ailments. As a society, we have become familiar with the Amazon Prime-style convenience. This clearly does not exist in the NHS. Yet, when we consider the care we provide for truly life-threatening conditions, such as sepsis or cancer, it becomes much harder to find international comparisons where care is delivered more efficiently or effectively.
Through the National Institute for Health and Care Excellence, we have near-universal access to state-of-the-art treatments. The presence of clear guidelines and structured clinical pathways creates a remarkable degree of consistency across the country. That uniformity may not always feel equitable from the inside, but from the outside, it is extraordinary – a healthcare system delivering care at scale across a diverse population, spanning both urban and rural environments.
Consultants are fundamental to the delivery of all of this. I am enormously grateful for the colleagues I work with, and it is important to remember why we do what we do. The purpose of becoming a doctor is, fundamentally, to care for the sick, not to become rich.
Of course, medicine should provide a stable income and a level of remuneration compatible with a reasonable quality of life. I am not denying that. But at this moment, with wars ongoing and a difficult economic climate, arguing primarily for increased pay feels somewhat misguided. Surely, there must be a better way to negotiate with the Government. Surely, there must be a more measured approach.
I am worried about the prospect of consultants striking. With the resident doctor strikes, it was easier to absorb the impact because responsibilities could be covered. But I feel very uncomfortable about harm occurring as a result of industrial action. As a consultant in an outpatient-based speciality, it is very hard to cancel patients you know, especially those who have been waiting a long time to see you.
There is, therefore, a difference between saying that I have voted for strike action and actually going on strike. I would need to be absolutely sure all other avenues had been exhausted, which I really do not think they have. The Government seems willing to have conversations and discuss the problems.
Surely, we should be doing everything possible to avoid strike action. Every time we strike, there is a risk of patient harm. And if that harm occurs as a consequence of action ultimately centred on our own financial gain, I struggle to reconcile that with the principles we signed up to when we chose this profession.
*As told to Joel Taylor.