Mirror Health Editor Martin Bagot breaks down what the Government’s position is – and why the doctors’ union is holding out for more
The increasingly bitter dispute between doctors’ union leaders and Wes Streeting has now apparently resulted in a staggering £3 billion cost to the NHS.
Just as doctors downed their stethoscopes for the 15th time on Tuesday, Health Secretary Mr Streeting told broadcasters that this could have paid for two new hospitals to be built. Doctors responded by saying he could have settled their dispute for £2 billion. These were the latest salvos in the claim-and-counter-claim between Mr Streeting and the British Medical Association (BMA), which has proven itself to be one of the most effective unions in the country in mobilising sustained industrial action from its highly educated members.
But most people will be asking, who is being unreasonable here? Here we will examine the case of both the Government and the BMA in this costly dispute for the NHS which has now dragged on since 2023 and resulted in hundreds of thousands of hospital appointments being cancelled.
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This industrial dispute started back in March 2023 when Rishi Sunak was Prime Minister and Conservative governments had overseen over a decade of pay erosion for public sector workers. “Pay restoration” was the demand from resident doctors – then called junior doctors – who had seen their real terms pay cut by around a quarter since 2008.
The Case For Strike Action
By the retail price index (RPI) measure of inflation resident doctors have now seen their real terms pay eroded by 21% since 2008. This is in large part because pay rises in recent years were swallowed up by high inflation triggered by the catastrophic Liz Truss government and the time taken for this to fall.
The BMA wants the government to work towards restoring pay to 2008 levels, which would mean a further 26% rise after inflation is taken into account. Its Resident Doctors Committee (RDC) says this does not have to be achieved in one year, but they require a multi-year commitment to above-inflation pay awards to get back to the 2008 level.
Trade unions prefer the RPI measure of inflation because this includes mortgage and rent costs and is usually slightly higher than the alternative consumer price index (CPI). The BMA says it uses this method because it is also used to calculate interest on student loans. The latest RPI rate was 3.6% as of February while CPI was 3%.
Put simply, the BMA believes that full pay restoration to 2008 will never be achieved without the threat of sustained industrial action. And with RPI inflation running at 3.6%, their headline pay offer of 3.5% is still a real-terms pay cut.
Add to this the fact that the pay settlements for the 2026/27 financial year were decided when inflation was coming down and independent experts expected to drop below 2% later this year. The US war with Iran has changed that inflation is now expected to rise.
RDC chair Dr Jack Fletcher said: “What the Health Secretary is asking us to reconsider now is essentially will you bake in more real terms pay cuts, not just this year, but for future years? So we’re more than willing to reconsider, or meet the Health Secretary and reconsider any offer that he puts to us. However, we can’t accept further real terms pay cuts.”
The BMA says doctors have also experienced a deterioration in working conditions and warns that more doctors could leave the UK if the situation is not resolved.
The Case Against Strike Action
Wes Streeting has preferred to focus on the before-inflation pay rises that resident doctors have been granted since Labour came to power in 2024. The Health Secretary has stressed that the deal he put to them would have seen resident doctors 35.2% better off than they were four years ago on average.
This includes a headline pay rise of 3.5% pay rise for 2026/27. Mr Streeting says the overall package of measures for this financial year would have led to resident doctors getting an average pay rise of 4.9%. This included reimbursement for exam costs and an additional 1,000 medical training places.
The Government says that, despite receiving the best pay deal in the public sector in recent years, doctors are striking and forcing worse paid NHS staff to cancel holidays to cover their shifts. Most other NHS staff including nurses and midwives have only been offered 3.3% for 2026-27. Other public sector staff including 1.5 million council workers have been awarded a 3.3 per cent pay rise.
Mr Streeting said: “The fact is that with the BMA, the only thing that stops them from striking is a level of funding that is simply unaffordable given the state of the public finances, the challenges in the economy, the state of the world frankly and the issue of fairness to other NHS staff and other staff across the public sector.”
Another point made by Mr Streeting is that the 2008 high water mark on doctors’ pay has been chosen deliberately by the BMA and he argues it is unreasonable to expect this Government to reverse such pay erosion so quickly. Mr Streeting has made the point that doctors are likely to get a much worse deal should Labour lose power at the next General Election.
Mr Streeting asked the BMA to “stop pretending to their members” that he can solve all the issues facing resident doctors in less than two years in power. The Health Secretary told BBC Radio 4’s Today programme: “They seem to think that this Government should, within two years, do something that it took the last Labour government more than a decade to achieve.
“And the reason they peg back to 2008 is because after more than a decade of Labour government they had seen year on year pay rises, they were much better off thanks to Labour. I don’t pretend that I have solved all of the issues facing resident doctors in less than two years. All I ask of the BMA is to stop pretending to their members that I can.
“Look at the state of the public finances, look at the state of our public services and look at the state of the world, and in the context of having been the standout winner across the entire public sector I think the BMA really need to consider whether their action is reasonable in that context.”
So Who Should We Believe?
The particulars of the pay deal are still slightly obscure and the latest strike dispute centres on claims by the BMA that the Government made “last minute changes” to the deal so that some aspects of the pay increase was phased in over three years. NHS leaders have disputed this and criticised the RDC for not putting the offer to its members for a vote and instead deciding to reject it.
Mr Streeting added: “What we have seen in the last few months, is that these people will get around the table, negotiate apparently in good faith, the BMA officers who we are negotiating with promised to take the deal that we negotiated to their committee, to recommend it to their committee, and then their committee rejected it, despite there being a 4.9% average pay rise, the training places, the scrapping of exam fees, action on pay and jobs that they were calling for. In the end, there is only so much that we can do as the Government, because it takes two to tango.”
RDC chair Dr Jack Fletcher told Times Radio: “This action was avoidable. This round of action was called because at the last minute, the Health Secretary chose to reduce the value of the investment on the table and then stretch it over a number of years. We gave him several opportunities to reverse that decision, and the Government decided not to.”