Wash your hands. Wrap up warm. If you think you’re coming down with something, kindly avoid spreading it to others. It may sound alarmingly basic, but this is the advice being given to anxious patients to try to keep themselves out of hospital as the NHS holds its breath during the latest, and potentially most dangerous, junior doctors’ strike.
Once again, much-needed operations and appointments have been cancelled and rotas ripped up to provide a bare minimum of emergency care for the six days of the strike, but things are stretched perilously thin: Cheltenham A&E has already closed for the second time in a month, a critical incident (meaning trusts are under exceptional pressure and need to suspend some routine functions) has been declared across Nottinghamshire, and up to 20 trusts have already triggered the formal emergency process for asking doctors to come back and pitch in, though the British Medical Association has questioned whether this safety valve is now being misused. The breaking point of the NHS, so long predicted throughout this year-long campaign of industrial action, seems very nearly upon us.
If all this feels uncannily like last January then there is one critical political difference. Last year, widespread public sector strikes were a disaster for the government, underscoring a fatal sense that everything was broken and the country falling apart. Conservative attempts to turn the resulting anger and frustration back on the strikers failed because public sympathy in a cost of living crisis was with those enduring years of pay freezes, even if they were making everyday life difficult for many. Last year, Labour could get away with little more than calling for ministers to get back round the table and privately crossing their fingers that the various disputes were settled before they were pressed too hard about what a Labour government would do instead.
But a year on, though the big teaching unions have settled their claim, junior doctors seem resolved to keep the dispute boiling until they get far closer to the 35% they are demanding. Tube workers are walking out yet again next week and the Royal College of Nursing remains in formal dispute with the government over pay, despite failing to renew its mandate for industrial action in last June’s ballot: unhappiness about pay still bubbles below the surface across the public sector. With a general election now on the horizon, MPs are starting to talk about the prospect of strikes straddling two administrations. Will some calculate that if they hold out a few months longer their pay deals would be done by a Labour government, which might find them politically harder to refuse? By publicly readying for a spring election, no matter how unlikely some think that is in practice, the government has opened up that possibility.
Steve Brine, the former Conservative public health minister who chairs the health select committee, has argued that neither main party can afford to give junior doctors what they want, in what sounded like a veiled warning not to string negotiations out in hopes of political change. Meanwhile shadow health secretary Wes Streeting is giving little sign that Labour would be more generous and must know that if he does, junior doctors will only be encouraged to wait this government out, with painful consequences for patients.
Yet increasingly this strike seems to be about more than just pay or even the crumbling state of the NHS: it’s both more political and more fundamental than that. Junior doctors’ leaders seem intent on driving change within their institutions and shifting broader attitudes to public services, but their battle has also become emblematic of a wider struggle among young professionals in seemingly good jobs to buy a house, cover the nursery fees and build the kind of life that used to come with a graduate salary. If Labour has answers to that deeper malaise, they are not quick or easy. While Streeting clearly longs to move on and talk about reforming preventive care, or how technology can transform services, the junior doctors are awkwardly probing Labour’s sore spot – which is that reform is necessary to putting the NHS back on its feet but obviously not sufficient. Somehow, from somewhere, there will have to be more money than currently promised. It is Labour’s sheer bad luck to reach the verge of power just as the professional goodwill that has kept this whole show on the road for years is evaporating.
If Rishi Sunak means what he said last January about cutting waiting lists – and don’t underestimate how angry the Tories’ ageing electoral base is about the fact that they have risen substantially instead – then he should find a way to settle fast, which would almost certainly save lives. But in crude political terms, it’s already probably too late for him to feel the benefit when the effects of this January’s stoppages alone on an already substantial backlog will be felt for months to come.
Meanwhile, Labour is now deep into the era that is an opposition’s blessing and its curse, where power shifts decisively away from a government on its way out and all anyone wants to know is what the next lot would do instead. Keir Starmer deserves more credit than he gets for having coaxed the Labour party to this point, less than five years after a catastrophic loss. But he will need all the cunning that required and more to negotiate the challenges of victory.