Re:View 25 July 2025
Research Manager and Head of Health
Quote of the week
“After a 28.9 per cent pay hike in the last three years and the highest pay rise in the public sector two years in a row, strike action is completely unjustified, completely unprecedented in the history of British trade unionism and shows a complete disdain for patients and the wider recovery of the NHS.”
Wes Streeting, Secretary of State for Health and Social Care
Happy Friday! This week MPs have packed up shop for summer recess. But while parliamentarians might be relaxing for summer, it is safe to say the British Medical Association (BMA) certainly is not. Today is the first day of a five-day walkout by resident doctors. This is, remarkably, their twelfth strike since March 2023.
Tolerance from all sides is wearing extremely thin. The public lack sympathy, the Government lack patience, hospital leadership lack goodwill and the BMA lack… well, apparently every single thing they have ever asked for.
There are numerous ways to analyse the strikes. First, the legitimacy of them – a complicated quagmire that combines legitimate misgivings with their working conditions with more than a few questionable comparisons and statistics. Second, what the litany of potential outcomes could mean for wider NHS workforce pay expectations and in turn, its fiscal sustainability.
Third, how these strikes, and the potential workforce and pay implications, align with the longer-term goals of the NHS – to shift to a more community, not hospital-based, system. And fourth, what such increases in pay would mean for the wider public sector.
Generally, all of the policy considerations point towards interventions that do not involve excessive sums of money. At a very basic level, the BMA’s numbers are misleading – whether you believe they are owed full pay restoration or not, the numbers do not add up. The use of Retail Price Inflation (RPI) rather than Consumer Price Inflation (CPI) is almost universally discredited and inflates their assessment of the scale of pay restoration ‘owed’ dramatically.
Using CPI, based on the 2024 settlement, average real-terms pay has in fact increased by 7.9 per cent since 2015-16, and is now only 1.6 per cent below 2010-11 levels (but this number becomes 15.5 per cent using RPI).
By contrast, their working conditions are actually mired by avoidable unpleasantries. These are much less costly to fix and, as the BMA will know, are not settled by pay negotiations. Doctors can’t get hot food out of sociable hours, often pay obscene prices for parking, have a terrible work life balance with little flexibility in their rotas, receive little development support and mentoring, among many other grievances. This needs fixing, but not via six months of strikes.
This is clearly an unenviable task for the Government but they are right to hold their ground. Disproportionately large pay settlements for one staff group would fail on all four major policy considerations. It’s the government’s job to ensure the NHS works for everyone – patients and the taxpayer – not just the vocal minority.
Read of the week
I’ll admit that I used to be a devolution sceptic. I am now converted (in no small part to our fantastic ‘Re:Imagining the Local State’ workstream), but it is for this reason that I enjoyed this excellent article exploring the three main justifications for English devolution which have been proposed by various governments, and whether these justifications in fact conflict with one another.