Lord Scriven (LD)
My Lords, I thank the Minister for putting the Statement before us, but do so with a measure of frustration—a feeling shared by countless citizens. This frustration with the ongoing and deeply damaging resident doctors dispute is directed at both parties, the Government and the British Medical Association leadership. We are witnessing a breakdown in negotiation, a failure of common sense and, critically, a failure of duty towards the patients who rely on the National Health Service.
First, let me address the actions of the Government. The manner in which this dispute has been handled is, frankly, not best practice. We have seen periods of silence followed by 11th-hour media interventions by the Secretary of State. This pattern suggests not a serious negotiation but a high-stakes, last-minute political gamble, PR approach. The way the reported details of the last-minute offer were put before the public and resident doctors serves only to deepen this suspicion. This approach disrespects the process and the professionals involved. Given that the issues addressed in the Government’s 11th-hour offer have been known since the general election, why did the Government choose a high-stakes, last-minute intervention, rather than presenting the offer within a calm, realistic timeframe that could have facilitated constructive consideration by resident doctors?
Further, I must express my dismay at the tone sometimes employed by the Secretary of State. Using rhetoric that seeks to divide resident doctors from the public is counterproductive. This dispute will not be solved through grandstanding but through respect and meaningful compromise. The Government must reflect on their tone and timing.
However, the frustration I feel over the Government’s handling is matched in equal measure by my frustration over some of the tactics and demands employed by the BMA leadership. The pursuit of this round of strike action, especially scheduled at the most challenging time of the year, is, in my view, deeply irresponsible. The BMA has a singular responsibility that transcends typical union negotiations. Their members are the direct custodians of people’s health. We are currently grappling with two severe pressures on the NHS: the rising tide of flu and the deliberate scheduling of this strike to coincide with the Christmas period. To choose this time, when hospital rotas are already thin and the NHS is under maximum strain, is totally unacceptable. It shows a disregard for the welfare of the most vulnerable patients. We on these Benches wish to thank the consultants, those resident doctors who decide to go into work, and the other dedicated staff who will keep our NHS safe during this unnecessary strike, for doing the right and decent thing.
The core demand pushed by the BMA leadership is full pay restoration. While I acknowledge the significant financial pressures facing resident doctors, a demand for full restoration to a prior decade’s real-terms value is neither achievable nor reasonable in the present economic climate. By focusing the entire dispute on this single maximum pay demand, the BMA leadership is allowing the Government to ignore the far more crucial systematic issues that genuinely plague resident doctors and threaten the future of the NHS workforce.
This failure is a stain on both parties. The Government must return to the table with a genuine commitment to a multi-year funded plan that addresses the systematic non-pay issues, and the BMA leadership must immediately reassess the morality of its current strike schedule and shift its focus from an unrealistic pay demand to achievable reforms in training and conditions.
I have two further questions for the Minister. The recent offer included a promise to create up to 4,000 extra speciality training posts. However, the BMA leadership has claimed that these posts are simply being cannibalised or repurposed from existing locally employed roles. Will the Minister confirm categorically that these 4,000 places represent genuinely new, funded training opportunities that increase the total number of doctors retained in the NHS career structure and are not merely a reclassification of existing roles?
Given that the pay restoration demand is deemed unachievable, how will the Government—outside of pay—guarantee fundamental reforms to the working time directive enforcement, the quality of training rotations and the rota planning to ensure that resident doctors are used efficiently for patient care and for the development of their skills, thereby making a medical career in the NHS sustainable and attractive?
Our healthcare system cannot afford this deadlock. I urge both sides to put down their political weapons, swallow their pride and focus on the real-world issues before the consequences become truly tragic.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, the Government have made a comprehensive offer to resident doctors to resolve their disputes. I listened closely to the assessment of the Government’s performance made by the noble Lords, Lord Kamall and Lord Scriven, and it is not a reflection I agree with. This has dominated the agenda, and the Secretary of State has taken a proactive and collaborative approach with the BMA resident doctors committee. For example, he has had 18 meetings and seven phone calls with the BMA; he has sent 10 letters; and there have been dozens of meetings with officials.
I cannot recognise the suggestion of a hands-off, confrontational approach: the Secretary of State has consistently chosen to do everything he can, particularly to cancel the Christmas strikes, which are timed for the most damaging period of the year. The Secretary of State even went as far as to extend the BMA’s strike mandate, giving it time to call off strikes while it consulted its members and an option to rearrange if the offer was rejected. I am astounded that the BMA rejected the offer that was put before it. It was a comprehensive offer to resident doctors to resolve their disputes, providing those currently applying with more training job opportunities, prioritising UK-trained graduates, and it would have put money back in the pockets of resident doctors. Among a whole range of things that noble Lords have rightly acknowledged, the rejection of the offer means that NHS colleagues will be cancelling Christmas plans to cover shifts and patients will have their operations cancelled as the NHS prepares for the worst.
The noble Lord, Lord Kamall, asked: what happens next? In these circumstances, it is a very powerful question. The Government will consider our next steps, with our first priority being to deal with strikes. I reassure noble Lords that the focus of the department and the NHS will be on getting the health service through the double whammy—as has been well referenced by noble Lords—of flu and strikes. We have already vaccinated 17 million people, which is 170,000 more than last year; we will continue to work intensively with front-line leaders to prepare for the coming disruption.
On the offer, the BMA asked us to create more training places, which is what we would have done. The offer would have created 4,000 new speciality training posts for resident doctors over the next three years, with an additional 1,000 for this year. Under this deal, more doctors in non-training roles would have had the opportunity to progress their careers and become the consultants and GPs of the future we all want to see. Sadly, this offer is no longer on the table, thanks to the rejection by the BMA membership. That is why our focus has to be on dealing with strikes and getting through.
Our operational response is to mitigate the impact of any industrial action. We should acknowledge, as we have heard from the Front Benches, that flu rates are the highest they have been in the last five years for this time of year. I am sure that all noble Lords, while recognising legitimate concerns about access to training places, will remain concerned that an offer that would have made a real difference has been wholly rejected and strikes are going ahead. In response to the noble Lord, Lord Scriven, I do believe there was a way out and the BMA membership has chosen not to take it.
On the estimated cost of strike action, the July strikes cost the NHS around £250 million. If those costs repeat themselves for November and December, strike action will have cost around £750 million in this year alone. The cost of the five-day resident doctors’ strike in July could have paid for training for over 1,600 GPs over three years or 28,000 hip and knee replacements. But, again, the Government’s offer has been rejected so we will have to make our first priority dealing with the strikes.
Through the Employment Rights Bill, we want to create a positive and modern framework for trade union legislation; we want productive and constructive engagement; we want to respect the democratic mandate of unions; and we want to reset our industrial relations. For me, this sets us back considerably, sadly, and that has been clearly acknowledged. What do strikes do? They suck up time, resources and energy, and the costs for the NHS, as I have already stated, are around £250 million. While we have made a number of offers and acknowledged legitimate concerns, I do not believe that that has been treated in the way it should have been.
The noble Lord, Lord Scriven, asked about the 4,000 roles. That was in response to the BMA, which asked us to create more training roles, which was a fair request and exactly what we would have done. It would have created 4,000 new speciality training posts for resident doctors over the next three years, with an additional 1,000 this year. It would have meant more doctors in non-training roles having an opportunity to progress. But, as a Government, it is our duty to consider our next steps, and our first priority will be to deal with the strikes.
Baroness McIntosh of Pickering (Con)
My Lords, will the Minister respond to the question asked by the noble Lord, Lord Scriven: are these genuinely new training places? I put this question last week and did not really get an answer. I understand that resident doctors are concerned about the inability to plan ahead for training places, and want to have a place that will last for up to a year or longer. They are at the age where they want to put down roots and probably marry and have a family, but because of the way training is organised, that is not possible.
Furthermore, I am not quite sure if it was a 29% or 30% pay increase in any one year, but whatever it was, I understand that this still leaves resident doctors with an under-pay performance of less than 17% compared to 2009. They are being paid less than a train driver, a tube driver or even an Uber driver. I believe we owe them the respect they deserve. My father and brother had to work every Christmas or new year. In my father’s time it was every other night and weekend on call. We have come a long way since then, but we need to give the British-born doctors who want to train a priority in the system which is not being shown to them at the moment.
Baroness Merron (Lab)
The noble Baroness has just made a very good case as to why the offer which has been rejected would have been so helpful. On the issue of pay, our door has remained open to the BMA and to reasonable, realistic solutions to resolving the dispute, on which we have been repeatedly clear. I know the noble Baroness did not say this, but I say more broadly that there can be no suggestion that the BMA was not aware that we can go no further on pay this year. Resident doctors have already had a good deal on pay—an average 28.9% rise over the last three years—but pay expectations have to take account of the fiscal position and the impact across the whole of the NHS and beyond. I am glad to hear that noble Lords are in agreement with that approach.
Lord Hunt of Kings Heath (Lab)
My Lords, the BMA pay claim has been ridiculous right from the start, and I share my noble friend the Minister’s outrage at the decision to carry out these strikes at a moment when the health service is on its knees, certainly in Birmingham. We are in a critical situation: the service is working under huge pressure, and ambulances are finding it very difficult to discharge patients at A&E because we cannot get the flow of patients through the system.
Listening to the noble Lord, Lord Kamall, I wondered if my noble friend the Minister shares my view. I remember the 2014 junior hospital doctors’ dispute. Although that was ostensibly about pay, what came through was frustration at the way training and working lives were organised, with inflexible placements and utterly insensitive rota allocations. It made junior doctors’ working lives increasingly difficult. This was 2014. Does my noble friend the Minister think that part of the reason we are here now is that nothing was done to respond to the substantive issues juniors raised at the time, and that at some point, there will be a constructive way forward? I am convinced that tackling the way junior and resident doctors are treated in the health service will have to be at the heart of what we do.
Baroness Merron (Lab)
I am grateful to my noble friend, and I share his view. I am sure he will be very familiar with this, but it is worth reminding ourselves that in the Statement we are debating, the Secretary of State said last week:
“On jobs, I have much more sympathy with the BMA’s demands. I have heard the very real fears that resident doctors across the country have about their futures; it is a legitimate grievance that I agree with”.
As the Secretary of State outlined and my noble friend referred to, we have inherited
“training bottlenecks that … leave huge numbers of resident doctors without a job … UK graduates”
used to compete
“among themselves for specialty roles; now, they are competing against”
the rest of the world.
“That is a direct result of the visa and immigration changes made by the previous … Government post-Brexit, and … compounded by the”
then Government’s
“decision to increase the number of medical students without also increasing the number of specialty training places”.—[Official Report, Commons, 10/12/25; col. 429.]
This has not just come about, and I am grateful to my noble friend for reminding us of the history of this.
Baroness Browning (Con)
My Lords, the Minister was asked what happens next. May I ask her to consider this? Notwithstanding what has already been discussed tonight in this Chamber, the general public out there are going to face a long period with a lot of bank holidays. If we think back to the Covid period, people, for different reasons, were reluctant to dial 999 or 111 to get medical advice or to seek assistance. I know from a personal point of view that I would really not want to be admitted into an emergency department unless I was literally dead. People have a fear of this: we see the trollies and hear now of the shortage of staff. I say that having worked in an operating theatre over a Christmas period.
Can the Minister say what plans the Government have already made to give accurate information to the general public about how they should proceed during this Christmas period if they have relatives who are showing cardiac symptoms or severe respiratory problems? There is a need for some practical guidance on what to do and to encourage people—if they are sitting at home and are genuinely that ill, they must seek help.
Baroness Merron (Lab)
I absolutely agree with a number of the points made by the noble Baroness, particularly her last one: people must seek the help they need. I assure your Lordships’ House that the entire focus of the department and the NHS will be on getting the health service through this double whammy of flu and strikes. Despite the huge extra numbers, there will still be people who are not vaccinated. Therefore, in addition to seeking help when needed, I also make a plea to those who have not yet been vaccinated please to do so; that will help immensely.
It is probably worth saying that the next round of strikes will bring the total number of days of strike action to 59, over 14 rounds of industrial action, since March 2023. So I remind your Lordships’ House that this did not start with this government but has preceded it for some time.
To the noble Baroness’s point about performance, I pay huge tribute—as I am sure we all do—to the dedication of NHS staff at this time. During the November round of strike action, the NHS set an ambitious goal to maintain 95% of planned care. It succeeded in doing that, which is totally down to the NHS workforce pulling round. We also proved last time that we could maintain a near full programme of elective care. Our immediate plan, which the noble Baroness asked about, is to replicate this over the upcoming five days of industrial action in December. There is no reason for these strikes, and I know the effect they have and the concern they create for the general public. The noble Baroness allows me to remind us that these strikes are not supported by the general public.
Lord Sentamu (CB)
My Lords, one of the four priorities named in the Budget delivered by the Chancellor of the Exchequer was reducing waiting lists. If this strike goes ahead, what increase would there be in the waiting lists? Secondly, the Secretary of State in his Statement said that he is putting
“money back in … doctors’ pockets by”
funding
“royal college portfolio, membership and exam fees … backdated to April”,—[Official Report, Commons, 10/12/25; col. 430.]
and increasing the allowance for less-than-full-time doctors to £1,500. Where is the money coming from? Is this funded, or will this money be borrowed?
Finally, taxpayers spend £4 billion training medics every year. Are the Government persuading resident doctors to keep their social contract with taxpayers? It seems to me that calling this strike at this point in time is a bargain betrayed.
Baroness Merron (Lab)
I certainly understand the noble and right reverend Lord’s point. The offer we made—which covered a number of the areas that the noble and right reverend Lord referred to, plus more—is not applicable because it was not accepted. We put it forward, developed it further and did all we could that was realistic. The noble and right reverend Lord asked whether it is funded, but I will change the tense of his question: it would have been funded, but the offer was rejected and therefore is no longer on the table. That is why it is not going ahead.
On waiting lists, as I mentioned to the noble Baroness, Lady Browning, we have proved that we can maintain a near full programme of elective work, with 95% of planned care being maintained—and, again, let us pay tribute to the NHS staff who have done that. But let us not suggest that there are no effects. It affects the staff who step in to cover for their colleagues. We have an NHS in desperate need of reform. We are turning it around, but these strikes get in our way. As I mentioned, we cannot underestimate the amount of effort, finance, direction and morale—the list could go on—that these strikes take up. I am grateful to the noble and right reverend Lord for raising those points.
Baroness Royall of Blaisdon (Lab)
My Lords, I share the outrage, fury and frustration about this industrial action. My noble friend the Minister and others around the Chamber are absolutely right to pay tribute to the workforce, and I give a particular shout-out to nurses. We are always focused on doctors—I hope noble Lords present who are doctors will forgive me—but nurses do a splendid job, and too often we forget that they work for relatively little pay as well.
I was glad that when the Secretary of State was negotiating, he was talking about the training places, because the training bottleneck is absurd. I know many brilliant young resident doctors who are so frustrated and have a terrible deal, so I urge my noble friend to pass on to the Secretary of State my view that, when he is next around the negotiating table, training places should be there in the negotiations.
Baroness Merron (Lab)
My noble friend rightly refers, as I did earlier, to the training bottleneck. The Secretary of State was glad to acknowledge the need to tackle training. While he felt that there was no point on pay to be accepted, he certainly felt that the BMA resident doctors committee had a good point on jobs. To be honest, that is why it is so disappointing to be where we are today.
I will pass on my noble friend’s generous comments to the Secretary of State. He offered to introduce emergency legislation in the new year to prioritise UK medical graduates and other doctors with significant experience of working in the NHS in speciality training posts. That would have made a huge difference, but it has been rejected. He also offered to increase the number of training posts over the next three years, from the 1,000 that was originally announced to 4,000, bringing forward 1,000 of those training posts to start next year—that would have made a huge difference. I could go on, but I have made my point.
I agree with my noble friend’s point about acknowledging the role of nurses. In fact, if my noble friend will allow me, I will go further: we are talking about the whole healthcare team. That is another point to the issue on pay: while the BMA doctors committee continues to press for a pay deal far in excess of anything that anyone else is getting, the impact across the NHS, both on staff and on services, continues to be under threat—and we cannot allow that.
Lord Patel (CB)
My Lords, as a doctor, I feel that a doctor withdrawing or withholding services from a patient is dishonourable and unethical—full stop. I find no reason that I can support for a doctor to withdraw their services, because their patients are trusting them with their lives. As far as I am concerned, junior and senior doctors should never go on strike, whether or not the issue with pay is justified—that is a separate issue; there are other ways to discuss and handle that. In response to the question from the noble Lord, Lord Kamall, about what should happen now, junior doctors or resident doctors, or whatever they call themselves, should go back to work and not go on strike—not now and not ever.
There is a separate and long-standing issue with training, which has been referred to. Some years ago I reviewed medical training and was chairman of the Specialist Training Authority. There is a need now to review doctors’ training completely, particularly postgraduate training. It is not sufficient to allow for more training posts—that does not solve the issue. What is required is a complete review of the training of speciality doctors. I hope that the Secretary of State, in his discussions, can make that offer and set up a review. I have no reason whatever to support the junior doctors’ strike.
Baroness Merron (Lab)
The noble Lord is an honourable man, as we all know in your Lordships’ House. I heard his comments on how he sees withdrawing labour in this regard, and I hope they are heard more widely. He makes a good point about reviewing training. Unfortunately, we are currently in the position of having made an offer that was rejected. The offer we made is not going ahead, so I cannot give the commitments that the noble Lord might like. We will deal with the strikes in the first instance, as I know noble Lords would expect. I am sure that if we ever get back to a constructive discussion, the issue of a review could be put forward, as the noble Lord suggested.
Baroness Neville-Rolfe (Con)
I agree with the noble Lord, Lord Patel, on strikes. Why are we still allowing in overseas doctors, when domestically trained doctors cannot secure the speciality jobs that they are applying for? When will the legislation that the Government have talked about come in? It really would make a difference.
Baroness Merron (Lab)
I can only agree wholeheartedly with the noble Baroness about what a difference it would make. It was actually included in the comprehensive offer that we made to the BMA on 8 December. Our first point was about introducing emergency legislation, which would—exactly as the noble Baroness asks for—prioritise UK medical graduates and other doctors who have significant experience of working in the NHS for speciality training posts. At the risk of repeating myself, I can do no more than to say that the BMA has rejected that, as part of the offer, and so it will not go ahead. Had the BMA accepted it, we would have been absolutely willing and able to introduce that emergency legislation. Our job will be to consider the next steps, now that we have had confirmation of the rejection of the very point that the noble Baroness rightly emphasised.
Baroness Wheatcroft (CB)
My Lords, has not the time come for the BMA to reject the way the resident doctors committee is behaving? I do not believe that the NHS I know would be supportive of its actions.
Baroness Merron (Lab)
I am sure that the BMA will hear what your Lordships’ House has said today and, in particular, the point made by the noble Baroness. Perhaps I could conclude this important debate by referring to a YouGov poll which was conducted on 12 December. It found that only 33% of the public support strikes in this area and that 58% of the public oppose strikes. The public have made their voice clear, as has your Lordships’ House, for which I am grateful.