Resident Doctors: Industrial Action

Lord Stoneham of Droxford Excerpts

Wednesday 16th July 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I begin by paying tribute to those conscientious resident doctors who have decided not to take industrial action so that they can continue their vital work and care of their patients. From these Benches, we find it deeply regrettable that a minority has decided to take this unjustifiable action of launching another round of industrial action. This action will undoubtably lead to greater waiting lists, more cancellations of appointments and a worse outcome for patients. Even the pro-government Independent newspaper has predicted that tens of thousands of patients face cancellations. Can the Minister tell the House what remedial action the Government will take to protect patients and offset as far as possible the negative impacts of these strikes and their impact on patients?

I hope the Minister will recognise that I try as much as possible to be constructive in these debates. Unfortunately, when the Government last year offered resident doctors a 28.9% pay rise to end the last round of strikes without attaching any conditions on productivity or on future promises on industrial action, many of those who have studied—and those who have not studied—behavioural economics, game theory or negotiation strategy predicted that the BMA would again call for strikes to extract even more money from taxpayers without improvements in patient care.

It reminds me of a conversation I had with the Secretary of State for Health when we were in government. He had what he thought was a very constructive conversation with a BMA committee, which agreed that some of the working practices needed to be modernised—we were still working on 1948 models. When he asked a BMA representative for advice on implementing the agreed changes, the response was, “How much more are you going to pay us?” The then Health Secretary said, “But I thought you agreed that these practices need to be changed”. “Yes”, the BMA representative replied, “but how much more money are you going to pay us?”

I have huge respect for trade unions and, along with friendly societies and mutuals, their wonderful history in civil society. Thanks to my father’s membership of the Transport and General Workers’ Union—I told the noble Lord, Lord Woodley, about this earlier on—my mother was able to get an appointment at the independent Manor House Hospital. The trade unions had a wonderful history in civil society of helping working people. But in this case it is clear that those who are on strike are more interested in producer interests than in improving patient care. It reminds me of the doctor who tweeted that the NHS is about doctors and nurses but was then asked, “What about patients?”

The current Secretary of State was warned about the risk of incentivising the BMA to call more strikes when he agreed the pay rise last year. My right honourable friend the shadow Secretary of State for Health was very clear when he said that simply caving in to the BMA was the wrong course of action, especially given that there were no conditions attached to that last pay rise. Unfortunately, that prediction came true.

We on these Benches welcome the Government’s indication that they will stand firm on the current dispute; this is surely the right course of action. Since 2022, the BMA has spearheaded more than 11 strikes in the current industrial action. One of the BMA’s leaders even went as far as saying that resident doctors are “excited to go again”. However, we should not tar all BMA members with the same brush; we should recognise that less than 50% of those eligible to vote did so. We should recognise that most doctors realise that further industrial action is not fair on patients or taxpayers, as indicated by the brave decision of the noble Lord, Lord Winston, to resign from the BMA.

Can the Minister tell us whether there has been any impact study on the forthcoming Employment Rights Bill, which we debated earlier and which will lower the strike ballot threshold? Do the Government recognise that this might make even more strikes by the BMA more likely? After resident doctors were awarded a 28.9% pay rise last year, they were offered another 5.4% pay rise this year. This is not only above inflation; it is also the largest pay rise in the public sector. As the Health Secretary himself has said, these are most certainly not the conditions for industrial action. I applaud the Secretary of State for indicating his intention to remain firm in the face of this action. We on these Benches will support him in that endeavour, but I hope that he will stick to his thus far tough stance and not allow the BMA to get the better of the Government.

However, there have been some reports that the Secretary of State is considering asking for the action to end now, with the promise of more pay rises in future. It would be unfair of me to ask the Minister to comment on reports in the press but, if this does turn out to be the case, can we implore the Government both to avoid the temptation of unconditional pay rises and to ensure that any future pay rises are tied to modernising the way in which doctors work, so that all patients can get a better service?

I would welcome any assurances that the Minister can give at this stage.

[Lord Stoneham of Droxford (LD)]

My Lords, in the interests of her husband’s care, my noble friend Lady Walmsley has not been able to stay until this late hour; she sends her apologies to the House. I will speak on behalf of these Benches.

We are disappointed that the BMA is planning to call a five-day strike on the votes of a minority of its members. We welcome the constructive approach of the Secretary of State. We believe that more attention should be paid by the BMA to the effect on patients and on other NHS staff, some of whom are paid much less well than resident doctors but will have to do their best to minimise the damage.

Resident doctors had a 29% pay increase last year. Another increase of that size, if it were granted, would be extremely damaging for the national economy. Many other public service workers who are less well paid than resident doctors have not received such pay rises. Under these circumstances, we believe the BMA’s demand to be unreasonable, unfair to patients and other workers, and, potentially, hugely damaging to the important work of the Government to restore the standards of care in the NHS. Public sympathy is not with the residents doctors at this time. Nor do they have the support of consultants, who will, of course, do their duty and step up to the mark to protect patients even though they are not in support of this strike. Like all public sector workers, doctors need—and normally deserve—the support and trust of the public. It is unwise for them to jeopardise that support and trust by taking unnecessary action.

A strike is unnecessary because the Secretary of State has made it absolutely clear that he accepts that there is a good deal more to be done to improve the lives and working conditions of resident doctors. He has shown many times that he is eager to meet them in order to work out how to make those improvements. I urge the BMA leadership to take him up on that offer. We on these Benches accept that many NHS staff have worked under unbearable strain for too long. There are issues around placements, rotations, lack of team support, backlogs preventing specialist training, the physical state of hospitals, and the stresses of not being able to deliver good care.

In that context, I have a particular question for the Minister. One of the areas that the Secretary of State mentioned in his response to a question in another place from my honourable friend Alison Bennett MP, about the reality of working conditions, was this issue of corridor care. We know that this is a result of the effect on the flow of patients through the hospital caused by delayed discharge from the wards of patients who are fit to go home but for whom the appropriate social care or physical adaptations are not available. While we wait impatiently for the Casey review on social care, what are the Government doing about delayed discharges? Will the Minister ensure that local authorities have the resources to fund necessary adaptations to help people live safely at home?

If I was a doctor or nurse in A&E, committed to delivering good-quality care, I would find having to deliver poor-quality care extremely distressing. This is surely critical to the morale of the NHS, affecting recruitment and retention even more than the pay issue. I can assure the Minister of our support if something effective were to be done about it.

[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

My Lords, I thank those noble Lords who have stayed for this very important debate at this late hour. I thank the noble Lords, Lord Kamall and Lord Stoneham, for their comments and their support for the approach that our Secretary of State has taken.

I emphasise that, since taking office, this Government have prioritised improving industrial relations with resident doctors. The Secretary of State met with them in the first week of taking office and agreed a fair pay deal, which sought to reset the relationship between government and the profession. While the majority of resident doctors did not vote for strikes, it is disappointing that the British Medical Association’s resident doctors committee has rushed to announce strike action that will significantly impact patients and set back the progress that we are making with the NHS. Resident doctors will receive the highest pay award of the entire public sector this year and will have received an average 28.9% pay rise compared with three years ago. Increasing this further would be unfair, not least to other public servants.

The Secretary of State met the BMA on 8 July and wrote to it on 9 July, and expects to meet it this week to discuss how strike action can be avoided. He has made clear to the BMA that while we cannot go further on headline pay than we already have this year, he remains committed to his offer to work with it, including meeting its entire committee, to resolve the legitimate issues that resident doctors face around their working conditions. I have not heard the rumours that the noble Lord, Lord Kamall, mentioned. They certainly have not come up in any conversations that I have been involved in.

As the Secretary of State explained in the other place, significant progress has been made to start to rebuild the NHS. Waiting lists have been cut by 260,000. We promised to deliver an extra 2 million appointments in our first year and have more than doubled that figure, delivering 4.6 million more appointments. For the first time in 17 years, waiting lists fell in the month of May and now stand at their lowest level for more than two years. This is what can happen when NHS staff and a Labour Government work together. We have put the NHS on the road to recovery, but we have to be honest: the BMA is threatening this progress.

Strike action can, of course, have serious consequences for patients and should only ever be a last resort. The Secretary of State spoke in the other place of the case of Phoebe, who suffers from a genetic condition. Her operation at Great Ormond Street Hospital was cancelled twice, first due to strikes and then because there was not the capacity to treat her. Strikes are unfair on patients, unfair on other NHS staff and unfair to the future of the NHS, which we know is in jeopardy.

Following a 28.9% pay rise, thanks to the action of this Government, the BMA’s threatened industrial action is entirely unreasonable; I put that on record here tonight. Along with the other noble Lords, we are of course urging the British Medical Association resident doctors committee to abandon this rush to strike and, instead, to work constructively with this Government to improve their working conditions and rebuild the NHS. We believe there is a lot of scope, as the noble Lord, Lord Stoneham, said. Their working conditions have been appalling over the last decade. There has been enormous sympathy for the conditions that they have been in.

The noble Lord, Lord Kamall, quite rightly raised the issue of how patients will be protected and how negative impacts will be offset. We want to work constructively with all the unions to avoid disrupting services for patients. We acknowledge that unions have the right to go on strike, but there will be robust contingency plans in place to minimise disruption. Employers will seek, across the board, to mitigate impact and to look at ways of rearranging elective care and maintaining, in particular, urgent action.

I have every confidence that the Secretary of State will stay firm and will work towards establishing better relationships and better conditions. I cannot possibly comment, as the noble Lord suggested, on rumours and speculation. It would just not be the right thing to do at this point in time.

I thank the noble Lord, Lord Stoneham, for his support and his recognition of the work that has been undertaken. On corridor care, I think every single Member in the Chamber who I have heard speak on this issue recognises the dire situation that we have with social care at this moment in time. To fix the NHS would be impossible without fixing social care; it is absolutely imperative that we move forward. We have confidence in the noble Baroness, Lady Casey, and her review—in particular, her ability to reach out and work cross-party with all the different agencies, pulling them together.

We need to take action immediately—the noble Lord is absolutely right—so over the next three years we will focus on the neighbourhood approach, which is one of the three pillars of the 10-year plan. We will target, particularly, those who have been most let down by the current system. That, of course, includes older people with frailties and those in care homes. Social care professionals will work alongside NHS staff in local teams, supporting recovery, rehabilitation and independence—that is absolutely critical to their ability to move out of the acute sector.

We will enable professionals to take on more health-related responsibilities—for example, taking blood pressure checks, around rehabilitation and, again, working on prevention to reduce avoidable hospital admissions. We are looking, importantly, to improve pay, terms and conditions through the fair pay agreement. In the longer term, the creation of a national care service, guided by the review by the noble Baroness, Lady Casey, will support deeper integration between health and care. This will build on the whole theme of moving services out of hospital into the community. Importantly, those closer links—and even integration—of health and social care will work with local authorities and the voluntary and community sector.

I think we all know examples of excellent practice in this space. The issue we have is that there is no consistency, and that is where we see problems. Those areas that have built supportive networks in their communities have done a tremendous job in making sure that patients do not end up in hospital unnecessarily, but also by introducing step-up and step-down facilities that will make a difference.

There are many aspects of this to consider, but I hope the Government’s strength of feeling and dismay at the decision to strike has come across loud and clear. I know we will all be looking to the Secretary of State, with his calm and clear exposition of his intention to meet the union and work out a way of getting through this situation to protect patients and the future of the NHS, and to make sure that we can get on with the reforms we have promised through the 10-year plan, which offer an exciting future for health in this country—when we are allowed to get on with it.