Resident Doctors: Industrial Action

Wes Streeting Excerpts

Wednesday 10th December 2025 Commons Chamber

[The Secretary of State for Health and Social Care (Wes Streeting)]

With permission, Madam Speaker Deputy, I shall make a statement on industrial action by resident doctors. I thank you, Mr Speaker, business managers and the official Opposition for facilitating this evening’s statement.

As we head into winter, our hospitals are running hot and the pressures on the NHS are enormous. Flu season has come earlier, with a sharp rise in cases and the peak still to come, and this year’s strain is more likely to affect older people more severely. Already, the number of patients in hospital in England with flu is the highest on record at this point in the year. It is 50% higher than this time last year and 10 times higher than in 2023. Some 95% of hospital beds are occupied, growing numbers of staff are off sick and we are already seeing the pressure in our A&E departments. It is against that backdrop that the British Medical Association is threatening to douse the NHS in petrol, light a match and march its members out on strike. This represents a different magnitude of risk to previous industrial action.

The BMA resident doctors committee is in dispute on two issues: pay and jobs. On pay, resident doctors have already received a 28.9% pay rise—the highest in the public sector. For a first-year resident doctor, that is the equivalent of a £9,400 pay rise. I have been consistent, honest and up front with resident doctors that we cannot go further on pay this year. There is a gap between what the BMA is demanding and what the country can afford. Nor would further movement on pay be fair to other NHS staff, for whom I am also responsible and many of whom will never in their careers earn as much as the lowest-paid doctor. As I have made clear to the BMA and other trade unions, I am open to discussing multi-year pay deals with any trade union if we stand a chance of bridging the gap between affordability and expectations.

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. My Conservative predecessors created training bottlenecks that threatened to leave huge numbers of resident doctors without a job. In 2019, there were around 12,000 applicants for 9,000 specialty training places. This year, that number has soared to nearly 40,000 applications for 10,000 places.

It used to be the case that UK graduates competed among themselves for specialty roles; now, they are competing against the world’s doctors. That is a direct result of the visa and immigration changes made by the previous Conservative Government post-Brexit, and it is compounded by the Conservatives’ decision to increase the number of medical students without also increasing the number of specialty training places.

Taxpayers spend £4 billion training medics every year—we then treat them poorly, and some leave to work abroad or in the private sector. It is time that we protect our investment and give bright, hard-working UK medical graduates a path to becoming the next generation of NHS doctors. Our 10-year plan for health set out our commitment to provide that path. It pledged to introduce 1,000 extra specialty training places and prioritisation of medical graduates from the UK and Ireland.

Today, in an offer to resident doctors, I can announce that I am able to go further. I want to thank Sir Jim Mackey, the chief executive of the NHS, and his team, who have been going trust by trust to see how many extra places can be funded and are needed. Thanks to their hard work, I am in a position today to be able to offer 4,000 specialty places for resident doctors, starting with an additional 1,000 for those applying this year.

In the Department of Health and Social Care, we have been working intensively on UK graduate prioritisation. The barriers have been legal ones, so I have been working intensively with my team to see how quickly we could introduce legislation. Thanks to their efforts, the co-operation of colleagues across Government, and my counterparts in Wales, Scotland and Northern Ireland, I can notify the House tonight that, subject to the agreement of resident doctors, we intend to introduce urgent primary legislation in the form of a Bill to be presented to Parliament in the new year.

The legislation will prioritise graduates from UK medical schools over applicants from overseas during the current application round and in all subsequent years. The reforms will also prioritise doctors who have worked in the NHS for a significant period for specialty training. This will not exclude international talent, who will still be able to apply to roles and continue to bring new and vital skills to our NHS, but it will return us to the fair terms on which home-grown medics competed before Brexit. The impact of these changes is that instead of four doctors competing for every training post, it will now be fewer than two doctors for every place. That is a good deal for doctors.

Following discussions with the BMA, we are also addressing the specific costs faced by resident doctors that do not apply to other NHS staff. Although I cannot go further on pay this year, I am able to offer today to put money back in resident doctors’ pockets by reimbursing royal college portfolio, membership and exam fees, with the latter backdated to April. The allowance for less-than-full-time resident doctors—many of whom are parents and carers—will be increased by 50% to £1,500, helping to close the gender pay gap.

In recent days, I formally made this offer to the BMA resident doctors committee. The BMA will now survey its members in the coming days on whether to accept this offer and end its dispute with the Government. The BMA told us that it will survey its members quickly and give us less than 48 hours’ notice of whether the strikes are going ahead. That presents serious operational challenges for NHS leaders, who need certainty now as to whether they are cancelling patient appointments and cancelling staff annual leave to cover strikes.

In my determination to prevent the havoc that strikes would cause this Christmas, I therefore made one more offer to the BMA, which I will now share with the House, the country and frontline doctors. So that the BMA could run a genuine ballot of its members and call off next week’s strikes while that ballot ran, I offered to extend its strike mandate. This would have allowed enough time for the BMA to reschedule next week’s strikes for the end of January, were the offer to resident doctors rejected in a ballot. It would have avoided the chaos that looming strike action threatens at the most dangerous time of year by removing the spectre of strikes next week. I knew that extending the BMA’s strike mandate would leave me open to attack from political opponents; that was a risk I was willing to take to stop the Christmas strikes going ahead. Madam Deputy Speaker, I must report to the House that the BMA’s leadership said no.

In the coming days, as the NHS prepares for strike action that may or may not happen, there are patients whose operations will be cancelled. There are NHS staff who will have to tell their families that they will not be home for Christmas because they have to cover for their resident doctor colleagues. This was entirely avoidable—no one should be in any doubt that the BMA has chosen to play politics with people’s lives this Christmas, and to continue holding the spectre of strikes over the NHS. I ask resident doctors to bear that in mind when they cast their votes.

The power to end these strikes now lies in the hands of doctors. Resident doctors face a choice: to continue the damaging industrial action in which everyone loses, or to choose more jobs, better career progression, more money in their pockets and an end to strikes. The deal that is on offer would mean emergency legislation to put our own home-grown talent first; to increase the number of extra specialty training places from 1,000 to 4,000, with a quarter of those places delivered now; to reduce the competition for training places from around four to one to less than two to one; to put more money in doctors’ pockets by funding royal college exam fees, portfolio fees and membership fees, with exam fees backdated to April; and to increase the less-than-full-time allowance by 50% to £1,500. It is a chance for a fresh start, to end this dispute and look ahead to the future with hope and optimism—a chance to rebuild resident doctors’ working conditions and rebuild our NHS. I urge every resident doctor to vote for this deal, and I commend this statement to the House.

[Madam Deputy Speaker (Judith Cummins)]

I call the shadow Health Secretary.

[Stuart Andrew (Daventry) (Con)]

I thank the Secretary of State for advance sight of his statement, and sincerely thank him for making me aware last night of his intention to come to the House today and make a statement. Given that the next set of planned industrial action is due just a few days before Christmas, and at a worrying time when winter pressures are increasing early, with more flu patients needing hospital beds, we all want to see an end to these strikes. We on the Opposition Benches offer our thanks and gratitude to all those in the workforce who have worked so hard to try to minimise the impact of the strikes so far.

In his statement, the Secretary of State talks about the competition for places. This is not new information. He said himself that the figures have soared in the last two years. Why is it only now that he is addressing it, so close to a damaging strike? He could have dealt with this issue back in the previous talks with the unions, but he did not. I have said, though, that I want us to be constructive in opposition, so I welcome the work that he has done to offer more places to UK doctors. Depending on the detail of the legislation, we will help to secure that aim. I make this offer to work with him to ensure that we get there.

On the 4,000 places that the Secretary of State has announced, and the 1,000 specifically announced for this year, can he tell the House in which specialisms those places will be? Can he break it down into GPs, surgery, obstetrics, anaesthetics and so on? Is he confident that there are enough trainers and that there is enough capacity in the training settings he has chosen? GPs are trained in general practice and in hospitals, and there is community training for some specialists, such as paediatrics. When will these places be available for applications? Will he also look at replicating the Australian model of placing any international doctors in areas of the country with the greatest need? We know we need to address those issues.

All of this is dependent on the BMA accepting the offer, but what if it does not? After all, its track record speaks for itself. We warned that giving pay awards with no conditions would encourage the BMA to come back for more, and it has. If its members rejects this offer, what are his plans to manage and deal with the situation? As the Secretary of State has said himself, the NHS is under pressure from combined flu and RSV, so what is he doing to ensure that those who are eligible for the vaccines actually have them? What additional resources has he made available to manage the strikes if they happen, and for winter pressures if they do not?

Does the Secretary of State recognise that if the BMA membership reject this offer and carry on with the strikes, his Government’s own Employment Rights Bill will make things much worse next year? Will he think again about the reductions in the minimum thresholds for strikes and reintroduce the minimum service levels? Does he expect that this new legislation and the announcements he has made today will have any implications for the Equality Act 2010? If so, what are they, and how will he address them? Will he have to disapply the Act?

These strikes must end. The BMA is behaving appallingly, but if the Secretary of State does not deal with those issues around thresholds and minimum service levels, it will only get much worse, with unions like the BMA causing more issues. It is patients—our constituents—and their families and loved ones who will suffer.

[Wes Streeting]

First, I thank the shadow Health Secretary for the constructive terms on which he has agreed to work with the Government. That should give resident doctors across the country who receive their survey the confidence of knowing that, should they vote for this deal, emergency legislation will be introduced in the new year. We will be able to work at pace, because with the majority that the Labour party has in this House, and with cross-party support in the other place, we can make sure that we expedite the legislation and achieve our goal of making the changes for international medical graduates that we have always intended to make, and that we committed to well in advance of today. By expediting those changes, there will be a direct impact on people applying for speciality places now and those who, even in recent weeks, have experienced the disappointment of not receiving the training place they had hoped for. We can keep that hope alive. We can improve the number of specialty places available if resident doctors vote for this deal, so I urge them to do so.

The shadow Health Secretary asked why we had not dealt with this before. I am tempted once again to revert to my usual analogy of the arsonist heckling the fire brigade, but given the constructive terms on which he has offered to work with us on this, I will pull my punches a little. I will say, however, that putting together the 1,000 extra places now, and bringing together the legislation urgently, requires significant operational detail. He is right: we have to ensure that we have enough trainers. Jim Mackey and his team have literally been working trust by trust to ensure that we can give the shadow Health Secretary, the House and resident doctors an assurance that we can facilitate those extra places.

When it comes to the legislation, the shadow Health Secretary will know, and people will appreciate, that this is fiendishly complicated. I have had to secure agreement from business managers, as we have a packed legislative programme. We have had to make sure that the Bill would be legally watertight and consistent with both domestic law and our international treaty obligations, and I have needed support from my counterparts in Wales, Scotland and Northern Ireland. I must thank them sincerely for the spirit in which, regardless of party, they have worked with this Government; we can give resident doctors that assurance.

As for what will happen if the strike goes ahead, let me say first that the shadow Health Secretary was right to say that frontline staff and NHS leaders did a superb job of managing previous rounds of strike action. In fact, during the last round we did indeed maintain 95% of planned care, and I believe—we will see when the waiting list figures are published in January—that the impact on waiting list progress will therefore not have been as severe as it might have been. However, I must be upfront with the shadow Health Secretary and the House and point out that there is a very different degree of risk this time. While we are aiming to maintain 95% of elective activity, I cannot guarantee that. I cannot give that assurance in all good conscience, given the level of pressure that we are under.

I offered to extend the mandate, so that the BMA could reschedule the same amount of strike action for January, if its members reject this offer, and I do not understand why the BMA would not do that. I find it inexplicable. As a Labour MP, I have spent a lot of time in rooms with trade unions and negotiating, and I honestly cannot think of a single other trade union in this country that would behave in this way. I am shocked by it. I am shocked because of the risk that it poses to patients and the pressure that it places on other NHS staff, and shocked because it threatens the recovery of the NHS that we all care about.

I would say this to resident doctors who are following these exchanges: listen to what the Conservative party has said about trade union laws, and about their rejection of the deal that we struck within weeks of coming into office. There is not a more pro-NHS, pro-doctor Government waiting in the wings. There is a Labour Government who are committed to the NHS, and committed to the NHS workforce, who have gone further than any other Government before on pay, on terms and conditions, and on the pace at which we are improving them. These were never grounds for strike action before, and they are certainly not grounds for strike action now. I appeal to resident doctors, over the BMA, to do the right thing, to vote for this deal, and to work with a Government who want to work with them.

[Paulette Hamilton (Birmingham Erdington) (Lab)]

I have always been a massive advocate for all medical and nursing staff, and I absolutely understand what a difficult job our healthcare workers do, but given that flu is running rampant across the country and most NHS staff—including resident doctors, but also nurses and other staff—are suffering at this moment, will the Secretary of State join me in urging the leadership of the BMA and the doctors to see sense and put patients first at this difficult time?

[Wes Streeting]

I agree entirely with my hon. Friend. She brings considerable frontline experience to this House, having worked in the NHS and dedicated her life to it. I am pretty sure that as well as speaking for her constituents, she speaks for so many other NHS staff. I do not want to see nurse pitted against doctor, or NHS staff pitted against each other. I do not want to see people resenting each other at a time when we should be pulling together to get the NHS back on its feet, and to make sure that it is well down the road to recovery. That is why, even at this late stage, I urge the BMA to think again. There is nothing to stop me extending the strike mandate tomorrow and giving Jim Mackey and NHS leaders the opportunity to stand down planning for strikes next week, even at this late stage. It would be an extraordinary gesture of good will, and it would be a Christmas present for the country. It would benefit doctors, resident or otherwise, and all NHS staff. Most importantly of all, it would benefit patients. I hope that message is heard in good faith by the BMA, even now.

[Madam Deputy Speaker]

I call the Liberal Democrat spokesperson.

[Dr Danny Chambers (Winchester) (LD)]

I thank the Secretary of State for his statement. People will be hugely alarmed at the threat of more industrial action right before Christmas, and we cannot forget how we got here. We know that the previous Government under-resourced the NHS. It was overburdened, people felt underappreciated, and the whole system was being held together by the good will of the staff.

Having said that, the timing is terrible, because we have the worst winter flu outbreak in decades, right before Christmas. We have to urge the BMA to work constructively to resolve this dispute in a way that is fair for both patients and taxpayers. Given that resident doctors received a 29% pay rise last year, I think most of the public feel that pushing for another 28.9% this year is unaffordable and unreasonable.

The Secretary of State touched on resident doctors’ legitimate concerns. The previous Government increased medical school places without increasing the facilities to deliver the necessary specialist training placements, so this was a predictable bottleneck that we are now up against. Waiting lists are long, we need more doctors, and we have doctors who have been trained largely at the taxpayer’s expense struggling to find work. We very much welcome the extra 4,000 placements that were announced today, which are hugely necessary. Can we ensure that they will address the acute shortages in general practice and psychiatry? To put those 4,000 places in context, 10,000 doctors applied for 500 psychiatric training places last year, and the Secretary of State said that about 40,000 doctors have applied for 10,000 places this year. Is there work to try to increase places as quickly as possible in the next few months and years?

At Winchester hospital, one in five beds is taken up by people who do not have any social care packages. That is not good for them, because they are stuck in the hospital, and we want to get them home for Christmas, but it will also affect the flow through the hospital right now, during a winter flu crisis.

We welcome this action and urge the BMA to call off the strikes, but can we address the legitimate grievances that the Secretary of State has mentioned?

[Wes Streeting]

I thank the Liberal Democrat spokesperson for his support, as well as for the constructive challenge. He is absolutely right to describe the challenge that we inherited, and we are seeking to deal with it. We have taken a number of steps along the way. For example, we promised to recruit an additional 1,000 GPs to the frontline in our first year. We expanded the additional roles reimbursement scheme in order to do that, and we were actually able to recruit an extra 2,500. The international medical graduate dimension of the deal means that the extra speciality training places go even further.

Although I would never pretend that the steps we have taken in our first 18 months in office have solved everything all at once—there is no shortage of things to solve—I say to those BMA members considering how to cast their vote that we have delivered a 28.9% pay rise, have taken action on international medical graduates through urgent legislation, and have expanded speciality training places. This is real progress. It is meaningful change in people’s pockets and to their lives, working conditions, career progression and prospects. 

The BMA should please not let the perfect be the enemy of the good. We have a lot of fires to put out on a lot of fronts as a Government, and that does take time. We are committed—and I am personally committed—to working constructively with the BMA on things like workforce planning to address those issues, if it is willing to work with us. That is all I ask. It is all I ask from any part of the NHS workforce. It should work with us constructively, understand our constraints, work through the challenges with us, and we will all get to a better place and create a rising tide in the NHS that lifts all ships.

[Alex McIntyre (Gloucester) (Lab)]

I thank the Secretary of State for his statement. My residents in Gloucester are rightly worried about strike action in the run-up to Christmas, and the impact that it will have on waiting lists in my patch in Gloucester. I am not surprised that there is no one here from the Reform party to hear about the challenges that our NHS is facing, and I am really shocked that there is nobody from the Green party, but there we go. Can the Secretary of State confirm that there will be resident doctors sitting at home in Gloucester tonight who will want to vote for this deal, who will not want to go on strike next week, and who want to get the NHS back on its feet? The BMA should do the right thing, and call off the strikes next week. It should listen to its members, and let us together get on with the work of repairing our NHS and the damage the Conservative party did.

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. I was about to say that it is always a disappointment when Reform and Green Members do not appear in the Chamber, but I would not want to be accused of misleading the House. I am sure they had a better offer, and there is a Christmas party up the road.

In all seriousness, my hon. Friend is absolutely right. The tragedy of the past couple of rounds of industrial action is that each round costs about a quarter of a billion pounds. Each round, despite the best efforts of NHS leaders and frontline staff, does cause disruption, and we all lose when that happens. One of the things that is really hard for staff is that they are also confronted in a very real way with the impact of the state of the NHS on their patients. They are not in it for themselves, but because they believe in public service and want to improve the health of our nation. We are so much better able to achieve our shared goals if we work together, and we can grasp that opportunity if doctors vote for this deal, we draw a line under this dispute, and we try to reset the relationship between me and this Government on one hand, and the BMA’s leadership on the other.

[Madam Deputy Speaker (Judith Cummins)]

I call the Chair of the Health and Social Care Committee.

[Layla Moran (Oxford West and Abingdon) (LD)]

This is just not the time for a strike. As much as we have huge sympathy with many of the grievances of resident doctors, we understand that the next few weeks will be critical for how the next few months will be for the NHS, so I echo calls for the BMA to listen to reason. However, I spare a thought, and I hope the Secretary of State does, for the overseas doctors we rely on so heavily, because there is an acute workforce shortage. How, through this plan and this legislation, will the Secretary of State avoid creating a two-tier system that risks undervaluing the critical work that overseas doctors do to prop up our NHS?

[Wes Streeting]

I thank the Chair of the Select Committee for that contribution, which is really important on two fronts. First, she is absolutely right that this really is not the time for this kind of disruption, and I think the BMA knows that. I do not think that those I am dealing with are bad people. I think they are frustrated with me and this Government—they do not think we have gone far enough—and I am equally frustrated with them, and the fact that they do not recognise how far we have come, and how fast, but that is the nature of the dispute. With the extended mandate, there is an opportunity for us all to park this and, in the worst-case scenario, revisit it in January. I hope, even now, that the BMA will seize that opportunity. I think it would do it the world of good in the eyes of the public, and in the eyes of its members and the wider NHS family.

I am really glad that the Chair of the Select Committee raised the point about international medical graduates and the overseas workforce. The NHS has always been an international employer. We have been so fortunate as a country that, since 1948, people have come from around the world to help us build and sustain a national health service. Without them, it would collapse, and we never want to be a country that closes the door to international talent.

What is extraordinary is that many of those overseas doctors, when they see the competition ratios and compare our approach to that of their home country and other countries, think we have lost the plot. They cannot believe we do not already do this, so I think they will understand what we are doing and why. I hope they will be reassured that international recruits who have given service to the NHS will also be able to apply for specialty places, because we want to recruit and retain great talent, but they will also recognise how this is a game changer for the ratios for homegrown talent. I think they will understand that. I think they will respect that. Not least, I have been at pains as Health Secretary, given some of the ugly rhetoric that has come from one corner of this Chamber, to emphasise that, while some people in this House might tell those international recruits to go home, as far as we are concerned they are home.

[Jen Craft (Thurrock) (Lab)]

My mum, a former shop steward, always drummed it into me that there are no winners in a strike. Never is that as stark as in the situation we are facing now. There will be healthcare workers in my constituency, already under tremendous pressure, who will be looking at the situation coming up in the next few weeks with dread. That includes resident doctors who will be looking at that uncertainty and wanting some surety as to where they should go. The Secretary of State has been incredibly reasonable and has set out a plan that I plead the leadership of the BMA to get on board with. Call off these strikes to get us through winter and through this difficult period for the benefit of patients and for the whole NHS. Will the Secretary of State join me in echoing that plea?

[Wes Streeting]

I am grateful to my hon. Friend and I hope that point is not lost on the BMA. On the Labour Benches, we are the party of labour. We were created by the trade union movement to represent the interests of working people. That has been our calling for more than a century, since this party was founded. We have shown through our actions, not just our words, that this is a party in government who are committed to defending and extending the rights of working people, to improving pay and conditions, to clamping down on exploitation, and to making sure that this is a Government with and for the people.

The BMA has a willing partner with this Government. I sometimes feel like the Government have changed, the policies have changed and the approach has changed, but the BMA’s tactics towards us have stayed the same. I understand their cynicism about politics and their grievances with the situation they are working in, but I ask them also to recognise the progress we have made when we work together. There is an opportunity confronting them now to make further progress and I urge them to seize it.

[Gregory Stafford (Farnham and Bordon) (Con)]

These strikes will have a massive effect on my constituents in Farnham and Bordon. I am already getting emails from constituents who are concerned about the fact that their operations will be cancelled. The BMA is being entirely irrational and it holds the lion’s share of the blame for this situation, but the Secretary of State also has to take some responsibility for what is going on. If he gives the doctors a 29% pay rise with no strings attached, it is absolutely no surprise that they come back for more. I welcome the 4,000 extra places. I would like to press him on exactly where those 4,000 places will come. Would it not be better to have published that in the workforce plan, which is continually delayed by his Department? When will that workforce plan actually come about?

--- Later in debate ---

[Wes Streeting]

I thank the hon. Gentleman for the first bit. As for the rest of it, let me just say that the NHS workforce plan we inherited came in the 14th year of the Conservative Government. It was so absurd—it was so absurd—that on its trajectories for the increase in staffing numbers, within this century, 100% of the public would have to work for the NHS to sustain that level of workforce growth. And that is against the backdrop of AI, machine learning, genomics and the revolution in life sciences and medical technology that will change the NHS workforce and change the face of medicine.

We are working with the royal colleges, think-tanks and trade unions to make sure that in the new year our workforce plan is more credible. The hon. Gentleman is right to say that we are taking a bit longer with the workforce plan than I had originally intended. We are doing that because I was asked to do so by the partners that we will need, to ensure that the modelling and assumptions underpinning the workforce plan are good. I am always prepared to take a little bit more time to get it right, than to rush something out. That is the spirit in which I have engaged in workforce planning.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

With a 28% pay rise and 4,000 extra specialty training places, it is starting to feel like the BMA resident doctors committee is deeply committed to not taking yes for an answer. It is not just about the services; it is about the parent who wants their kids to have their elective appointment before Christmas. It is real people in my constituency and across the country who are suffering, so I urge the BMA to come to the table and be reasonable. While we are looking at the training crisis, will the Health Secretary look at the specific areas where we have real training crises, such as mental health, GPs, sexual health and palliative care? There are a lot of areas in the NHS where this deal can be a win-win, as we can both open up the extra training places and solve some of the workforce crises that we know about right now.

[Wes Streeting]

My hon. Friend is absolutely right. I do wish the BMA would take yes for an answer sometimes; I would like it even more if the BMA gave yes as an answer to me once a while, but that has not happened in a little while. He is right to talk about the need for workforce planning. The workforce plan, which is in production, is all about making sure we have the right people in the right place at the right time. He mentioned mental health specifically. Our manifesto committed to 8,500 extra mental health workers over the course of this Parliament, and I am happy to report that we have already delivered well over 6,500. There is lots done, but more to do.

[Sir Julian Lewis (New Forest East) (Con)]

I find it rather shocking that when the Secretary of State for Health has offered the BMA leadership an opportunity to strike a few weeks later, they have turned it down, presumably because they prefer to strike at Christmas, when, frankly, lives will be lost as a result. Am I missing something here? Why is it, according to the Secretary of State, that the BMA leaders seem to be so determinedly militant? Does he think that in reality, they simply do not represent the views of their own membership?

[Wes Streeting]

I will say to the right hon. Gentleman that we are doing everything we can to mitigate against harm during the proposed strike dates, but I cannot in all honesty and integrity assure him that no patient will come to harm next week should the strikes go ahead, because the situation is so dire. I really urge the BMA to reflect on that overnight and into tomorrow and to ask themselves—perhaps their members will also ask this of their reps—whether it is really necessary to strike next week, given the offer of an extension to mandate.

To the right hon. Gentleman’s final point, when I was the president of the National Union of Students, I was once asked by a Labour member of a Select Committee that I was appearing before whether I was speaking for my members or for my activists. There is sometimes a difference between the two. I know that lots of people have campaigned hard for pay restoration and that many people are involved in the Doctors Vote campaign in pursuit of that aim. I think there are many doctors, however, who recognise that there has been real progress on pay and that what we are putting forward now is meaningful progress on jobs, too. I say to all members of the BMA: do not let the perfect be the enemy of good, especially when the stakes are so high.

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

I congratulate our own frontline team, because this is a great deal. I came to Parliament partly to speak up for our NHS, and I have spoken in many debates. I have also trained many surgeons over the years, and I know that my fellow surgeons will be up for this deal. College presidents will support it, and I urge all resident doctors to support it, too. I will just issue a word of caution from my son, a resident doctor, who is up there in the Gallery: if we increase the number of trainees, we will also need to increase the number of consultants and GPs. If we do not do that, we will simply push the bottleneck down the road.

[Wes Streeting]

My hon. Friend is absolutely right about the need to address bottlenecks and to do adequate workforce planning. He draws attention to his son, in the Gallery, who is a resident doctor and no doubt a voter—it is almost tempting to break the rules and start appealing to voters in the Gallery for a yes vote in the survey.

I would say one thing to any resident doctors who are watching, and not just the immediate members of my hon. Friend’s family. I do listen carefully to what resident doctors say and how they feel, so I know there will be some who are listening to my hon. Friend and thinking, “It’s all right for you and your generation—you’ve had it easy. We are fed up with these consultants and college presidents telling us what to think and feel.” I hope that they know the extent to which my hon. Friend has fought their corner and spoken up for their concerns—not just on the Floor of the House, but in meetings with Ministers. He keeps us anchored in the sentiment and experiences of all parts of the profession, especially resident doctors. I know that my hon. Friend feels a real commitment to ensuring that resident doctors have a bright future and a bright career. I hope they will heed his advice, just as I do.

[Mr Louie French (Old Bexley and Sidcup) (Con)]

Given the seriousness of the pending strikes, it is understandable that the Secretary has decided to focus his comments today on the BMA and this upcoming strike. I ask the Health Secretary this question constructively: what assessment has he made of the impact of the giveaways he has just announced on the likelihood of future strikes and on other NHS staff, particularly nurses, who are already feeling hard done by following last year’s pay rise?

[Wes Streeting]

That is a very thoughtful and appropriate question. Just to reassure the House, the Minister of State for Health and I have been working with Agenda for Change unions, particularly Unison, the Royal College of Nursing and GMB, to ensure that we are dealing with the structural reform of Agenda for Change that they are seeking. We have been exploring how we can deliver fairer pay for other parts of the NHS workforce and an improvement to the conditions and status of the nursing profession specifically, while maintaining fairness for all NHS workers. That is one of the considerations I have had to bear in mind when it comes to what we can offer the BMA and resident doctors. I have been very clear with the resident doctor reps about that privately, and I am happy to restate that publicly.

Doctors have not had a bad deal from this Government, frankly, and I have a responsibility to all parts of the NHS workforce, especially those who are lowest paid and who often lie awake at night worrying about their bills.

[Dr Simon Opher (Stroud) (Lab)]

On international medical graduates, I commend the Secretary of State. It is something we have discussed in the past, and bringing forward emergency legislation is absolutely crucial here, so I thank him for that. I also want to mention trainers in the NHS. I can reassure the Conservatives that we will make this happen. I have been a GP trainer for 25 years. We will work to make this happen; that is what we do in the NHS.

I have many resident doctor friends who do not like this action. Can we urge those doctors to talk to their fellows and try to call off this strike? It is not generally well supported among resident doctors, and it is something that we can change.

[Wes Streeting]

My hon. Friend makes a really good point. Sometimes during ballots people who are opposed to industrial action choose not to cast a ballot at all because they know that the turnout threshold is material. In the coming days, it is absolutely vital that every resident doctor makes their voice heard. This is their chance to tell me and their reps how they want to proceed on this deal. I respect the fact that the resident doctors committee has chosen today to present the deal in neutral terms to its members so that they can make a choice. I really do respect that. Now I urge resident doctors to make their views known and take the opportunity in front of them so that we can move forward together to make real changes to their lives.

[Several hon. Members rose—]

[Andrew George (St Ives) (LD)]

I welcome the Secretary of State’s statement and the manner in which he has been handling the issue. However, I want to ask him about the way he summarised the position at the end of his statement. He presented it as a choice between striking and having more jobs and the other parts of the offer. I seek clarity on the matter. Is he genuinely saying that he is going to withdraw that? Was that purely for oratorical effect, or is that his negotiating position?

[Wes Streeting]

I regret to say that if the BMA rejects this offer, we will not proceed with it at this time. I wish that we were not in this transactional lock. I wish we could just move forward together in a spirit of partnership, with a bit of give and take. That is not where we are, and I think I would be crucified by the public if I were to take a different approach. It would be the wrong thing to do and it would incentivise people to strike further, and I cannot tolerate that any longer.

[Justin Madders (Ellesmere Port and Bromborough) (Lab)]

Our constituents will consider it absurd that we spend billions of pounds every year on training doctors who will never work in the NHS. I am pleased that we are grappling with this issue, just like the Secretary of State is grappling with many others. He has shown that by working constructively through the issues, we can, hopefully, reduce industrial action. I contrast that with the comments from the shadow Secretary of State, who talked about bringing back the minimum service level laws. Will the Secretary of State remind the House that those laws were so unworkable that no public sector service ever actually used them? In fact, we had the highest levels of industrial action in 40 years under the previous Government.

[Wes Streeting]

My hon. Friend has so much expertise on health and on employment rights and trade union law, and he is right. That is why this Government have chosen a different approach. We want to work with all our trade unions, we want to work with the BMA, and we can still do so if we hit the reset button and each of us commits to building a more constructive relationship.

[Jim Shannon (Strangford) (DUP)]

I congratulate the Secretary of State and I fully support his stance on the resident doctors’ strike action. “Stand firm” is the message that I send to him, and I ask that God bless him and his team.

This will be the 14th strike since March 2023 and it is expected to cause major disruption. With the recent influx of flu, some wards have 70% occupancy. That could put the healthcare system under extreme pressure. Accident and emergency in the Ulster hospital, Belfast city hospital and the Royal Victoria hospital are under intense pressure. If they did not have the doctors from India and Africa, we would be under real pressure. What discussions has the Secretary of State had with the BMA about the impact this strike will have on emergency care and, ultimately, on getting patients back home before Christmas?

[Wes Streeting]

I am grateful to the hon. Gentleman for his support. He is right to raise concerns about the impact on urgent emergency care. We will do our best to keep the show on the road, but I cannot make guarantees in the way that I would want to about the quality or timeliness of care. I place on record my thanks to my counterpart in Northern Ireland, Mike Nesbitt, as well as to my counterparts in Wales and Scotland, for the constructive approach that they have taken in making this possible.

[Laurence Turner (Birmingham Northfield) (Lab)]

I draw attention to my membership of the GMB and my chairship of its parliamentary group. The BMA is currently in dispute with its workforce over an offer of 2% for this year, which is below the inflation rate on the retail prices index and the consumer prices index. Does my right hon. Friend agree that there is a striking inconsistency between the heads of claim that the BMA has advanced and its own record as an employer?

[Wes Streeting]

I should also declare that I am a member of the GMB and Unison. I say to my hon. Friend that there is a striking inconsistency between what the BMA is demanding for its members and what it proposes to pay its own staff. There is a word for that. In the spirit of trying to engage more constructively, I will not use it. However, I urge the BMA to engage constructively with us and with its own staff. It certainly will not want to see me on the picket lines outside BMA House.

[Kim Johnson (Liverpool Riverside) (Lab)]

I am a lifelong trade unionist and a proud member of Unite and Unison. I was proud to stand on the picket line with resident BMA doctors in my Liverpool Riverside constituency recently. They talked about the challenges around fees, and I am sure that they will welcome the fact that more money will be put in their pockets. There was some inconsistency, however. Will the Minister clarify that all resident doctors of all specialisms will be subject to the fee waivers?

[Wes Streeting]

I can give my hon. Friend the assurance that the royal college fees that I outlined in my statement will be covered by us. That will be a material saving in resident doctors’ pockets. Exam fees will also be backdated, recognising that many doctors will have already done those exams and paid the fees. I hope that that gives my hon. Friend and resident doctors in her constituency the confidence that this is a good deal and one that we can move forward on and campaign on together.

[Kevin McKenna (Sittingbourne and Sheppey) (Lab)]

I have worked so many Christmases and new years as a nurse in the NHS, and I know the weary dread with which so many colleagues are facing this threat of strike action, particularly against the background of a spike in respiratory illnesses. It will be devastating. In a good year without strikes, it would be bad enough.

I really commend the Secretary of State for the work he has done to address what have been long-running sores in the experience of resident doctors. Some of this is genuinely transformational, and what I know a lot of clinical colleagues have been after for so long. But healthcare is a collective activity. It is the multidisciplinary team that delivers healthcare, not individual doctors or individual nurses, so can I recommend that the Secretary of State keeps focusing on that collective improvement to the NHS, as I know he has been doing? I implore everyone in the BMA who is listening: let’s just put this to bed now. It is time for everyone to have a healthy Christmas.

--- Later in debate ---

[Wes Streeting]

Of course, my concern is always patients, first and foremost, but it has been playing on my mind and my conscience that, going into this December, a lot of consultants, nurses, allied health professionals and other NHS staff are more tired than they would otherwise have been because they are putting in those extra shifts and extra effort both to cover the previous round of strikes and then to help the NHS to recover in that long tail that follows in the days and weeks afterwards. I really feel for them at the moment because of the conditions they are working in. I think all of us would breathe a sigh of relief—and also, frankly, express a great deal of gratitude, myself included—if the BMA were to take up the offer of postponing strikes until January. It is not too late. I urge it to think about that overnight and to do the right thing.

[Shaun Davies (Telford) (Lab)]

I thank my right hon. Friend for his leadership, and also the NHS bosses up and down this country for theirs. They often do not get the praise that they deserve in this House. This situation is bad for patients and their families and also for NHS staff, but above all it is bad for trust and confidence in our NHS. We know that there are people in this House and across the country who want to attack the very principle of the NHS. Does my right hon. Friend agree that the BMA needs to take into consideration that this is about not just the deal on the table today but the very principle our NHS?

[Wes Streeting]

My hon. Friend is absolutely right. To be honest, the thing that causes me most anxiety is that, although I know that the NHS is on the road to recovery, we are surrounded by an enormous amount of jeopardy. We need, as much as we possibly can, to make sure that we are not inflicting avoidable damage or setbacks on our progress, and it feels like that is what this round of strike action represents. My hon. Friend is right to praise NHS leaders and managers. I know how emotionally invested they are in seeing their patients and their staff through this Christmas, and I urge resident doctors and the BMA to take up not only the deal but the opportunity to at least put off strike action to January.

[Rachel Taylor (North Warwickshire and Bedworth) (Lab)]

I thank the Secretary of State for all his work on this matter so far, but I know that people in my constituency are going to be really worried about what might happen to them over the Christmas period. I thank all those hard-working NHS staff, be they nurses or doctors, who have continued to look after us and are facing a really difficult situation over this Christmas. Does my right hon. Friend agree that we need to urge the BMA to call off this strike and, in doing so, will he commit to continuing that dialogue with the profession so that it knows that he really understands the challenges it faces, the training opportunities it needs and the job opportunities it deserves?

[Wes Streeting]

I entirely agree with my hon. Friend. This is the point that I have impressed on the chair of the resident doctors committee. This deal is not the end of the conversation about jobs and career development in the NHS, because there are plenty of problems for us to solve. Although we cannot afford to go further on pay this year, what we have done so far—28.9%—is not the extent of what the Government can and are willing to do on pay. It just requires a bit of give and take, and I think we will make much more constructive and meaningful progress if we work together. I have my part to play in that, and from my point of view, we need to reset the relationship. It has hit the buffers somewhat in recent weeks. I am willing to do that. We have people we can work with on the resident doctors committee, but I think we are going to have to grasp the olive branch as it is presented today so that we can make more progress in the new year.

[Mike Reader (Northampton South) (Lab)]

People in Northampton are on a bit of a rollercoaster: they have seen the benefits of a Labour Government in the £16 million that has been secured for our new urgent care centre at Northampton general, but they will now rightly be worried reading the news. Will the Secretary of State send a message to my constituents to assure them that they will be kept safe should the BMA take this disastrous action?

[Wes Streeting]

I congratulate my hon. Friend on all his campaigning to secure investment in his constituency. One thing I can assure everyone in our country is that NHS leaders, frontline staff and I will do everything we can to mitigate harm during these strikes; I am afraid what I cannot do is guarantee that there will be no harm. That is the thing that keeps me awake at night at the moment, and that is the thing that the BMA should keep foremost in their minds when deciding whether or not, even at this late stage, to take up the offer to postpone strikes until January and take the mandate extension.

[Amanda Martin (Portsmouth North) (Lab)]

As a proud trade unionist, I know that trade unions are there to represent their members’ interests and views, yet by pushing ahead with this strike action, the BMA appears set to ignore its members. The offer on the table is real and comes from a Government who are listening and making positive change. Would the Secretary of State urge the BMA to take stock, think again about patients and its colleagues, and pause action while its members are consulted on the new terms? It has nothing to lose from pausing, yet the NHS and the population have so much to lose.

[Wes Streeting]

I completely agree with my hon. Friend. The BMA has put the offer to its members in neutral terms, but the fact is that it is now going to run a hasty survey over the next few days in order to give us what will still be less than 48 hours’ notice of whether or not these strikes will go ahead. If it took up the mandate extension, it could run a referendum properly and give its members more time to consider and discuss the offer in the workplace and with their families and reps. I do not see how more participation in the conversation and in the ballot could possibly be a bad thing.

As I have made clear to resident doctors, there are no downsides for the BMA in this. In fact, the only person who risks having a downside is me if, even after accepting the mandate extension, the deal is rejected and the doctors go out on strike again in January. This is not even a win-win scenario; this is a potential win-lose scenario, so I do not know why the BMA would not take it up.

This is a great offer for doctors. I know there will still be more to do, whether that is the implementation of the 10-point plan that Jim Mackey has come up with, my offer to work with the BMA trust by trust and employer by employer to see progress, or any of the other things we can do together. If we work together, we can get more done together. If we are working as partners rather than adversaries, we will all enjoy it a lot more and we will make more progress, and that is the opportunity that is available.

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

I am very concerned that flu has hit hard and hit early this year. Hospital bed occupancy for flu is more than 50% higher than it was this time last year and resident doctors are central to tackling that. I have to admit to being very shocked that the BMA turned down an offer that would allow it to postpone next week’s strike. Does the Secretary of State share my worry that any strike action would make tackling this flu crisis much harder?

[Wes Streeting]

My hon. Friend is absolutely right. It also costs us roughly a quarter of a million pounds each time the BMA does this, and we cannot afford to keep paying that. It may say, “Well, then just do a deal with us and you will not have to fork out,” but then why would the rest of the NHS workforce, or the entire public sector or the entire economy, not go on strike? That is not constructive, and it is not going to get the NHS or Britain out of the enormous hole it was left in by the Conservatives. We are making real progress together, and I thank resident doctors for that. We will make more if we work together.

[Lewis Atkinson (Sunderland Central) (Lab)]

The coming weeks are always the most dangerous time of year for the NHS, and it is important to note that the patient safety risks arising from the strike will be present not just during the strike period but in the weeks following it. Some of my most daunting, and indeed scary, times in the NHS involved working alongside resident doctors, nurses and others in the early hours of the morning in January and late December to try to ensure that ambulances could still be offloaded under the most difficult circumstances. In that spirit of one team working for patient safety, I urge the resident doctors to accept the offer that the Secretary of State has set out. Will he confirm that NHS England and local NHS leaders will have his full support in taking the difficult decisions that they need to take to keep patient flow going and emergency care going during this period if strikes do take place?

[Wes Streeting]

I thank my hon. Friend for what he says and for the experience he brings to bear. I hope his urging is heeded by the BMA. I can give him that assurance. I think its operational leaders will face some fiendish choices in the coming days and weeks if strike action goes ahead. They will have my full backing. Myself, the Minister for Health and the Minister for Care are working closely with both the NHS and the social care sector, but this will be extremely challenging, and that is why I urge the BMA to adopt that “one team, one NHS” approach that he urges them to adopt.

[Josh Newbury (Cannock Chase) (Lab)]

I too thank the Secretary of State for the lengths he is going to for resident doctors. As somebody who worked in our NHS before coming to this place, I know what a pressured time winter is for staff and patients alike. With strikes at this time of year, NHS staff will this week be taking calls from harried managers and cancelling plans to be with their families at Christmas to cover shifts, and of course patients will have their operations cancelled. Does he share my concern about the human impact of this planned strike?

[Wes Streeting]

That is the only thing I have been thinking about in recent days, and it is why I have offered to extend a strike mandate for the first time, even though the BMA has asked me to do that on previous occasions in different contexts. I think it is a sensible compromise, and it avoids that dreaded phone call to the NHS staff member who has to cancel their holiday plans for Christmas and go back to work. Most importantly of all, it avoids that dreaded phone call to the patient who has been gearing themselves up for that test or scan that they are worried about, or that operation or procedure that they have waited far too long for. Indeed, it avoids the dreaded situation of someone having to call 999 in an emergency uncertain about whether the ambulance is going to arrive on time and anxious about whether they will be waiting in a car park, in a queue, in the back of an ambulance or, indeed, on a trolley in a corridor.

It gives me no pleasure at all to acknowledge that the bleak situations I have described are in play today in the NHS. Activity is already being stood down, but even if this strike action were not looming, the NHS is not in a state that I would want myself, the people I love, the people I represent or anyone in our country to be treated in, because of the enormous pressures that it is under.

With that in mind, and after listening to the contributions we have heard from across the House from Members on both sides who are not anti-doctor or even anti-BMA, I urge the BMA to do the right thing—not just to adopt this deal, but even at this late stage to adopt the offer of mandate extension in order to put off till January the spectre of strike action, and to give their members time to think, vote and make a decision on whether to accept a deal that would make a meaningful material difference to their job prospects, to their careers and to the future of our national health service. It is not too late to change course. It is not too late for the BMA to change its mind, and there is never any shame in doing so for those who think that is right.

I thank all hon. Members for their contributions, and you, Madam Deputy Speaker, for giving us so much time on such an important issue.