The Secretary of State for Health and Social Care (Wes Streeting)
With permission, Madam Deputy Speaker, I will make a statement on the proposed industrial action by resident doctors.
Yesterday evening, the British Medical Association called its latest round of strikes for 7 to 13 April, immediately following the long Easter bank holiday weekend. The announcement came just hours after its resident doctors committee rejected an historic deal that would have boosted pay, created jobs, improved career prospects and put money back in the pockets of its members. This was deeply disappointing after months of highly constructive and good-natured talks between the Government and the leadership of the RDC. In that context, the fact that the BMA’s immediate response was to call such extensive strike action, rather than return to the table, speaks volumes about what we are up against.
I will set out how we have reached this regrettable position. Since the start of this year, the Government have been holding extensive and intensive discussions with the BMA resident doctors committee leadership, who engaged in good faith. I have spoken personally to or met with the chair several times, and those engagements were, of course, on top of the near-daily dialogue that his team held with officials from my Department.
Together, we got further than many thought possible. As a result of our discussions, a landmark deal was put formally to the full resident doctors committee on 22 March. Based on our engagement with the BMA officers, we were optimistic that it would be received positively, although I was aware of the officers’ preference that it should be a deal over two years rather than three years, and that they had expected the independent recommendation of the Review Body on Doctors’ and Dentists’ Remuneration—the DDRB—to come out slightly higher than it did. Regrettably, despite the deal having been designed with and supported by the BMA leadership, the committee itself rejected it yesterday.
I will run through what the RDC has unilaterally rejected on behalf of the 81,337 resident doctors in this country. The headlines of the deal are: reform of the pay structure, so resident doctors would benefit from more frequent pay rises at each stage of their training; pay rises over three years baked in, linked to the independent DDRB recommendations, as requested by the BMA; and reimbursement of Royal College exam fees from April this year, which resident doctors currently pay out of pocket. They can be as much as £2,200 for psychiatry, £2,300 for paediatrics and £3,700 for ophthalmology. Other headlines are: contract reform for locally employed doctors to ensure they also benefit from greater job security, equal opportunities for pay progression, and improved terms and conditions; and up to 4,500 more specialty training places created over the next three years, including 1,000 for this year’s applicants.
Alongside the deal, the Government have just passed the Medical Training (Prioritisation) Act 2026, so that domestically trained resident doctors no longer compete on equal terms with overseas graduates for specialist jobs. The Act will reduce the competition ratio for jobs from almost 4:1 to almost 2:1. The deal also follows the 28.9% pay rise already delivered by the Government.
As a result of the proposed package, resident doctors would have seen an average pay rise of 4.9% this year; starting pay for new graduates entering the profession this year would have been nearly £12,000 higher than four years ago; the lowest-paid foundation year ones and foundation year twos would have seen a pay boost of at least 6.2% and 7.1%, respectively, this year; and there would have been 1,000 more resident doctor jobs in a matter of days from this April.
Along with pay decisions that I have already taken, the package would have meant that, this year alone, resident doctors would have been, on average, 35.2% better off than four years ago. There are not many, if any, professions in our country for which that is true. The DDRB recommendation is 3.5%, which is significantly less than what is on offer as a result of pay structure reform.
The BMA has pointed to the war in Iran as reason to reject the deal. I will spell out the consequences of what this country is facing. The Government want to see de-escalation and a swift resolution to the conflict, with a negotiated agreement that puts tough conditions on Iran, specifically in relation to its nuclear ambitions. However, we are planning on the basis of a prolonged conflict, because that is the prudent thing to do. In that eventuality, there would be an impact on the economy and on the public finances. Were that to happen, a future offer to resident doctors would not look better than what is on offer today.
The Government’s tolerance for costly and disruptive action that undermines a critical public service is fast diminishing. In three years’ time, I do not want resident doctors to look back on this moment with regret as they turn down three years of guaranteed pay rises, more money in their pockets through reimbursement of exam fees, and more jobs. The BMA is choosing more strikes. As a direct result of its decision, and despite our best efforts, resident doctors will be worse off. Indeed, on the very day that 1,000 more specialty training places would have opened up for resident doctors with this deal, the BMA will be on strike, demanding more job opportunities.
Let me turn to the impact on patients and the NHS. Yesterday, the British social attitudes survey revealed that patient satisfaction has increased for the first time since before the covid pandemic. Dissatisfaction has seen the sharpest decline since 1998. Patient satisfaction with access to GPs has gone from 60% when this Government came to office to more than 75% today. Wating lists are the lowest they have been for three years, four-hour performance in A&E is the best for four years, and ambulances are arriving faster than they have for half a decade. All of this has been achieved despite the BMA’s strikes, so I want to reassure patients that the NHS’s recovery will continue.
In the most recent round of strikes, the NHS team pulled together and delivered 95% of planned elective activity. I am confident that we will see the same outstanding efforts if further action is taken. But to the BMA, I say: we can achieve so much more, and the improvements can be so much faster, if you take this deal and stop your strikes. Strikes have a significant financial cost. Every penny spent on keeping the show on the road during strikes is a penny that cannot be spent on improving staff pay and working conditions or better care for patients. The impact on the other staff working in the NHS, who are left to pick up the pieces, is severely felt.
So I am asking the BMA’s resident doctors committee to reconsider. I will meet again with its officers. I also repeat my offer to meet with the entire committee, who have thus far refused to meet me since I became Secretary of State. Indeed, they are the only group of people I have offered to meet who have declined, which I find extraordinary in these circumstances. The deal on the table shows what we can achieve when we work together. In contrast to my predecessors, I have shown good intent from the outset. I have listened to the complaints that resident doctors have about their working lives—I agree with them, and I want to work with them to improve their working conditions as we improve the NHS.
But when it comes to making a deal, the reality is that it takes two to tango. The BMA has until next Thursday to reconsider before we have to call time on the extra jobs, and the focus of the NHS and my Department turns to minimising the disruption from this unnecessary and unwarranted strike action, which would also consume the money set aside for this deal. But there will be a cost to the NHS, to staff and to patients. This was an historic opportunity, developed in tandem with the BMA leadership. I urge the committee to reconsider. I urge the BMA to call off its industrial action. I commend this statement to the House.
Madam Deputy Speaker (Caroline Nokes)
I call the shadow Secretary of State.
Stuart Andrew (Daventry) (Con)
I am grateful to the Secretary of State for advance sight of his statement. Only yesterday he was boasting about progress in the NHS. Today we are back here again, facing more strikes, more disruption and more uncertainty for patients—quite the contrast. In opposition, he made resolving these strikes sound straightforward: “Just get around the table. Just negotiate. Just sort it out.” He repeatedly stated that the power to stop the strikes lay in the Government’s hands. Well, the power is now in his hands. He has had every opportunity to prove it, and yet here we are again. Not so easy after all, is it?
The Government came into office promising to end these disputes. Instead, they have conceded heavily on pay, at enormous cost, and still failed to make it work. The Secretary of State says a comprehensive deal was on the table, developed with the BMA leadership. Despite that, we still face further strikes, so what exactly has this strategy achieved? After all the concessions, all the cost and all the disruption, there is still no resolution. If, as he says, the BMA leadership helped to shape the deal, why did it not secure the support of the wider committee? This morning, the chair of the BMA’s resident doctors committee said that all the Secretary of State needs to do to avoid these strikes is come back with a better offer. That was the Secretary of State’s argument in opposition, too. He has now had every opportunity to test that theory in government, and it has not worked, just as we warned.
There is also an irony here that will not be lost on the public. The BMA says that a 3.5% pay rise for doctors is a “crushing blow”, yet it is offering its own staff just 2.75%. While it demands more from the taxpayer, it will not even meet its own standard for fairness. The inconsistency is obvious and hypocritical.
The Government’s own position on affordability no longer seems to add up. In October, Ministers were clear that anything above 2.5% would have consequences for wider NHS commitments. They said that every additional 0.5% would cost around £750 million, yet we are now beyond what they previously said was affordable, so what has changed? Were those warnings overstated, or are other parts of the health budget now going to pay the price? The Secretary of State even pointed to global events as a reason for future constraints. That is a long way from “just negotiate and sort it out”. After repealing minimum service levels, the Government cannot now be surprised that patients are once again exposed to greater disruption.
Labour promised to end the strikes. It paid a very high price, and it still did not get the result. Ultimately, it is patients who are caught in the middle of all this, but it is unfair on others in the NHS, too. Consultants are left picking up the pieces yet again. Other doctors and NHS staff are expected to carry the burden and keep services running—they do not get to walk away. That is not sustainable, and it is not fair.
The Secretary of State says he may now have to call time on the extra jobs he announced. Were those jobs ever truly secured, or were they always conditional on the BMA accepting the deal in full? When he says that strike action will consume the money set aside for this deal, is he not really admitting that his own approach has ended up burning through the very resources he said would improve pay, jobs and conditions? What is the cost of this latest round of strikes expected to be, and where will that money now come from? What assessment has he made of the impact on patient safety, consultant morale and the training progression of junior doctors? What is his plan to end this dispute, rather than simply manage the next round of disruption?
Patients need certainty. The NHS needs stability. That is why we have been clear that doctors should not be allowed to strike and that minimum service levels must be restored to protect patient safety.
Wes Streeting
I thank the shadow Secretary of State for his response and questions. Beneath some of the criticism of the Government was a consistent message about the unreasonable and unnecessary position of the BMA, but let me address his criticism none the less.
The shadow Secretary of State accused me of “boasting” yesterday about the progress this Government are making on the NHS. For once, I cannot say we are following the pattern of our predecessors, because of course, they did not make any progress. From the moment they entered government, we saw the NHS begin to slide in the worst direction, to the extent that we went into a modern health emergency—the pandemic—woefully underprepared, leaving our country more damaged as a result. I am proud of the progress we are making. We know that what we have seen in terms of results and patient satisfaction are grounds for optimism, not cause for complacency. What we are trying to do as a Government is absolutely essential for the country, to give it back an NHS that is there for people where they need it, when they need it. That is why the BMA’s position is both disappointing and self-defeating for all of us.
The shadow Secretary of State talked about the approach I took in opposition. There is a difference between the approach that this Government have taken and the approach of our Conservative predecessors. We have always been prepared to get around the table; we never close the door. As I said from the other side of the House, the power to end strikes does sit with the Government when they are willing to compromise, willing to negotiate and willing to treat the workforce with respect. That is what this Government have done, in contrast to our Conservative predecessors, which is why it is so disappointing that with a deal available—a good deal—the BMA is turning away.
The BMA should reflect not just on the contrast with the past, but on the contrast with the future. There is no more pro-NHS, pro-doctor Health Secretary or Government waiting in the wings. I am not even sure that the alternative is a Conservative Health Secretary; that person may well come from Reform UK—the party whose Members occasionally turn up and sit in the corner, when they can be bothered and when they are not flouncing out in a hissy fit. Catch them on a good day and Reform Members may even say the quiet bit out loud: they do not believe in the NHS. They do not believe in it as a public service free at the point of use, and they are certainly not going to treat the BMA or resident doctors with more respect or generosity than a Labour Government. I think the BMA needs to reflect on that.
The shadow Secretary of State asked about affordability. One of the great things about the deal that we agreed is that it is affordable because it involves productivity gains—not just the productivity gains that we have already achieved in the NHS, the target being 2% and the reality that we have achieved 2.7%, but the productivity gains built into the pay structure reform.
The shadow Secretary of State asked about the jobs. I will be honest, and I am sure NHS chief executives will want to say more about this. The fact is that I and Jim Mackey have had to do a considerable degree of persuading and arm-twisting to persuade NHS trusts to create additional specialty training places, because they have not been convinced of their necessity or utility. Part of their reservation has been about the conduct of resident doctors and the BMA. I have had a hard job to do to sell that. Those jobs will not materialise if the BMA rejects this deal, I am afraid. There is a not a “something for nothing” culture here.
I say to the crab people who still believe that they are pursuing a really effective “bank and build” strategy that they should look at what they are confronting now, and look their members and their colleagues in their eye. This is not bank and build any longer; this is a high-and-dry strategy, and it is not going to work. That is why it is important that we end this dispute and that we do it together, in the spirit of partnership. There is still time to do that—there is still a week. The door is not closed; the offer is still there, and I urge them to take it before it goes.
Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
I share the frustrations of Ministers and of the Government. I know that they have worked really hard on this. Dr Fletcher of the BMA has also worked hard, and I am sure that there is a deal to be done somewhere. The Medical Training (Prioritisation) Act 2026, to prioritise UK graduates, was very welcome, but I wonder whether we can also do something to fix the foundations of medical careers, by devising a much better system than the crazy foundation lottery that sends a doctor from Norwich to Belfast and a doctor from Belfast to Norwich. That would be a great expression of good will. Meanwhile, I am sure that my colleagues in the NHS will work around this strike—our patients will be safe—and I am sure that our NHS will continue to improve under this brilliant Labour Government.
Wes Streeting
I thank my hon. Friend for his support in trying to influence a more constructive approach, for the advice that he has given me and members of the resident doctors committee, and for the experience that he brings to these exchanges. He is right to praise Jack Fletcher for the constructive approach that he and his officers have taken. It has not been easy, but I know that officials have enjoyed the constructive engagement, and I thank enormously the officials who have worked tirelessly on this. I think all those involved in the discussions, on both sides of the table, are disappointed by the outcome, and that is why I urge the BMA to seize the offer before it is too late.
My hon. Friend talks about other changes, such as to placements and rotations. I think that BMA officers recognise my desire to not only do this deal, but to create a new business as usual with the BMA, where we have people around the table on a regular basis looking at what we can do to improve the health service for patients and staff and to make real progress on those issues. We cannot do that if we are in conflict. That is the tragedy of the position we find ourselves in. I think we have built trust through engagement and dialogue with the BMA committee officers. It is only disappointing that members of the committee are not prepared to get around the same table as me, because if they did, they might realise the sincerity and the opportunity.
Madam Deputy Speaker (Caroline Nokes)
I call the Liberal Democrat spokesperson.
Helen Morgan (North Shropshire) (LD)
People across the country will be extremely concerned about the prospect of further strikes, having faced so much disruption already in recent years. It is important to recognise that the strike is a symptom of an NHS still coming to terms with the damage caused by the previous Conservative Government. Doctors are burnt out from working in high-pressure environments under poor conditions—often trying to save lives on corridors with no space or privacy. However, we all know how difficult public finances are, and that is now being compounded by Donald Trump’s reckless war in the middle east. Therefore, a further 26% pay rise is not affordable or realistic at the moment, and it is time the BMA recognised that.
There is much more the Government could be doing to support both staff and patients. The BMA has a mandate to strike until August, yet patients struggle to get GP appointments and suffer months of pain while stuck on waiting lists. How will the Secretary of State stop the situation dragging on throughout the year and causing yet more harm to patients?
We must also show staff and patients that things will get better. Lib Dem plans to recruit and retain more GPs, offer one-to-one midwife care and fix the social care crisis would offer the NHS the hope that is needed by easing pressure on staff and patients. Will the Secretary of State consider fixing crumbling hospitals as a priority, to give staff and patients the working conditions and dignity that they need and deserve?
At Shropshire’s major hospitals, it is common to see ambulances queuing up outside, unable to offload their patients, while staff inside are struggling to cope with patients in corridors. Will the Secretary of State commit to ending the misery of corridor care by the end of this Parliament? I welcome his intention to build additional training places, but will he outline a timetable for publication of the workforce plan, because that is critical for the future of our NHS?
Wes Streeting
I thank the Liberal Democrats for their support. I really hope that resident doctors appreciate that this is a party with a spokesperson who supports the NHS and wants to see it improving, but, even from the vantage point of opposition, is clear that what the BMA is demanding is unaffordable. We know from experience that it is easier to make promises in opposition than to have to deliver them in government, so when an Opposition party is also saying that the demands are unaffordable, resident doctors should accept that. [Interruption.] Thank you for the noises off from the Conservative Front Bench.
I reassure the Liberal Democrats that we are committed to ending corridor care by the end of the Parliament. I am really impressed by some of the progress that we have seen recently in some hospitals: Queen’s hospital in Romford has shown it can be done and other hospitals are showing real progress. We are determined to put the foot down on the accelerator. We will absolutely see capital investment to improve the NHS estate. We have 2,000 more GPs now than when we came into office—the highest number of GPs on record, in fact—although there is more to do.
Let me give this commitment to the “Agenda for Change” workforce. So much of the oxygen and airtime has been consumed by doctors, but 1.5 million people work in the NHS, many of whom will never be paid as much as the lowest paid doctor. They have been overlooked for too long, and we are determined, through the negotiations and discussions that we are having with “Agenda for Change” unions, to put that right. That will be my focus for the future of the workforce.
Laurence Turner (Birmingham Northfield) (Lab)
I declare an interest as chair of the GMB’s parliamentary group. The week after next, there will be another strike, when GMB members of the BMA’s own staff go out on industrial action, as has already been referenced. Their employer’s offer is 2.75%, which is lower than the 3.5% for doctors that the BMA called a “crushing blow”. Does the Health Secretary agree with the GMB union when it says:
“These strikes have laid bare the BMA’s ongoing hypocrisy”?
Wes Streeting
It is frankly breathtaking hypocrisy. It rather looks like doctors in their ivory tower saying one thing, and lecturing us about what is and is not affordable, but when it comes to how their subs are spent and how their own union behaves towards its own staff, not being prepared to pay them. I have been very complimentary about the officers who have been engaged with Ministers and my officials in recent weeks to try to get this deal over the line; so have BMA staff. I am stunned by the BMA’s unwillingness to practise what it preaches. I will not be joining resident doctors on the picket line. I should have declared, Madam Deputy Speaker, that I am GMB member, so if there is one picket line that I will be visiting during the doctors’ strikes, it may well be that one.
Madam Deputy Speaker (Caroline Nokes)
I call the Chair of the Health and Social Care Committee.
Layla Moran (Oxford West and Abingdon) (LD)
This is clearly the wrong move again. It is really stark; we keep hearing from patients across the country about how much they want the NHS to improve, but this is another blow to them, and they may even wonder if it is safe to go into their local hospital during the strike period.
I am grateful to the Secretary of State for coming to the Committee and talking about corridor care. The really interesting thing about that session was that the hospitals that have turned things around did so because of leadership from the top. Their executives and board members were going into hospitals out of hours and on weekends to speak with resident doctors, nurses and patients, to see what things were like on the ground. When was the last time the Secretary of State did that? This is not a “gotcha” moment—I have not done that recently, but I want to. If we are to lead a change in culture in the NHS, we should all show how we would do it, and should urge board members and executives to do the same, in every hospital across the country.
Wes Streeting
The Chair of the Health and Social Care Committee is absolutely spot on. I am relieved to report that I was doing exactly what she mentions only last Friday; I was walking the corridors of Queen’s hospital in Romford. I was there in January as well, seeing the worst of the situation. I have been spending time on the frontline in the places that were under the most pressure, just as I did last winter. I went along, not to look down my nose at people, but to listen, and to see at first hand what was happening, why it was happening, and what we need to do differently. The team at Queen’s hospital can really take pride in what they have achieved, but we have to sustain that progress. Last week, there were no trollies on the corridor, and in February they saved 10,000 corridor hours. That is thanks to brilliant frontline staff and senior clinical leadership on the front door, and we will see that again during strikes.
There is a certain irony about the fact that during resident doctors’ strikes, urgent and emergency care improves, because we have more experienced, senior clinical decision makers in urgent and emergency care. There is something to learn from that. I do not say that to denigrate resident doctors for a moment—they are learning and building their experience, and we do not want to lose that—but we are seeing that improvements can be made, and have to be made everywhere. We have to see this as a priority, because corridor care can never be the safest care, and it is never dignified care.
Sir Julian Lewis (New Forest East) (Con)
One thing we have not yet heard is the Secretary of State’s assessment of the motivation of the BMA committee members who are so militantly rejecting a deal that he evidently regards as generous. As he says, they are refusing even to sit down and talk with him. What is behind that? Why are they behaving in what appears to be an unreasonable and extreme way? To what extent does he think they represent resident doctors?
Wes Streeting
If the committee had ever taken me up on my offer to meet the entire committee, I might be able to answer the question, but since it has never done so, I do not know. It is for resident doctors to decide, based on what I have set out, if the committee’s rejection of this offer is reasonable.
Given the material benefits that the offer would bring to resident doctors in a matter of days—an additional 1,000 jobs and significant pay uplifts—and what that would mean for the next few years, I have to be clear that this is our best and final offer. We cannot go any further. If I may say so, we are at a point where the public would judge that we have gone as far as we can; I think quite a lot of people in the country who are watching would say that we have gone further than we should. I do not take that lightly. Resident doctors should not look a gift horse in the mouth, and I hope that they will make those representations to their committee.
David Reed (Exmouth and Exeter East) (Con)
I thank the Secretary of State for his robust view and position on the BMA. In reference to what was said by the Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), on the inflationary pressures that we will feel as a result of the conflicts in the middle east, do the figures for the three-year deal use the inflationary projections from the Office for Budget Responsibility and the Bank of England? If not, given that this is all about pay, and that the BMA will always come back for more—I think it is being unreasonable at the moment—does the Secretary of State agree that we need new rules around minimum service levels if we want to have a reliable NHS in this new world?
Wes Streeting
Pay structure reform and future pay are linked to the DDRB, which is an independent pay review body; its recommendations are one of the things that the BMA wanted the deal to be shaped around. The Government’s position on minimum service levels has been clear.
The hon. Gentleman sets out an alternative position from the Conservative party. I think the BMA should look at that, and judge whether it would be better to do a deal with this Government and move forward constructively. Does it honestly think that if it hampers NHS progress, and goes on endless strikes over the coming years, it will have a better Government to work with at the end of this? I do not think so.
I ought to say one final thing, which we should take really seriously. I have been thinking about this issue in the context of the covid inquiry report, and where we are in terms of threats to this country, the war in Iran, and the war in Ukraine. This country was more exposed during the pandemic than it might have been if the NHS had been in better shape. This country faces some serious threats in the world, and the NHS is not in good enough shape. In that context, we have to start thinking about whether the actions of the BMA are tolerable.