Resident Doctors: Industrial Action

Baroness Blake of Leeds Excerpts

Wednesday 16th July 2025 Lords Chamber

[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.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, I endorse the comments of my noble friend Lord Kamall about recognition of those doctors who have decided not to take action. There can be no way that doctors abandoning patients is compatible with the Hippocratic oath they have taken. For 17 years as chancellor of a university, I have listened to doctors on qualification saying that they are taking their Hippocratic oath and that they will give priority to patients and do no harm. Taking five days of industrial action does a great deal of harm to the patients and, of course, to others in the profession who have to pick up the load—the nurses, the consultants and others.

I endorse the great disappointment expressed by the noble Lord, Lord Stoneham, that the report by the noble Baroness, Lady Casey, is going to be so slow in arriving, given that it is so essential to the next steps in the health service.

I wonder whether the Minister could come back on the point I made to her last week about resident doctors taking industrial action and then signing on as locums at a premium rate in another health authority or hospital, whether in the NHS or otherwise. Resident doctors are doing the profession enormous harm. Extraordinarily, we still have incredibly high entry standards for doctors. It remains one of the most popular and sought-after professions for school leavers. I take with a pinch of salt this idea that they are all leaving. Lots of doctors go on rotation to America or Australia and to get experience around the world, but I still think that, thank goodness, they regard working in Britain as a worthwhile activity and profession. But the damage these resident doctors are going to do to that trust and respect is enormous.

[Baroness Blake of Leeds (Lab)]

I thank the noble Baroness for her comments and the background. I shall particularly pick up on the issue of moonlighting, which she has raised before. As a point of reference, during the industrial action in 2022-24, it was picked up. There were isolated and anecdotal incidents of this behaviour. It is difficult to get accurate information, and with the current systems in place there is no clear or easy way to monitor the practice. However, resident doctors moonlighting while on strike is clearly unacceptable and in clear breach of the GMC code of practice. As I have said before, it is up to the employers to take any reports of this very seriously, and I am sure they will.

I echo the noble Baroness’s comments about the medical profession in this country. We have some extraordinary people working in the whole of the NHS, not just the doctors. It is a phenomenal organisation, and we believe it is our absolute duty to do everything we can to protect it and preserve it for the future, and to keep it true to its principles of delivering care free at the point of delivery and reaching everyone that needs it.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I gave prior notice to the Minister that I want to ask a couple of questions about the Leng review into physician and anaesthetist associates which was published today, dealing with issues of high relevance to the concerns and the levels of dissatisfaction among resident doctors. Indeed, the review directly addresses some of the training issues for resident doctors which are set out in this Statement and which the Government say they are seeking to tackle, particularly rotational training and the lack of training places.

I have two questions. First, when and by what mechanism will Parliament, and particularly your Lordships’ House, have the chance to discuss the Leng report, given the high level of engagement on the statutory instrument that created the GMC registration of PAs and AAs in February 2024 and the level of expertise in your Lordships’ House?

Secondly, and this reflects many questions with which I am being bombarded by those concerned with these issues, some of the main recommendations of Professor Leng include the renaming of physician associates and anaesthetist associates as assistants. Professor Leng says they should not be seeing undifferentiated patients except within clearly defined national clinical protocols; they should get at least two years’ experience in secondary care when newly qualified before taking roles in primary care or mental health trusts; and there should be a named doctor as a line manager, which puts into question people operating as so-called locum physician associates.

Presumably, at least the first of these, the naming question, would require a new statutory instrument. Others may or may not. Can the Minister give me and all the other interested people some idea of how the Government are planning to take this forward?

[Baroness Blake of Leeds (Lab)]

The noble Baroness is certainly up to date as the report was published only this morning. If I am honest, asking such detailed questions at this stage is possibly slightly premature. We have committed to bringing in an implementation plan, which will be published in the autumn. The government-commissioned work has been very detailed. Professor Gillian Leng led the review, and the report sets out 18 recommendations that will give much-needed certainty and clarity to staff and patients. The Government are accepting these recommendations in full. By doing this, the Government have demonstrated their commitment to evidence-based policy informed by expert clinical advice, listening to patients and professionals.

I look forward to the implementation plan coming forward to make sure that we get some clarity. One of the most dangerous things is the lack of clarity that has surrounded these positions. The debate had, quite frankly, become polarised and in some cases toxic. That is not in anyone’s interest. Of course, there will be conversations between all interested parties following the report’s publication today and I look forward to discussions. I am sure it will come back to this place at the appropriate time.

[The Earl of Effingham (Con)]

My Lords, the Secretary of State said that resident doctors

“should start to experience an improvement in their working conditions on everything from the availability of nutritious food and drink”—[Official Report, Commons, 10/7/25; col. 1150.]

to other items. I would be interested to know: how exactly are the Government intending to achieve nutritious food and drink for these resident doctors?

[Baroness Blake of Leeds (Lab)]

I do not want to take that lightly, but resident doctors work extraordinary hours and put themselves on the line every time they go into work. Making sure that their employers provide them with the support they need is a fundamental job that they should all do, and I suspect that in some cases that has not been the case. There are so many other ways that all medical staff need supporting. Unfortunately, many medical staff meet violence in the workplace and meet discrimination and all sorts of challenges, and they need to feel that they have support. Making sure that they have access to nutritious food is fundamental and important, and I think we all know, looking back over the last decade, that the conditions that we have expected those wonderful professionals to work in have simply not been good enough. We will do everything we can to ensure that whatever aspect is causing concern is picked up and taken very seriously.

House adjourned at 11.40 pm.