Yves here. While there has been a bit of reporting that has made its way across the pond about financial and other stresses at the NHS, I must confess to not knowing that doctors had been threatening to strike and the odds of that happening look high. So it looks like Keir Starmer’s fixation with Project Ukraine is having a measure of success by relegating this fiasco to secondary media coverage.
It’s not hard to see that (just like with the US VA system), the NHS has been squeezed financially to make it hard to deliver good care, so as to justify privatization. I wish this article presented the doctors’ demands. However, even if there was a sea change in the government’s position, it would still take time and investment to reverse the effects of budgetary starvation.
As to the politics, a query and an observation. I thought Wes Streeting hoped to succeed Starmer and indeed in some way depended on Starmer to raise his odds of success. Am I correct in understanding that this was due to the fact that Streeting was too right wing for most Labour members, but he might be able to position himself as the only option that remained? I would assume regardless that a mess at the NHS would very much dim whatever prospects he had.
The observation is that Murphy contends that this year’s flu arrived early but there is “no clear indication as yet” that this flu season will be seriously bad. IMHO that is unduly optimistic. First, the current variant is nasty, to the degree that the authorities are recommending mask wearing. The Nikkei has carried prominent stories about the severity of the surge in Japan:
🚨 GLOBAL FLU SURGE ALERT 🚨 Reports say H3N2 influenza is spreading across Europe and parts of Oceania and Asia, including the UK, Spain, Germany, France, Italy, Australia, New Zealand, and Japan, with hospital footage showing patients experiencing symptoms such as fever and… pic.twitter.com/zvgFRw9X8g
— Ray Escobar (@raymonix_00) December 15, 2025
UK: Super flu is ‘beyond catastrophic’
“Just two weeks before Christmas, top clinicians say this is the worst winter they have seen”
The Independenthttps://t.co/J8JDTIVdmN
— CoronaHeadsUp (@CoronaHeadsUp) December 15, 2025
And as we have been reporting (see today’s Links for yet more examples) evidence continues to mount that past Covid infection increases vulnerability to other contagions.
By Richard Murphy, Emeritus Professor of Accounting Practice at Sheffield University Management School and a director of Tax Research LLP. Originally published at Funding the Future
The confirmation that resident doctors will strike over Christmas was entirely predictable, as Roy Lilley has noted in his NHS-related daily email today.
An 83.2 per cent vote to continue action, on a solid turnout, signals confidence and discipline.
But what is also clear is that this is not just a labour dispute, as Wes Streeting is trying to claim, or a disgrace, as Keir Starmer would have it. This is a dispute about who is responsible for a system already stretched close to breaking point.
Doctors are very clear that it is not them, and with good reason.
They are equally clear that the failure is on the part of successive politicians, all of them sharing the same austerityculture.
The public has no difficulty deciding who to side with in this case: doctors are not the problem, and are the ones seeking the solution to it.
The public blames politicians who are now trying to pin the blame on doctors for an NHS crisis of Labour’s own making, which attempt is backfiring as a result.
Wes Streeting has compounded the problem. He has chosen belligerence over negotiation, framing a pay dispute as a test of authority and repeatedly warning of NHS collapse, winter crisis and patient harm. Christmas was supposed to concentrate minds. It has not. Instead, each supposed “final” position he has suggested has quietly expanded, revealing successive weakness on his part rather than strength. The doctors know they have him on the run.
This is ultimately a credibility failure. Exaggerated threats, shifting red lines and hostile briefings may win headlines, but they corrode trust. Once trust is lost, negotiations become endurance contests rather than problem-solving exercises. That is where this dispute now sits, and the BMA has outmanoeuvred the government as a result.
The NHS will almost certainly muddle through the strikes. Trusts are well rehearsed. Elective work will be cancelled, rotas simplified, and Christmas capacity reduced as it always is. If the apocalyptic scenario does not materialise, as is likely, Streeting’s authority weakens even further, and for all the rhetoric, there is no clear indication as yet that the UK is suffering a serious flu crisis this year; it may be nothing more than normal, but just earlier than usual.
Doctors are, admittedly, consciously trading public goodwill for bargaining power, judging pay erosion to be the greater threat. But this dispute is no longer really about Christmas or even pay. It is about who runs the NHS, how fragile it has become after years of neglect, and how quickly Number Ten realises this needs to be resolved through respect, negotiation and competence and not confrontation.
The problems are that:
- No.10 can’t sack Wes Streeting right now, even though he is hopelessly out of his depth and has grossly mismanaged this dispute by making it personal.
- No.10 has also made it personal, which was a gross error of judgment on their part.
- Labour has, as a result, nowhere to go but lose, as they are bound to do.
What a mess.
And we, and doctors, are paying the price for yet another government that has no clue how to negotiate anything.
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“… another government that has no clue how to negotiate anything.”
That seems to be a root cause of all sorts of problems around the world right now. Governments that see negotiation as “weakness” and deleterious to their “power.”
Good governments are often free-wheeling contests to see what approach ‘solves’ problems the best. Of late, governments look to be run by strict ideologues who are so blinkered by their internal biases that reality is ignored until it smashes each and all alike.
What did the Neo-liberals think would happen after their ‘task’ of “drowning the government in the bathtub” was accomplished? The dawning of A New Golden Age?
At least, the UK has non governmental associations that will step up and challenge the government when necessary. Can anyone here imagine American medical cadres doing the same, (with the exception of the Nurses Association?)
I don’t rule the world, so I’ll keep my preferred “fixes” to the myriad problems besetting the West to myself.
Stay safe. Prepare well, Hard Times ahead.
Novara Live covered this yesterday (starting at 30:38-46:50). In the first minutes Streeting is shown with his take (the gov had offered a 28% pay rise last year but the doctors came back with another 26% demand and other factors). Host Michael Walker offers analysis, such as the use of CPI vs RPI in various calculations. This is over my pay (no-pay) grade to explain, but it does strike me that doctors in the UK don’t make that much compared to the US.
They don’t have our level of student debt/ed costs, and they don’t have to spend a day+ a week fighting with insurance or paying for their staff and probably not medical malpractice insurance either. But I suspect even with those big adjustments, that the specialists in the US are better paid. PCPs may not be.
Sadly higher ed in England is no longer free. UK medical students graduated in 2021 with an average debt of 71,000 pounds. This takes a young doctor approx. 10-15 years to pay off.
NHS doctor here – UK medical school from 1993, doctor in training from 1999, “senior doctor” for >10years.
The whole NHS, every single part, has been slowly strangled. There is far more privatisation than anyone knows – most Brits still think there is no or only very little privatisation of “our NHS” – my prediction is that in the next few years the government will announce that health insurance is the only way to go.
There have been several strikes by doctors in the UK over the past few years, this is not the first strike by this group of doctors. The strategy (for patient safety reasons) is that senior doctors (called consultants in the UK), “junior” doctors (these are people with a medical degree who have between 0-15+ years of clinical experience) and “staff grade” doctors (too complicated to explain but basically fully trained and experienced doctors) are balloted for strike action at different times. So if one group is on strike there are other doctors available.
Resident doctors (the new name for junior doctors) demands are:
1. pay restoration, ie make current pay what it would have been if pay increases kept pace with inflation. There have been many years of below inflation pay increase (eg inflation 8% pay increase 3%).
2. training places negotiations. Medical school places were expanded – more money for universities. Training places in hospitals were not expanded – these cost money for the government. So now you can be unemployed even though you have a medical degree and are no different from other doctors – it is just the luck of the draw.
resident doctors need pay restoration because:
1. student fees £9k per year x 5-6 years. Pay for doctors is higher than the repayment threshold so the repayments start. Repayment is some percentage of pay.
2. doctors have to live close enough to their place of work because they work shifts, 7 days a week. So they cannot choose somewhere affordable.
3. doctors have to pay for training courses, professional examination fees, registration with professional bodies, medicolegal cover. This could be several thousand per year.
4. if you have a child/children, then childcare is essential (shifts 7 days a week). this is several thousand a month.
None of this is ever reported. Instead people focus in on which measure of inflation is being used, and whether the pay uplift is 20% or 18% or some other number.
Getting into medical school (as has been discussed at NC before now) means sacrificing a lot of your childhood and adolescence to get the grades and CV points. Then 6 years of medical school, memorising huge amounts of information and incurring huge debt – that’s your early 20’s gone. To then realise that your life for the next 10-15 years is not particularly well-paid (especially if comparing with peers who went into finance or law), unsociable (shift work!) and unstable (in training it is normal to move every year to a different job which often means moving your whole life) – it is a wonder that people are not more angry.
Well said — you’ve captured what many of us are trying to say. The missing point is that governments now actively discourage investigations, operations, and management that used to be routine and are often essential for good patient care. They control the budgets, then quietly shift the blame onto doctors, making it look like clinicians are choosing not to act.
Yes, funding is tighter — but imposing austerity on health services and expecting good outcomes is simply unrealistic.
Thank you! People are angry, grimly it is purposefully misdirected by demagogues against the other so as to minimize social cohesion. People who dedicate so much of themselves to areas that have such clear social benefits should not have to fight so for just rewards. The financial elites dedicate so must less yet watch as the system they have rigged brings them vast sums.
oops meant as a reply to RW above
From reading Paul Johnson’s Follow the Money and conversations with cousins who are doctors (recently retired), the following thoughts flow more broadly about the NHS.
1. The Internal Market (introduced in Thatcher’s day) has significantly increased paperwork demands on GPs. More time on paperwork means less time for patients.
2. There have been so many reorganisations that the service is punch-drunk. Sweeting’s solution ? Another reorganisation.
3. Inadequate investment in staff and equipment. Consequences obvious..
4. Social care has been severely underfunded. As a result many hospital beds are taken up with patients who should have been discharged but cannot be as there is insufficient support for them when they return home.
5. PFI has drained the NHS by imposing costs in excess of what direct government funding would have cost (Reference Howard Davies: ‘A fraud on the public’).
In the 1950s and 1960s the NHS was regarded as the best run health service in the world. Then the British politicians got to work.
Excellent points.
I’d disagree on one point. The obsession with avoiding admission and pushing early discharge has worsened outcomes and increased costs. Caring for sick patients often requires fewer staff in hospital than scattered across the community, especially where travel, traffic, and delays are involved.
At home, care is frequently inadequate: investigations are harder to arrange, infection risks are higher, and patients are often discharged before fully recovered. In hospital, tests can be done on-site, sanitation is better, mobility is supported, and care is more consistent. Early discharge isn’t efficiency — it’s false economy.