PARLIAMENTARY DEBATE
NHS Winter Update - 8 January 2024 (Commons/Commons Chamber)

With permission, Mr Deputy Speaker, I would like to make a statement on the winter pressures facing the national health service and social care, as well as the impact of the ongoing junior doctors’ strikes. The NHS employs 1.3 million people and the social care system a further 1.5 million people. Together, they treat and care for tens of millions of people every day. We all know that winter is the most challenging time of the year for the NHS and social care, as our workforce have to tackle the pressures created by cold weather and seasonal viruses.

To put our health and social care system in a strong position heading into winter, this year we started preparing earlier than ever before. In January last year, we published our recovery plan for urgent and emergency care and provided £1 billion of dedicated funding to boost emergency capacity. The plan committed to delivering 5,000 new permanent staffed beds. I am pleased to update the House that more than 3,000 were already in place in December, and in the coming weeks NHS England will meet the 5,000 pledge and make sure that it has almost 100,000 core beds ready when covid and flu peak.

Our recovery plan also pledged 10,000 virtual ward beds so that more patients can be monitored safely at home, away from hospital. I am pleased to update the House that we have delivered more than 11,000 virtual ward beds, and they have been a vital service for eligible patients over the festive period.

We have boosted our ambulance service with £200 million of additional funding, putting new vehicles on the road, improving response times and getting crews out and about for more hours. In recognition of the importance of patients being discharged promptly from hospital when it is safe to do so, we have made sure that every acute hospital in England has access to a care transfer hub, bringing together teams from the NHS and social care to speed up discharge, backed by an extra £600 million for social care. To help prevent the spread of winter viruses, we brought forward flu and covid vaccinations, protecting the most vulnerable and making them less likely to require hospital treatment.

But no matter how thorough our preparations are, winter will always be the most challenging time of the year for our NHS. That is why it is extremely regrettable that the British Medical Association’s junior doctors committee has chosen to strike not once, but twice at this time of year. It has also chosen to strike for an unprecedented length of time, putting profound pressure on hospitals and GP surgeries throughout the country.

Before Christmas, the BMA’s strike caused the cancellation of almost 90,000 appointments, some of which will have to be rescheduled for a second or even third time. That is in addition to the 1.1 million appointments that have already been affected since strikes began in December 2022. This is not just another statistic; there is a person behind every one of these appointments, who may be in pain or distress and who now must wait longer for the care they deserve.

Last week, a member of the BMA leadership said

“strike action benefits absolutely nobody.”

They were absolutely right on that. The ongoing strikes are causing more appointments to be cancelled and more worry for patients, and are putting a significant strain on staff.

During December’s and this week’s strikes, the NHS’s priority has been to protect patient safety. Resources have been channelled into urgent and emergency care, including vital neonatal and maternity services. Huge efforts were made to make the most of the working days between Christmas and new year, because throughout any strike action, it is crucial that every patient who needs urgent medical care comes forward as normal. We continue to face challenges, and strikes have stretched emergency care, but thanks to the meticulous hard work in local trusts in preparing for strikes, as well as to the huge personal sacrifices that clinicians and staff are making to pick up the slack, emergency care has largely held up and the system has coped under the circumstances.

Staff across the NHS deserve our sincerest thanks for the heroic efforts they have made throughout the unprecedented strikes. I thank the doctors, nurses, paramedics and all frontline staff who have come into work to support each other, deliver care and protect patients; the consultants, including Members of this House, who are working extra hours, cancelling their holidays or even coming out of retirement to safeguard patient safety; the managers, administrators and NHS leaders who are working day and night to make sure that the right staff are in the right place to protect patient safety; and all those working in social care, from local authority staff to care workers and carers, who have rallied round to support hospitals.

I know that work does not stop when the strikes stop. NHS staff will begin turning their attention to recovering from the impact of the industrial action, restarting elective treatment and improving the flow of patients through emergency departments. The junior doctors committee’s choice to strike at this time of year means that that work must now be done under additional pressures, as staff move to catch up from industrial action as well as tackling the impacts of cold weather, covid, flu and norovirus.

I want to find fair and reasonable solutions to industrial action. One of my first acts as Health and Social Care Secretary was to bring in the British Medical Association for talks to end these long-running disputes, as well as meeting representatives for Agenda for Change unions who speak for frontline staff, including nurses. We have reached agreements with unions that represent consultants and specialty doctors on offers to be put to their members. Those offers will modernise contracts, realign pay scales and improve doctors’ career progression, while delivering value for the taxpayer and protecting the hard-won progress we have made to halve inflation. Consultants and specialty doctors are pausing strike action while members vote on the offers, with the results of both ballots expected shortly. The Government and BMA agree that they are the best deals available to us, and I very much hope that members will vote in favour so that those positive changes can be made and we can move the NHS forward.

On junior doctor negotiations, the talks that began in November had been progressing with the BMA junior doctors committee. The talks were constructive, exploring a range of proposals that would improve the working lives of doctors across the NHS. I was therefore extremely disappointed when the BMA turned its back on the negotiations before they had concluded to call the damaging strikes that we face today. The Government will not negotiate with the BMA while strike action is under way and patient safety is at risk. Every strike is hugely disruptive for our NHS. The NHS and patient safety cannot be switched on and off on a whim. I do not believe it right to negotiate with unions while they are being unreasonable and some of their members are walking out of hospitals at the busiest and most challenging time of year for patients.

I remind the House that the junior doctors committee’s headline demand of a 35% pay rise is simply unaffordable for taxpayers. Last summer, we accepted the recommendations of the independent pay review body in full. That meant that junior doctors received average pay rises of almost 9% in their September pay packets—some of the most generous increases across the entire public sector. Meeting the 35% demand would stoke inflation just as we as a country have halved it, burning a hole in the pockets of families up and down the country, and it would be totally out of step with the pay rises awarded to other dedicated public servants and employees throughout the private sector. Staff across the public sector have agreed fair and reasonable deals on pay; only the junior doctors committee has repeatedly walked away from talks.

Let me address the issue of NHS leaders asking some junior doctors to return to work when patient safety is at risk, in what are known as patient safety mitigations or derogations. As of 9.30 this morning, 40 patient safety mitigations have been submitted during the current round of strikes, and two have been accepted by the BMA. NHS leaders, many of whom are themselves members of the BMA, have decades of combined experience. They know their patients and they know their rotas, and they would ask for mitigations only if they were absolutely necessary—in, for example, a children’s emergency department. They are wholly independent of Government: it is for them to make those decisions. I trust them and I trust their judgment. That is the reality, and that is the truth about patient safety mitigations.

One of the reasons why I came into politics was the NHS and what it had done for me and my family. That is also one of the reasons why I am a Conservative. This is a Government who have delivered record NHS funding, the first ever NHS long-term workforce plan, and 50,000 more nurses for our NHS. We are providing the NHS with the doctors it needs for the future by doubling the number of medical school places, opening five new medical schools and pioneering one of the world’s first medical apprenticeships. We have also supported doctors by making changes to pensions for those at the very top of their career path—at that point, that was the BMA’s No. 1 ask, and a policy that the Opposition seemed to oppose.

Those are not the actions of a Government who are turning their back on the NHS, as some have declared. They are the actions of a Government who are building a health and social care system that is sustainable for the long term. To do that, we must put the strikes behind us and move forward together, because the NHS belongs not just to the junior doctors committee: it belongs to us all. It belongs to the millions of people who rely on its being there when they need care, as well as the millions of taxpayers who pay for it. For their benefit, it is time for the members of the junior doctors committee to show that they are serious about doing a deal. They have legitimate concerns about their working lives, and a fair and reasonable deal can be reached, but calling damaging strikes is not the way in which to achieve that. Earlier this week I said that if they called off their damaging strike action, I would get round the table with them in 20 minutes. I am, of course, extremely disappointed that they refused my offer, and continue to refuse it—the strikes are ongoing as we speak—but if they come to the negotiating table with reasonable expectations, I will sit down with them.

This Government have a clear, long-term plan for the NHS. Our recovery plans in elective, emergency and primary care can improve access to treatment, transform services, and give patients more choice in and control over their care. Our long-term workforce plan will give the NHS the staff it needs to thrive for decades to come, our social care reforms will build a better care workforce to support our growing number of older people, and by creating the first smoke-free generation we will reduce long-term pressure on our health service. We have eliminated the longest waits, but we have not yet made a significant enough reduction in waiting lists. To do that, we need the junior doctors committee to come to the table and do a deal that is in the interests of patients, in the interests of our NHS, and in the national interest. Then we can build an NHS that is not only stronger today, but stronger for our children and grandchildren.

I commend this statement to the House.

I welcome the hon. Gentleman back from his world tour promoting his book. It is very nice to meet him for the first time across the Dispatch Box. While he was away in sunnier climes, he may have missed what is actually happening in Wales, which interestingly has been described by the Leader of the Opposition as the “blueprint” for how Labour will run the NHS, were it ever to come into government. Interestingly, in the Labour-run Welsh NHS, people are almost twice as likely to be waiting for treatment, and they are waiting an average of five weeks longer for NHS treatment under Labour in Wales than they do in England. Indeed, the number of patients in Wales seeking treatment in England has increased by 40% in two years because of the experiences that people are having in Wales.

I will just correct the hon. Gentleman on a couple of other things, too. Just to help him understand, we are delivering the 800 new ambulances—those are new ambulances—at pace at the request of the NHS, just as we are putting in 5,000 extra beds in hospitals across England, because we understand the point about capacity and we want to help the NHS look after people in a timely and efficient manner.

I will also just correct him again on the doctors in training point. I am surprised he has come on to that at this point, but had he spoken to his friends in the BMA, he would have understood that that is the phrase that the BMA is using. It has passed a motion to stop using the phrase “junior doctors”. [Interruption.] Yes, the BMA passed a motion. The hon. Gentleman referred to doctors, but he perhaps does not understand the complexities of contractual negotiations. The phrasing is used to denote those professionals who are still on formal training pathways who are not specialty doctors or consultants. That terminology has been agreed with the BMA.

In terms of the strikes themselves, I note—I know that those sat behind me on the Government Benches noted it, too—that the hon. Gentleman did not condemn the strikes. I am happy to give way, if he would like to confirm whether he condemns the strikes. Unfortunately, he has missed his chance to do so, but I suspect that everybody, including the patients at home waiting for appointments, will see the Labour shadow Minister’s failure to condemn these strikes. That is because, in line with public sector strikes more generally, the Labour movement will always prioritise union harmony over patient safety. That is not what we as Conservatives do; we will always put patient safety first.

I thank my hon. Friend for asking that question and for noting the enormous efforts that clinicians across the NHS have gone to in order to cover these strikes. We are conscious of the personal impacts that has had for many, and clinicians have had a very tough few Christmases. We were all collectively hoping that this Christmas would be just a little bit easier for them, but sadly these strikes have a real impact on people who are working to pick up the slack from junior doctors not turning up. I am grateful to everyone who has gone into work, who has worked extra shifts and who has cancelled time off with their families. We must find a fair and reasonable solution to this industrial action, which is precisely why I was so very disappointed that the BMA junior doctors committee chose to walk away from these discussions.

I imagine that the hon. Lady has seen that we accepted in full the pay review body’s recommendations last year and, as of September, junior doctors and doctors in training have received on average an 8.8% increase on their basic salaries—they also earn money on top for antisocial hours, working overtime and so on. In addition, they have pension contributions of some 20%, which is a rare employment benefit across both the public and private sectors. In the future, I want to find a fair and reasonable settlement with the junior doctors, as we have been able to reach with consultants and specialty doctors, but we cannot do that if junior doctors are on strike. That is why it is so very disappointing that they walked away from the discussions.

I welcome my right hon. Friend back. I have said throughout this that I was extremely disappointed that the committee chose to walk away from discussions. I also think that there is a lot more to discuss apart from pay—I have made it clear that I would like to look at other aspects of their working conditions—but, unfortunately, the junior doctors committee walked out. The strike action has had a real-terms impact on patients. We need to find a fair and reasonable solution, but I will not do that while the junior doctors committee maintains strikes. It will have to come to the table with reasonable expectations and change their minds on the validity of strike action.

I am so sorry, I do not know who the hon. Lady is referring to. On the Conservatives’ plans, at the 2022 autumn statement we announced up to £7.5 billion of additional funding—an historic increase—and we did not stop there. This summer, we announced an additional £600 million, which brings it up to £8.1 billion of additional funding over two years. That will support our care workforce, and the majority of the funding will end up in the pockets of the amazing people who provide care and support to the patients we are all concerned about.

First, I sincerely thank my hon. Friend. I was in contact with her over the weekend when she had come off a very long shift in emergency care, looking after patients locally. I have nothing but admiration for her and the many, many other people who stepped in at short notice to cover urgent and emergency care in our NHS during the strikes. On minimum service levels, she will know that we have already introduced them for ambulance services—something that was opposed by the Labour party—but we have just closed the consultation on minimum service levels in hospitals and we are, of course, carefully analysing the responses. Again, the point that 40—four zero—patient safety mitigations were made by NHS leaders yet only two were granted by the BMA, is very, very worrying when it comes to how seriously the BMA is taking concerns about patient safety.

I thank the hon. Lady for re-emphasising the critical timing of the strike actions and the impact it has on patients. We know that winter is difficult. It is not just difficult for our healthcare system. Around the world, when cold winter strikes, it has physiological impacts on people with underlying health conditions. We also have a rise in infectious conditions, too. As she will appreciate, that is precisely why, on the advice of clinicians, we brought forward the flu and covid vaccination programme to try to protect the most vulnerable in our society. But again, the timing of the strikes is so very cynical, because their impact and tail will, I am sorry to say, have consequences beyond tomorrow’s stop date.

I thank my right hon. Friend for her work in the Department. She knows only too well the difference an inspirational leader can make to a local NHS trust, and at regional or national level. Managers who are good and committed to their local area, who work with their clinicians and other healthcare staff to try to look after patients all year round, have been put under the most enormous pressure over the last few weeks because of the strikes. I thank every single one of them for doing what they can to safeguard patient safety. As I say, I trust their judgment. If they have put patient safety mitigations in, it is because they consider, in their professional judgment, that they are needed.

I am extremely grateful to the right hon. Lady, who will know that our constituencies, albeit not necessarily in the same region, nevertheless share similarities, being relatively close to each other. The work and the progress made on urgent and emergency care is precisely because we were concerned about, for example, ambulance response times and hospital discharges. We worked with NHSE to bring together the urgent and emergency care plan and, for example, bring about 800 new ambulances on to our roads and about 5,000 more core beds into the NHS to try to address those needs. Unfortunately, the strike action that we have seen over recent days has very much militated against those efforts. We all accept that winter is a very difficult time for the NHS, and through the urgent and emergency care plan we have worked with NHSE to try to meet the demands that she so rightly puts forward.

My hon. Friend sets out clearly the many pressures and factors at play in running emergency departments and hospitals at the best of times, when we are not in the middle of winter and facing the pressures that it always brings on the healthcare system. I thank not only staff in his trust, but staff throughout the country for the work they have done over recent weeks to support the NHS and to bring treatment to patients. We are working hand in glove with NHSE regional and local leaders to see whether there are practical measures that can be taken to improve the flow through hospitals.

I hope the hon. Gentleman will be interested to know that we have made cancer treatment waiting times a key focus of our elective recovery plan, which has been backed by an additional £8 billion in revenue funding across the spending review period. We have made progress by delivering record numbers of urgent cancer checks, with more than 2.9 million people seen in the 12 months to October last year. Of course there is more to do, and I would be very happy to meet him and colleagues across the House to discuss the practical ways by which treatment can reach our constituents. He will not be surprised to know that cancer is a priority not just for me personally, but for the Government as a whole.

I thank my hon. Friend for all his work in making that happen. He worked very hard on virtual wards when he was a Health Minister, and they represent a real step change in how we treat people with long-term conditions who can be monitored safely at home. They mean that people do not have to spend time in hospital, with all the pressures that can mean for us as individuals. Importantly, that also frees up beds for other patients who need them. I am keen to roll the scheme out further. Indeed, we have not just met but exceeded our initial ambition, which is why I can confirm that we have delivered 11,000 places in the virtual bed ward category.

The figure that the BMA relies on is in fact from 2008, when the Labour party was in government for the first two years. The BMA cites a 35% pay rise. Just to clarify, independent organisations such as Full Fact and the Institute for Government rely on the consumer prices index measure, which shows a difference of 11% to 16%. I am sure that the hon. Gentleman will take into account the fact that we have already given graduate doctors, in their first year out of medical school, a rise of 10.3%, and I was willing to negotiate further and consider additional settlements that are fair and reasonable to the taxpayer.

My hon. Friend is a brilliant advocate on the challenges facing his rural and coastal community. We all know that geography is a factor in the difficulties of delivering healthcare in his corner of England, but everything the trust and clinicians do is about trying to improve healthcare for his constituents. I cannot be the only one who felt uncomfortable at the image of some on the picket lines last week singing while our constituents were struggling with cancelled appointments and worried about urgent and emergency care times. I am very keen that we should reach fair and reasonable settlements with junior doctors, but in order for that to happen they must act reasonably, change their minds and call off the strikes.

We have—in the NHS long-term plan. We have set an ambition to grow the mental health workforce by an additional 27,000 staff between 2019-20 and 2023-24. That is in addition to the at least £2.3 billion of additional funding a year by March this year.

Indeed. I thank my hon. Friend for all the hard work and advocacy she puts in on behalf of her constituents. If I may, I will ask the Minister for Health and Secondary Care to visit my hon. Friend’s hospital to discuss with her the concerns of local residents and to ensure that the trust is aware of them.

That is a very fair challenge, and I will look into it, given that the hon. Gentleman has raised it.

I will follow that advice with great enthusiasm. I have another statistic for my right hon. Friend: the Labour-run Welsh Government were hiding 45,000 patients from their A&E waiting figures in the first half of 2023, and falsely claiming that they perform better than England. If that is the blueprint for how it runs things, we should all be very worried if Labour ever again forms a UK Government.

I reassure the hon. Lady that the impact of mental health patients remaining in A&E for any length of time, let alone beyond 72 hours, is genuinely a metric and factor that we look at very carefully, as we have done throughout the strikes. We appreciate that A&E is not the right environment for most people who are suffering from a mental health illness or a psychotic episode, and we want to move them into appropriate care as quickly and safely as we can. With that in mind, I hope that she will welcome the fact that we are spending some £7 million for up to 100 mental health ambulances over the next two years, to try to ensure that people get the right care they need, when they need it. More than 160 projects are being allocated funding in the community, including crisis cafés and safe havens, so that hopefully people are caught before the crisis happens and they end up in A&E.

I would be happy to do so. I am pleased to hear of local NHS leaders actively seeking the views of the patients and communities they serve, in order to ensure that their services are what the public expect from their local hospitals, and from primary and secondary care services.

We are making progress. The hon. Gentleman will appreciate that that figure alters not just day by day, but hour by hour. We have been investing in social care packages precisely because we understand the importance of being able to discharge people promptly and safely into the appropriate social care setting, which can have a huge impact on flow through the hospital.

Other factors can also have an impact on flow, such as practical measures for people who perhaps do not need social care help when they leave hospital. We are looking at what we can do to improve those local factors as well. The hon. Gentleman is right to make the point that the social care system goes hand in hand with our NHS and hospital care. That is why we have been so keen this year to inject extra investment into social care—to try to alleviate some of the issues that he rightly raises.

I pay tribute to both my hon. Friend and my right hon. Friend the Minister for Health and Secondary Care for their work as first responders. I would get into a lot of trouble in my own constituency if I did not mention the wonderful LIVES—our community first responders, who get to the scene of road accidents or emergency calls before ambulances and conduct the most extraordinary and complex procedures very safely on patients when they need it.

Recently, I was pleased to visit the London Ambulance Service to see for myself what team work can achieve across an ambulance service and how these highly qualified and experienced individuals can make a real difference to people’s lives and health after recovery. I send my sincere thanks to everyone who has been working in those capacities in recent weeks and over the festive period.

I think the hon. Lady was claiming that there was no winter under Labour, but perhaps that is yet another thing that does not quite stack up. I fully endorse her call for an end to blame culture, but point her to the real and practical measures that we have taken to improve urgent and emergency NHS care. I assume that she joins those on the Government side in condemning the unprecedented strike actions that the junior doctors committee has called at this particular time of year.

I most certainly can confirm that—those doctors have already received the rise. As I said, I wanted to continue discussions on more fair and reasonable settlements for junior doctors, recognising as I do how tough their job is and the conditions under which they work. May I thank my hon. Friend for the leadership he has shown with his local trusts and clinicians? I agree with him that the one thing we have not heard from the Opposition is that they condemn the strikes. They seem to prioritise union harmony over patient safety.

I will ask the Minister for Health and Secondary Care, my right hon. Friend the Member for Pendle (Andrew Stephenson), to liaise with the hon. Lady directly. As I say, the latest figures I have from NHS England, working with local trusts, is that more than 3,000 of the extra 5,000 beds were in situ in December, and we expect the 5,000 deadline to be met very shortly. I hope she will see that at local level in her hospital very soon.

Very much so—the NHS belongs to us all, as I say repeatedly. It goes without saying that doctors are a critical part of our workforce. That is why, since becoming Secretary of State, I have wanted to have a good, constructive working relationship with all of the representatives of doctors and the wider workforce. That was why I called in the BMA and “Agenda for Change” as soon as I possibly could, and I am pleased that I have been able to find fair and reasonable settlements with consultants and specialty doctors. I very much hope that junior doctors will call off their strikes and come back around the table so that we can find solutions for them too.

As I said earlier, strikes have very serious consequences for the NHS. We cannot pretend that the NHS can be switched on and off at whim. My one ask of the junior doctors committee was that it stop the strikes so that we can return to the table. As the number of patient safety mitigations has revealed—by the way, it is the highest number of patient safety mitigations that local NHS leaders have ever asked for, because of the unprecedented length and timing of the strike—and because the BMA has refused even those derogations, with the exception of two, we have to get to a place where it returns to a more reasonable frame of mind and comes back to the table with more reasonable expectations, so that we can try to find a solution. I will not put patients’ safety at risk: I have to enable NHS England to make preparations and continue the work it is doing day by day, hour by hour, to safeguard hospitals and patients during this very damaging strike action.

My hon. Friend puts it eloquently; there is a real human cost to these strike actions. It is why I did everything I could when we were in negotiations to try to find fair and reasonable settlements for junior doctors. I was very disappointed when they walked out, but we have to find solutions for the sake of our patients and of all 1.3 million people working in our NHS across England. There have been some brilliant examples of local trusts, local clinicians and other members of staff working really hard and pulling together to cover these damaging strikes, but all we ask of junior doctors is to come back to work, do their jobs and look after our patients.

Waiting lists are coming down, but they are still too high. Towards the end of last year, we had a period without any strikes in the NHS. We saw the waiting lists fall by tens of thousands—indeed, by 65,000—over the period of October, which shows the impact of the industrial action. Sadly, we know that more than 1.1 million appointments have been rescheduled in the last 12 months. It is having an impact on waiting lists and, for the sake of patients, we ask the junior doctors to come back to work.

First of all, I join my hon. Friend in thanking Ms Bullock for her work and public service, and I wish her a speedy recovery.

On the progress made in my hon. Friend’s local area, he is right: there are some really encouraging signs for the future of the NHS. All the work that we have been doing across all the recovery plans—whether it is for urgent and emergency care, primary care or elective recovery plans—is about embedding progress in the future of our NHS in this year of all years, as we celebrate 75 years of its establishment.

On the impact of the junior doctors’ strikes, my hon. Friend is right to refer to the number of new nurses and the progress that has been made locally. In fact, this year we have been able to announce that we have met a manifesto commitment to recruit 50,000 more nurses. We made that promise in 2019. We have met it early, as well as the commitment to have 50 million more GP appointments than in 2019—two manifesto commitments made, and two manifesto commitments kept.

I hope the hon. Gentleman is injecting the same anguish into the conversations that I imagine he is having with his local junior doctors, asking them to come back to work. Of course, having junior doctors not working in hospitals across the NHS has an impact—of course it does; they are a vital part of our NHS. The attention of NHS leaders, medical directors and clinicians over past weeks has had to be diverted towards covering the strike action rather than making the sorts of improvements and progress we all want to see across urgent and emergency care, in line with our recovery plan.

I thank my hon. Friend. We know the figures for previous strike actions, but sadly we will hear the true extent and impact of the strike action over the last six days later this week, and I suspect we will have even more missed and cancelled appointments to add to the list she rightly sets out.

On the point about pay, the basic pay of a foundation year one doctor has risen by 10.3%. Once one takes into account factors such as overtime and unsocial hours payments, that means the average salary is £40,800, a figure that I hope begins to reflect the importance we put on doctors and their role in the NHS. As doctors progress with their careers, there is a good package of development and progress, culminating in the pay settlement, currently out to ballot with the BMA, that I hope consultants, who are at the end of their career and do so much to help train younger doctors, will vote for. There is much work to be done, but progress has already been made on pay. That is why the decision by the BMA junior doctors committee to call strikes of such length at this time of year was so disappointing.