It's "strike season" for health workers in the UK. First, junior doctors staged a five-day walkout. Then, after it ended, thousands of senior doctors (around half of the country's senior doctors) went on strike -- the first one in a decade. Now, specialist doctors are also considering action, and more follow-up strikes are likely to come. Oh, and nurses were already on strike at the end of 2022 and the beginning of 2023.
So what gives?
Less money, more work
In July, doctors in England staged a 48-hour strike on Thursday and Friday, marking the first strike over pay by consultants in nearly 50 years. Over 20,000 consultants (86%) voted in favor of the strike in the British Medical Association’s ballot. This led to severe disruption in the NHS, with hospitals operating at a reduced level of service, though areas of urgent and emergency care like A&E, intensive care, emergency surgery, and maternity services continue to function.
The grievances that doctors mentioned ranged from being overworked to being underappreciated and underpaid. Money seems to be a particular problem. Most doctors are saying that the government has steadily squeezed their salaries in the past decade. According to a BBC analysis, medical consultants have had their real wages adjusted for inflation drop by 17%, while nurses and junior doctors have both had 10% salary cuts.
Most hospitals and medical practices are also understaffed. There's a whopping backlog of 7.5 million patients -- which means that 1 in 10 people in the UK are currently on a hospital waiting list. The strikes accentuated this issue, leading to thousands of postponed treatments and costing over $1.2 billion. Since the start of the year, nearly 1 million appointments have been delayed because of strike action.
Most doctors said they took the decision to strike with a heavy heart, but they just reached a mental tipping point where they couldn't take anymore.
A 2022 survey of 4,553 junior doctors found that 40% of them plan to leave the National Health Service as soon as they can find another job. Around a third of respondents said they planned to work as doctors in another country in the next 12 months. This is all the more problematic because since Brexit, the country's departure from the EU, there's been a shortage of both specialized doctors and nurses, which means more work and more shifts for existing doctors.
The situation has created a paradoxical scenario: while the medical workforce has been repeatedly on strike, demanding better pay and working conditions, the demand for healthcare professionals is higher than ever. If you search for doctor jobs on any platform, you'll find a lot of hospitals and clinics struggling to fill their workforce. But striking doctors are firm in their position.
"I never thought I would ever vote to strike," one doctors told The Guardian. "However, this government has incrementally, over the last 13 years, starved the NHS of money. We’re paid a good wage but it’s fallen significantly in the last 10 to 15 years – we’re just not valued and it’s reached a point where we just can’t stand there and take it."
"I didn’t become a doctor for the money, I’ve never done private practice as a matter of principle, but I’m no longer willing to stand by and do nothing while this government try and effectively destroy the NHS via their refusal to appropriately value its staff. So with a heavy heart I voted to strike."
All this is brewing into an extremely unstable pot that the British population is not very used to.
Looking at the past 12 months, medical strikes have become a relatively common occurrence in the UK. What makes this all the more striking is that British nurses had never gone on strike in their century-long history as organized labor.
Doctor strikes are also not common historically. But in today's UK context, it really makes sense. Train workers are striking, airports are striking, firefighters, doctors, environmental workers, buses, postal service, barristers, and more -- they're all striking this year. There's even a Wikipedia page for the 2023 UK strikes, and it's not a short one.
But while the situation in the UK is particularly dire, the labor concerns behind this crisis (staffing shortages, pay, working conditions, pandemic burnout) are common across multiple countries. The UK, like many other countries, praised their medical forces as 'heroes' and lauded them repeatedly -- while neglecting to give them decent working conditions.
An analysis of global health worker protests in the first year of the pandemic found that grievances related to remuneration and working conditions are common. The UK medical workforce is on the brink, but elsewhere in the world, things could spiral very quickly.
"This suggests there is something fundamentally askew with health workforce policy globally," write Veena Sriram and Sorcha A. Brophy from the University of British Columbia and Columbia University respectively, in an article for The Conversation. The two looked at what lessons the UK crisis could have for Canada.
"While the structure of Canadian healthcare might not result in a national protest similar to the ones in the U.K., the shared DNA across events in Canada is undeniable. These protests are clear manifestations of the deeper crisis in Canadian healthcare, fuelled by underinvestment, staffing shortages and attrition, burnout, and repeated waves of COVID-19 and other respiratory illnesses," the two write.
But if these problems are shared by developed, affluent economies like the UK and Canada, it's likely that many other countries face similar issues. Data is scarce regarding the frustrations and grievances of medical workers in many parts of the world, but underfunding in the medical system is a common theme. There's another way through which this is spelling trouble for developing countries.
Richer countries often try to recruit nurses and doctors from low- and middle-income countries -- which also triggers further labor shortages in these areas.
Another common theme, the two researchers working in Canada emphasize, is that policymakers typically only focus on putting out the immediate fires. This creates a system where the longer-term problems are not addressed.
Not close to ready for a new pandemic
The international report has shown that poor funding, staff shortages, and inadequate preparation are affecting health systems worldwide. In addition to day-to-day pressures, this means we're woefully unprepared to cope with another pandemic.
Internationally, there should be a concerted effort to address this. The pandemic has shown that while every population has its own individual particularities, international collaboration is key to positive health outcomes. Countries need to collaborate, sharing best practices and working together to ensure that recruitment from low- and middle-income countries does not deplete already scarce resources in those areas.
Meanwhile, governments, especially in developed countries, need to recognize the complexity and urgency of the crisis and act accordingly. Beyond immediate salary adjustments, there must be a significant investment in healthcare infrastructure, staffing, education, and support systems.
We're not doing this at the moment.
The UK's 'strike season' is more than a national crisis; it's a wake-up call to the world. The appreciation and applause for healthcare heroes must now translate into action, investment, and a renewed commitment to value and support those who are at the forefront of saving lives. Whether the UK and the world will heed this call remains to be seen, but the opportunity to transform healthcare for the better is within our grasp, and the time to act is now.
Moreover, it's vital that the world takes note of what's happening in the UK as a cautionary tale. Governments, labor unions, and medical institutions must come together to address the challenges facing healthcare professionals before they reach a boiling point. Prioritizing the well-being of medical workers is not just a moral imperative but a necessity for the robustness of global healthcare.