Afternoon summary
The BMA has hit back at Victoria Atkins after she claimed that many junior doctors were unhappy about its decision to call strikes for this week, and for six days in early January. (See 3.07pm.) But it has defended her decision to call junior doctors “doctors in training” during interviews this morning, even though Labour said the term was insulting. (See 11.24am.) The BMA said it found the term junior doctors “infantilising”. (See 1.57pm.)
Last month, after the autumn statement, George Osborne, the former Tory chancellor turned podcaster, was one of the first commentators to suggest that Jeremy Hunt’s announcements had made a May election more likely. Today, proving that he has grasped the first law of punditry, which is to cover all your bases so that you never look wrong, he has said that he expects the election to be in November or December.
On his Political Currency podcast, which he co-hosts with Ed Balls, Osborne said:
I’ve been talking to various people … and so all my conversations do indicate to me that they [Downing Street] are looking at the back end of next year. I don’t think anyone at the top of the Tory party is now thinking that a spring election, a May election, is a running possibility.
And even an October election is not really on the cards because they’ll be thinking of using September, October, to launch what is more likely, in my view now, to be a November, December election. But it will be in 2024.
To be fair, Osborne never said he expected the election to be in May; he just said that the autumn statement opened that up as an option.
Three-quarters of pupils could still get face-to-face teaching on strike days under minimum service level plan, DfE reveals
More than three-quarters of pupils would be able to attend school in person on strike days in England under one plan for minimum service levels (MSLs) in education, the government has said.
The figures are set out in the impact assessement published this week by the Department for Education covering its plans for MSLs.
Under the Strikes (Minimum Service Levels) Act passed this year, the government now has the power to insist that some public sector workers, such as teachers, railway workers, ambulance staff and border officials, have to provide a basic level of service on days when a strike is taking place.
In practice, this will mean some people having to work – which is why trade unions believe the act is in breach of international human rights law.
Originally Gillian Keegan, the education secretary, wanted to reach a voluntary agreement on MSLs with teaching unions, but when that did not happen she launched a consultation in November on two ways in which MSLs for schools and colleges would be enforced under law.
Under one plan (2a in the chart below) face-to-face teaching would continue on strike days for vulnerable children and young people, for children doing exams, and for children of critical workers.
And under the second plan (2b), face-to-face teaching would continue for all those three groups, plus all primary school pupils.
The consultation document did not say what these policies would mean in terms of numbers of pupils able to attend school on strike days. But the impact assessment does set those figures out in this table.
It shows that, even under the less extensive option (2a), 43% of pupils and students would continue to receive face-to-face teaching on a strike days. Under the more extensive option (2b), that figure is 77%.
The document says that it would be for employers to decide what staffing levels were needed to provide this level of face-to-face education, and that requiring 100% of pupils to get face-to-face teaching would not necessarily mean 100% of staff having to be present.
But the figures suggest that, in practice, there would be very limited scope for teachers at special schools and colleges to go on strike under either of these options. And if Keegan chooses 2b, primary school teachers could find their right to strike in practice very limited too.
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Scottish government's budget will leave council services 'at breaking point', local authority leaders say
Council leaders have warned that the Scottish government’s budget will leave services at “breaking point”, with “cuts in every community” and potential job losses across local authorities, PA Media reports.
The Convention of Scottish Local Authorities (Cosla) met today to discuss its response to Tuesday’s budget, which offered £144m in compensation for freezing council tax.
In a joint statement, Cosla leaders said the figure would not fully fund the council tax freeze – something the first minister, Humza Yousaf, had pledged would be the case.
The Cosla president, Shona Morrison, said:
Cosla’s initial analysis shows a real-terms cut to our revenue and capital spending power, which will leave council services at breaking point, with some having to stop altogether.
The budget in its current form could result in service cuts, job losses and an inevitable shift to providing statutory services only.
This means potentially losing libraries, leisure centres and all the things that improve our lives.
Cosla’s initial analysis of the budget is that the council tax freeze is not fully funded.
Leaders from across Scotland agreed today that decisions on council tax can only be made by each full council, and it is for each individual council to determine their own level of council tax.
With any sort of shortfall in core funding, the £144m revenue offered for the freeze is immediately worth less.
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BMA hits back at Victoria Atkins, saying she is wrong to claim many junior doctors don't support strike
The BMA has hit back at Victoria Atkins after she claimed that many junior doctors were unhappy about its decision to call strikes for this week, and for six days in early January. Responding to her comments during interview this morning (see 9.26am), Dr Robert Laurenson and Dr Vivek Trivedi, the co-chairs of the BMA’s junior doctors committee, said:
It’s disappointing after what we felt was an improved tone and approach from Ms Atkins, compared with that of her predecessor, that she appears to have a different recollection of our discussions.
Throughout negotiations with the government we had a mutually agreed deadline for them to make a credible offer. This deadline passed and we were therefore forced to call strikes. We did not walk away from negotiations and we are happy to talk to Ms Atkins at any time. It is the government’s insistence that they will not talk while strikes are scheduled that is blocking progress and wasting unnecessary time. We appeal directly to Ms Atkins and the government to drop this precondition and get back around the table.
We’d also ask Ms Atkins what evidence she has to suggest that we do not represent the profession, and how many of England’s 70,000-plus junior doctors she has spoken to recently. Members of JDC are working junior doctors, elected by their peers and are engaging with thousands of colleagues across the country on a daily basis, and the profession remains united in support.
Ms Atkins may have forgotten that mandates are derived from democratic votes. In our February ballot 98% voted for strike action on a 77% turnout. This mandate was reconfirmed in August when 7,000 more junior doctors voted yes than they had in February. And compared to last December, we now have 15,000 more junior doctor members in England.
The health secretary says she wants to ‘get this done’. If she is serious about this, she should stop trying to divide the profession and instead turn her focus to getting back around the table with us.
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Keir Starmer has said Labour is ready for a general election.
In an interview with GB News during his trip to Estonia, Starmer said:
We are ready for a general election. I’ve had my whole team on a general election footing for some time now.
I think that given the complete state of failure now in the country, there’s a real sense that everything is broken, nothing is working, that the sooner that election comes the better, because for millions of people they can’t afford to wait any longer for that general election.
He also said Labour would be able to produce a manifesto whenever the election was called.
I’ve had a mechanism in place for over a year to make sure we have a manifesto when we need it. I’m not going reveal it to you right now, but we will. We will be absolutely ready.
'High-tax Humza' under attack from Tories and Labour over Scottish budget in final FMQs of 2023
At the final FMQs of 2023, the Scottish first minister, Humza Yousaf, faced attacks from both Tory and Labour leaders who were united in their conclusion that Tuesday’s Scottish government budget meant Scots would be “paying more but getting less”.
The Scottish Conservative leader, Douglas Ross, went for “high-tax Humza” after the draft budget introduced a new “advanced” rate of income tax of 45p for anyone earning above £75,000 to partly fund a freeze in council tax rates announced by Yousaf in what was seen as an attempt to win back aspirational voters who turned to Labour at the Rutherglen byelection.
The Scottish Labour leader, Anas Sarwar, went for those at the other end of the scale, asking why those earning £29,000 a year should pay more tax than their counterparts in England. “These are not the people with the broadest shoulders, but are forced to pay the price for SNP failures,” he said.
The Convention of Scottish Local Authorities is meeting today to assess the impact of the budget on local services. Members have already said the government’s offer of £144m extra to cover the freeze is nowhere near enough, estimating they will lose nearer £300m.
Last week the independent Fraser of Allander Institute estimated in its pre-budget report that the new tax band was likely to raise £41m, far less than previously calculated and again not enough to balance the £1.5bn black hole facing Scottish government finances, as a combination of surging inflation and expensive public sector pay deals put extreme pressure on spending.
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BMA confirms it prefers 'doctors in training' to 'infantilising' term 'junior doctors'
The BMA has confirmed that it does not like the term “junior doctors”, and that it prefers the term “doctors in training” – although it also says this is still not ideal.
Asked about the row generated by Victoria Atkins’ use of the phrase (see 11.24am and 12.56pm), a BMA spokesperson said:
During talks there was a mutual recognition with DHSC [the Department of Health and Social Care] that the term ‘junior doctor’ is infantilising and doesn’t adequately characterise the role of any working doctor. This was also recognised at our annual conference this year, where BMA members voted to move away from the term.
Whilst ‘doctors in training’ is a stepping stone in nomenclature, it may still suggest that doctors are not yet qualified, when in fact they are, but are developing further skills and experience towards a specialty.
UPDATE: Chris Smyth from the Times, who is now the paper’s Whitehall editor, points out that the health service was trying to find an alternative name for junior doctors more than five years ago, when he was health editor.
The competition to rename junior doctors is officially revived https://t.co/Ko9303H82o https://t.co/VZbS61AzZE
— Chris Smyth (@Smyth_Chris) December 21, 2023
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Readers have been questioning why Victoria Atkins is claiming many junior doctors do not support the strike taking place this week when 70% of them (and 98% of those taking part in the ballot) voted in favour when the BMA last consulted them, in August. (See 11.47am.)
According to a health department source, Atkins was making a point based on personal discussions she has had with doctors, and on what she has picked up during visits. The source said Atkins was also reflecting the fact that some junior doctors have been working this week, in defiance of the strike (although the precise figures will not be available until after Christmas). And Atkins was referring to frustration some doctors felt about not getting a chance to vote on the government’s offer, the source said.
Hospital staffing levels during strike in January won't be 'sustainable' without further exemptions, NHS Employers say
NHS Employers has said hospital staffing levels seen during this week’s junior doctors’ strike in England will not be “sustainable” when they stage the longest walkout the health service has ever seen next month.
Danny Mortimer, the chief executive of NHS Employers, which is part of the NHS Confederation, made the point in a letter to the BMA seen by PA Media. In it Mortimer said January would be when the NHS faced “greatest pressure on services and teams, each and every year”.
Junior doctors are planning a six-day strike starting on Wednesday 3 January. It will be the longest strike in NHS history.
Mortimer said:
In a system already facing enormous demand, it is the week that most teams dread as it is likely to be the busiest for emergency care.
Your joint letter with NHS England makes clear that in relation to the December action that the staff recall and derogations process remains largely the same as the previous strikes.
This arrangement will not be sustainable in January.
In the previous periods of industrial action taken solely by your junior doctor members, the core duties typically carried out by striking junior doctors have been covered by other medical colleagues and members of the wider team.
This position will not be tenable in January.
Mortimer said during the strike this week derogations meant junior doctors were working in three high-risk areas: fast-progressing cancers, time-critical inductions of labour or urgent elective caesarean sections, and corneal transplant surgeries.
He urged the BMA to extend these exemptions from strike action in January so that urgent and emergency care pathways, and services across acute and mental health trusts are also included. He said:
I recognise that there are countless examples where our colleagues are not able to do their very best for their patients, but the first fortnight in January is one of the times when this risk dramatically increases.
I would urge the leadership of the BMA to not therefore make this position worse during strike action in January.
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Atkins says she called junior doctors 'doctors in training' because it is term used by BMA itself
Victoria Atkins, the health secretary, has defended her decision to call junior doctors “doctors in training” – arguing that this is the term that the BMA itself prefers.
She posted this on X this morning, commenting on a post from Wes Streeting, her Labour shadow, criticising her terminology.
👇 https://t.co/3chjQ2kQHS pic.twitter.com/ZncrlbTf89
— Victoria Atkins (@VictoriaAtkins) December 21, 2023
The screenshot comes from this tweet from the BMA from 2017.
.@gmcuk strongly encourages doctors in training to #exceptionreport - read their statement here: https://t.co/a9DRH3kgYN pic.twitter.com/QpRN4DsJDp
— The BMA (@TheBMA) March 9, 2017
A health source said Atkins was using the phrase “doctors in training” because that it the term that the BMA uses itself when referring to junior doctors. For example, it is the term used internally during meetings.
The BMA does also use the term junior doctors in press releases, but this may just be in recognition of the fact that this is the phrase understood by members of the public.
The BMA has been approached for a comment.
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Covid-19 infection levels are rising, with around one in 24 people in England and Scotland likely to have tested positive for coronavirus in mid-December, up from one in 50 at the start of the month, PA Media reports. PA says:
The virus is estimated to be more prevalent among 18- to 44-year-olds than in older age groups, with London and the south-east experiencing the highest regional rates.
The data has been published as part of the new winter Covid-19 infection study, which will monitor prevalence of the virus during the next few months.
It is a smaller version of the UK-wide infection survey that ran for nearly three years and which tracked each wave of the virus on a weekly basis.
The new study will publish estimates every fortnight and is limited to just England and Scotland rather than the whole of the country.
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Schools in England ‘face legal risks if they follow new transgender guidance’
Schools in England could face legal action if they follow new guidance on how to treat transgender children, ministers’ own lawyers have reportedly warned. Robert Booth has the story.
David Cameron, the foreign secretary, has said “everything that can be done must be done” to get aid into Gaza, including the possibility of using British ships to bring supplies by sea, PA Media reports. PA says:
The former prime minister, on an official visit to Egpyt, said he wanted to see the United Nations security council reach consensus on a resolution on humanitarian relief.
Cameron said the UK was “pushing very hard” to ensure aid supplies reach Gaza, both through the reopened Kerem Shalom border crossing and possibly by sea.
He said: “Are there opportunities for aid to come from Cyprus in British ships to be delivered to Gaza? We’re working on that. Everything that can be done, must be done to get aid into Gaza to help people in the desperate situation they are in.”
At the UN in New York, the US is working intensively to find a compromise resolution it will not veto on the supply of aid.
At a press conference with his counterpart in Cairo, Cameron said: “We are very keen to see consensus arrived at so that security council resolution – which is really all about aid and the delivery of aid, and the need to upscale the aid and the need for it to get through in far bigger numbers – that can go through. Talks continue and Britain will do what it can to try and build that consensus in New York at the security council.”
How 70% of junior doctors - and 98% of those participating in ballot - voted for strike action
In her Today interview this morning Victoria Atkins, the health secretry, claimed that many junior doctors would feel uncomfortable about the strikes this week and in January called by the BMA. (See 9.26am.)
But when the BMA last balloted junior doctors in August, 70% of all those entitled to vote backed strike action.
Turnout in the ballot was 71% and, of those who did vote, 98% of them voted in favour.
There was also a ballot in February. In that ballot, 76% of all those entitled to vote were in favour of strike action. Turnout then was 77%, and 98% of those voting were in favour.
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Atkins accused of insulting junior doctors by describing them as being 'in training'
In an interview with BBC Breakfast this morning Victoria Atkins, the health secretary, said she preferred to refer to junior doctors as “doctors in training”.
'Doctors in training as I prefer to call them walked out of our negotiations'
— BBC Breakfast (@BBCBreakfast) December 21, 2023
Health Secretary Victoria Atkins spoke to #BBCBreakfast about the 72 hour junior doctors strike in Englandhttps://t.co/YKYqO83Xrp pic.twitter.com/PDCwoRRDaI
Andrew Gwynne, the shadow social care minister, has called this insulting.
How insulting from the secretary of state “in training”…
They are doctors, they save lives every day.
How insulting from the Secretary of State “in training”…
— Andrew Gwynne MP 🇺🇦 (@GwynneMP) December 21, 2023
They are doctors, they save lives every day. https://t.co/4bYYFdN4Lv
Jim Reed, the BBC’s health reporter, has also suggested Atkins’s use of the term was unwise.
So not sure the "doctors in training" tag is going to go down brilliantly with junior doctors (some of whom have a decade plus of experience after medical school). https://t.co/cRB4Kuo2tB
— Jim Reed (@jim_reed) December 21, 2023
But John Appleby from the Nuffield Trust, a health thinktank, says he thinks Atkins was trying to be respectful to junior doctors by avoiding the term “junior”, which, as I explained earlier (see 9.26am) is a misnomer.
Tbf think she was trying to avoid the word ‘junior’. Junior doctors are qualified doctors in clinical training https://t.co/k2slvr34Xq
— John Appleby (@jappleby123) December 21, 2023
As this Full Fact blog explains, the term “junior” is misleading because many junior doctors have a level of experience way beyond what would be expected from a “junior” in most other workplaces.
It is true to say that they are “in training”. But this is arguably misleading too, because in other workplaces the trainees tend to be the people at the very bottom. Medicine is unusual because the training process goes on for years, and includes people with considerable expertise.
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Starmer says there are 'grounds for changing law' to allow assisted dying – while stressing it should be free vote matter
Keir Starmer has said that he thinks there are “grounds for changing the law” to allow assisted dying – while stressing MPs should have a free vote on any legislation.
He was speaking after the TV presenter Esther Rantzen, who is dying of cancer, reignited the debate about the issue with an interview this week in which she said she would like the option of being able to kill herself, but was worried her relatives might be prosecuted if they helped her under the current legislation.
Speaking on his visit to Estonia, Starmer said he voted in favour of changing the law to allow assisted dying when MPs last debated this in 2015. He told reporters:
On the question of assisted dying, there are obviously strong views both ways on this, which I respect.
And that’s why traditionally, this has always been dealt with a private member’s bill and a free vote and that seems appropriate to me.
I personally do think there are grounds for changing the law, we have to be careful, but it would have to be, I think, a free vote on an issue where there are such divided and strong views.
In 2015 the Commons rejected by 330 votes to 118 – a majority of 212 – a bill proposed by Labour MP Rob Marris that would have allowed assisted dying under strict conditions.
It would have allowed a terminally ill person diagnosed as having less than six months to live to request help with dying. But a judge would have to declare the person had full capacity, based on a declaration signed by two doctors.
Earlier this week Michael Gove, the levelling up secretary, said he thought it was now “appropriate for the Commons to revisit” this issue. Kit Malthouse, the former Home Office minister who co-chairs all-party parliamentary group on choice at the end of life, has said there may soon be a majority of MPs in favour of changing the law.
But the government has shown no indication that it intends to make time for a debate on this issue soon. In her interview on the Today programme this morning, Victoria Atkins said that, given that she was health secretary, she did not feel it appropriate to express her personal view. “If there is a will in parliament [for the law to be changed], it will happen,” she said.
In the past the law on so-called “conscience issues” like assisted dying has been changed by private members’ bills, subject to a free vote. There is no private member’s bill on assisted dying due to be debated before the election.
But, regardless of which bills come top in the private member’s ballot, the government does have the option of setting aside time for a debate on a matter like this if it wants.
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Starmer stresses Labour's support for Nato, and deterring Russia, on visit to British troops in Estonia
When British troops were fighting in Afghanistan, it was usual for the prime minister to make a brief visit just before Christmas to show the government’s support for what they doing, and for the armed forces generally. The army is not fighting any wars at the moment, but Rishi Sunak honoured this tradition on Monday when he visited a military base in northern Scotland.
Today Keir Starmer is doing his own version, visiting British troops at a Nato base in Estonia. At least in photo opportunity terms, he has upstaged Sunak. In their advance briefing, Labour stressed Starmer would be near the border with Russia And the pictures are more dramatic than the ones of Sunak at RAF Lossiemouth. Starmer’s longish visit to Cop28 was a good example of how Labour is keen to present him as looking and acting prime ministerial, and today is another move from the same playbook.
Starmer is also using the visit to stress Labour’s support for Nato and its willingness to stand firm against Russia. Speaking to broadcasters this morning, he said there was a “real and constant” threat to Europe from President Putin. He said:
I think we have to be mindful of that threat from Russia to Europe, to ourselves in the UK and the interference that goes on.
Stamer said the UK and its allies “need to be prepared, we need to deter”. And he went on:
And that’s why there’s a real sense of purpose here at this base, particularly since the conflict in Ukraine. This is a real and constant threat from Russia, measured in years, and measured back home in the UK as well.
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'Many doctors will feel deeply uncomfortable their committee has called these strikes,' says health secretary
Good morning. Junior hospital doctors in England are on the second day of a three-day strike. And they are planning a six-day strike in January. Victoria Atkins, the health secretary, has been doing a broadcast round this morning and, as well as stating her willingness to resume talks on pay and conditions if the strikes are called off, she also sought to drive a wedge between the BMA’s junior doctors committee and the thousands of medics it represents.
She said “many, many” doctors do not support what the BMA is doing, and she encouraged them, in effect, to make this clear to their union leadership.
(It is worth stressing, of course, that “junior doctors” is a misnomer. The term covers hospital doctors below consultant level. Mostly they are not people just out of medical school. Many have years of experience, and they provide the backbone of medical staff in hospitals.)
In an interview with the Today programme, Atkins said:
The junior doctors committee decided the date of their strikes. They decided to do it three days in the run-up to Christmas and they have also now picked the worst week in the NHS’s calendar [the first week in January] to be on strike.
There will be many, many doctors listening to this who will be deeply uncomfortable that their committee has called these strikes at this time. And I would encourage anyone who feels like that, quietly, to consider whether this committee is representing their views.
I know, for example, that consultants and nurses and other doctors who aren’t on strike are today, yesterday, and will be over January, coming in, doing extra shifts to ensure that that level of care is provided for patients. And they are being expected by the junior doctors’ committee to pick up the slack of their strikes.
Atkins said that she had shown she was prepared to be “fair and reasonable” in pay negotiations. Referring to a deal agreed with speciality doctors last week, she told the Today programme:
Having managed to find fair and reasonable offers for consultants and for specialty doctors, I would say the proof is in the pudding, if you see what I mean. I have shown that I’m willing and keen to find agreements.
She said she wanted to make an offer that covered conditions, as well as pay. She told BBC Breakfast:
It’s not just about pay, of course this is really important and indeed this year alone, junior doctors have already had a pay rise of around 8.8%, the most-junior of doctors, the first and second year of doctors, they’ve had the highest pay rises within the range up to 10.3% because we understand as a government, we’ve heard what the doctors are saying to us.
But I also want to do more than that, I don’t just want to look at pay, I also want to look at their conditions because when I walk around hospitals, when I talk to doctors, they tell me one of the things they want to feel is valued. And I absolutely understand that and I want to work with them to enable that to happen.
But she also said that, for talks to resume, the strikes would have to be called off. She told Sky News:
We have always said if there are strikes happening at the moment affecting patients, affecting the public, we will not negotiate but the moment they call them off, I will be back round that table.
Parliament is in recess and, politically, we should be in for a quiet day. But Keir Starmer is in Estonia, near the border with Russia, visiting British troops at a Nato base, Jeremy Hunt, the chancellor, is going to Switzerland to sign a mutual recognition deal for financial services and Humza Yousaf, Scotland’s first minister, is taking FMQs for the final time this year in the Scottish parliament.
If you want to contact me, do try the “send us a message” feature. You’ll see it just below the byline – on the left of the screen, if you are reading on a laptop or a desktop. This is for people who want to message me directly. I find it very useful when people message to point out errors (even typos – no mistake is too small to correct). Often I find your questions very interesting, too. I can’t promise to reply to them all, but I will try to reply to as many as I can, either in the comments below the line; privately (if you leave an email address and that seems more appropriate); or in the main blog, if I think it is a topic of wide interest.
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