After four tense days when you could almost feel the NHS holding its breath, striking junior doctors are preparing to return to the wards.
But the relief, such as it is for anyone who cares about the NHS, is only temporary. This week’s planned stoppage may be ending but the strike very much is not. And judging by the increasingly personal nature of political briefings against the British Medical Associations’s young turks, if anything the two sides in this dispute look further apart than ever. And, worryingly, they seem to be separated by something more than money.
What makes the junior doctors’ strike different from other waves of industrial action is precisely that they are junior, and therefore young. This is Britain’s first, though almost certainly not its last, proper generation Z strike. Middle-aged ministers may be irritated by the junior doctors’ fondness for WhatsApping each other under the table during negotiations, or using crab emojis to symbolise their collective solidarity, but they should arguably have been better prepared for what they’re dealing with. After all, it was a Conservative government that largely created it.
For these are the disappointed children of a lost economic decade, finally coming of age. They were still at school, pushing themselves for the A*s they needed to get into medical school, when the banks crashed and changed their lives in ways they couldn’t then have foreseen. Having done their training in an austerity era of pay freezes across the public sector, junior doctors are emerging in their mid- to late 20s into a world shockingly different from the one they thought they had been promised.
Doctors were the kids who always came top of the class at school and, while they expected the job to be stressful, they probably never dreamed they’d end up worrying about the cost of putting the heating on. They want what they feel they’re owed, which is the life they would be living if wages had kept relative pace with 2008 levels – but also, perhaps, in some ways the lives their parents had: ones where a career like medicine would be hard work but rewarding, where doing well at school reliably paid off, and where someone in a good professional job could take home ownership pretty much for granted.
As the Oxford professor of primary care Professor Trisha Greenhalgh tweeted this week, on a junior doctor’s salary of £15,000 in the 1980s she was able to buy a London flat for £50,000; now the equivalent salary might be £35,000 but the same flat costs £600,000. Meanwhile junior doctors are starting out six figures deep in debt for medical degrees that Greenhalgh’s generation didn’t have to pay for.
True, all this can sound horribly entitled, especially to anyone who can only dream of earning the kind of salaries junior doctors may ultimately command if they go on to become consultants and take on lucrative private practices. The government knows that unlike nurses – who have rejected their own pay offer and announced a new 48-hour strike later this month – the junior doctors’ relative privilege is their achilles heel. This presumably explains a flurry of well-sourced newspaper stories about their leaders’ often affluent backgrounds. (A decade ago, when some of today’s strike leaders will have been applying, a quarter of medical school places went to the privately educated.)
But if this is one of the posher protests in union history, it nonetheless taps into a much more universal sense of generational injustice. The feeling that life is somehow going backwards is widely shared not just by other young public sector workers – teachers, civil servants, social workers, legal aid lawyers – but also private sector workers squeezed by soaring rents, painfully expensive childcare and lately rocketing inflation. It’s just that junior doctors have the confidence – and, thanks to the fact that lives depend on their work, the political clout – to push back.
With his peculiar gift for being years ahead of everyone else in spotting something but not quite being able to turn it into a soundbite, Ed Miliband started talking way back in 2011 about the betrayal of what he called “the promise of Britain”, or the unwritten assumption that kids would be better off than their parents.
What he correctly foresaw then, and what has become even clearer since, was the painful long-term consequences for the young of a crash followed by sluggish growth and falling living standards, compounded by an asset bubble pushing up housing costs. The young got a raw deal during that decade in part because it was assumed they wouldn’t vote, but the strikes have shown that voting isn’t necessarily the only way of exerting influence.
What makes the junior doctors particularly powerful is that, as highly skilled workers, they have options. Their qualifications are sought after in Canada or Australia, where salaries aren’t just higher but potentially stretch to a nicer way of life; decamp to Sydney and you can spend your days off surfing in the sunshine. Or you could just stay in rainy Britain, where Rishi Sunak was this week reminiscing about buying his first flat in an interview with the website ConservativeHome while simultaneously confirming that national targets to build more houses – one of the few tools for boosting affordable supply – are being scrapped, because grassroots Tories objected.
The big immediate risk to government, however, isn’t youthful emigration to countries offering brighter prospects than struggling, sulking post-Brexit Britain. It’s older voters revolting as the consequences of industrial unrest work their way through the system. The economy stalled in February, thanks partly to public sector strikes. Sunak has promised to cut NHS waiting lists, but every operation cancelled on a strike day makes that harder. Put simply, he may need junior doctors now more than they need him, which is why the BMA’s call for Acas to step in now and broker a compromise seems wise.
Nobody expects doctors to get a 35% rise overnight but a fair deal might involve a pay uplift staggered over several years, plus some imaginative short-term thinking. Given how badly we need their skills, why aren’t we forgiving student debt for newly qualified doctors who stay in the NHS for a minimum period? Why are young medics expected to make such big contributions into what now looks like an over-generous pension scheme And could their total compensation package be weighted more towards salary when they’re young?
But even if a deal can be done, buying off junior doctors doesn’t solve the wider political problem for the Tories of a rising generation with good reason to feel betrayed reaching the age where it finally finds some leverage. Those crabs have pincers, and they’re only just starting to use them.
Gaby Hinsliff is a Guardian columnist
