Doctors have the same legal right to strike as any other employee in the public or private sector.
In the UK only members of the police force and non-civilian members of the armed forces are legally prohibited from going on strike. The right to strike is also an article 11 human right – the right to freedom of association – under the European Convention on Human Rights (which is part of UK domestic law). If members vote to take industrial action, the BMA will ensure all legal requirements are met and will advise members accordingly.
Deciding whether to take industrial action
Saying that industrial action raises ethical issues does not mean that it is unethical. It means that there is a need to balance the rights, duties and responsibilities owed to different parties, and all relevant factors, to reach a decision about the best course of action.
Doctors have ethical responsibilities to protect and promote the welfare of their patients. The dilemma for doctors is that both action and inaction have ethical costs.
Should they take industrial action, which will risk causing harm to patients (and their colleagues) in the short term? Or should they abstain, potentially leading to greater harm to themselves, their colleagues and patients?
The position of doctors can be thought to be ethically similar to other public sector workers whose job is focused on preventing harm or protecting the public. For example, fire fighters, social workers, nurses or ambulance staff. All of these groups of workers may strike if it is justifiable, balancing their obligations to the people they serve with their own present and long-term interests.
Factors for doctors to consider
Whether to strike or not is a decision for each individual doctor. The factors that individual doctors consider will vary but are likely to include the following:
- How the industrial action will affect existing and future patients and in what way. This will include arrangements for critical and emergency care and the impact of industrial action on existing health inequalities.
- The current risk of harm to patients due to the state of the NHS both generally and the specific challenges in their area of practice
- Whether they believe doctors are being treated fairly – in terms of their pay and working conditions – in return for the work that is expected of them and the significance of the decisions they are required to make on a daily basis.
- The personal impact of pay erosion. This includes direct financial hardship, high levels of student debt and their ability to make important life-choices such as buying a house or having children; and the indirect impact of pay erosion which exacerbates staff shortages and impacts on their ability to care for patients.
- The risks to their own mental and physical health and wellbeing, and that of those close to them and their colleagues, of working in the NHS now and in the future.
- The consequences of not taking any action including the impact of current levels of funding on the viability of the NHS and the provision of comprehensive health care to all, free at the point of delivery. The inability to attract and retain doctors due to pay erosion and poor working conditions significantly contributes to these threats.
- How effective industrial action is likely to be.
When making this decision, individual doctors will naturally give greater weight to some factors than others. This will be based, at least in part, on their own circumstances, experiences and beliefs. Doctors should remain respectful of the views of colleagues whose decisions may be different to their own.
The role of Government
The Governments across the UK have a duty to promote a comprehensive health service for the people. These Governments have also committed themselves to be a fair employer.
Within these powers, the government has a wide discretion to decide how much taxpayers’ money to allocate to the NHS and social care, and how those monies should be divided up within the NHS.
The BMA believes that the NHS and social care is substantially underfunded. One of the consequences of this underfunding is that NHS employers have not been allocated sufficient funds to maintain the pay of junior doctors.
These Governments therefore carry significant responsibility for the consequences of any industrial action doctors feel compelled to take.