NHS consultants have announced a two-day strike next month in a new dispute over pay and working hours, leaving the rest of the country to ask: who will foot the bill?
At 6.59am on 25 November, England’s most senior hospital doctors will walk out of their hospitals and provide only Christmas Day cover for 48 hours. Routine and elective care will stop. The costs of the strike will not be carried by the medical professionals withholding their labour; they will be carried by patients, and a health service already stretched to its limits. As if the NHS is not struggling enough, senior health leaders report “ominous signs” that winter pressures are already affecting the service, and NHS bosses are warning of “pain, discomfort and inconvenience” for patients. A strike at the front door of winter, with waiting lists standing at 7m, leaves us questioning its necessity. The consultants will tell you this is a last resort. The facts say otherwise.
Let’s start with the money, because the union would prefer if we did not. Consultants take home more than £150,000 on average, after a 28.5 per cent increase in basic starting pay over the last four years worth around £25,000, including a 3.5 per cent rise this year. But the headline salary understates it. According to the Nuffield Trust, additional earnings account for an average further 27 per cent of pay on top of a consultant’s salary. Under the 2003 Labour contract, they may earn unlimited sums from private practice on top of full-time NHS salaries, and in some specialities more than half do, boosting salaries by as much as £200,000. This lucrative pay does not stop at retirement. Estimates from the Department of Health and Social Care show that a consultant who joined the NHS pension scheme in 2016 would receive an annual pension upon retirement at 65 of £81,000. These are not people sacrificing their livelihood, being starved into industrial action. They are among the most generously rewarded professionals in the country, asking the taxpayer to fund a further £16,000 each and a five-hour shorter week.
The BMA’s answer is that consultants have suffered a 25 per cent real-terms pay cut over 17 years, and that medics are being driven from the NHS. The BMA is also demanding that consultants based in England have their pay boosted and hours reduced to bring them more into line with NHS colleagues in Wales, where the most senior consultants earn £166,585 and work a 37.5-hour week.
Perhaps this earns a seat at the negotiating table. It does not buy the right to undermine the care of patients.
And here we are at the moral heart of the matter. Unlike other union strikes, it will not be the profits of a company that are affected, but the care of patients. Then look at the hours. Health officials believe the BMA’s proposal to cut the standard full-time working week from 40 hours to 35 would increase waiting times and cost taxpayers more than £2b. A 2026 survey of NHS consultants in England found that just under a quarter work in the private sector on top of their hours spent within the NHS. This leaves us to question whether the cut to a 35-hour week would be used to prevent burnout, as the BMA frames it, or to allow consultants to earn more within the private sector.
Every postponed operation is somebody’s hip, somebody’s heart, somebody’s cancer scan, delayed for the sake of a consultant’s pay.
The mandate deserves scrutiny too. The statistic that seventy-six per cent of consultants who voted backed action sounds emphatic, until you learn that just over half of eligible BMA members took part and nearly half of England’s consultants are not BMA members at all. A fifth of a workforce is entitled to be heard. It is not justified to shut down planned surgery nationwide.
The strongest parts of their case are real. The 25 per cent real-terms erosion is documented, consultant pay in Ireland runs to as much as double England’s, and burnout among senior clinicians is a genuine reality. They have a case for reform. However, this strike is not the right response. It is for a demand the country cannot afford, backed by a fifth of the profession, delivered at the worst moment of the year.
“March for the National Health Service” by Alan Stanton is licensed under CC BY-SA 2.0.
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Upcoming NHS strike: Placing the burden on patients
NHS consultants have announced a two-day strike next month in a new dispute over pay and working hours, leaving the rest of the country to ask: who will foot the bill?
At 6.59am on 25 November, England’s most senior hospital doctors will walk out of their hospitals and provide only Christmas Day cover for 48 hours. Routine and elective care will stop. The costs of the strike will not be carried by the medical professionals withholding their labour; they will be carried by patients, and a health service already stretched to its limits. As if the NHS is not struggling enough, senior health leaders report “ominous signs” that winter pressures are already affecting the service, and NHS bosses are warning of “pain, discomfort and inconvenience” for patients. A strike at the front door of winter, with waiting lists standing at 7m, leaves us questioning its necessity. The consultants will tell you this is a last resort. The facts say otherwise.
Let’s start with the money, because the union would prefer if we did not. Consultants take home more than £150,000 on average, after a 28.5 per cent increase in basic starting pay over the last four years worth around £25,000, including a 3.5 per cent rise this year. But the headline salary understates it. According to the Nuffield Trust, additional earnings account for an average further 27 per cent of pay on top of a consultant’s salary. Under the 2003 Labour contract, they may earn unlimited sums from private practice on top of full-time NHS salaries, and in some specialities more than half do, boosting salaries by as much as £200,000. This lucrative pay does not stop at retirement. Estimates from the Department of Health and Social Care show that a consultant who joined the NHS pension scheme in 2016 would receive an annual pension upon retirement at 65 of £81,000. These are not people sacrificing their livelihood, being starved into industrial action. They are among the most generously rewarded professionals in the country, asking the taxpayer to fund a further £16,000 each and a five-hour shorter week.
The BMA’s answer is that consultants have suffered a 25 per cent real-terms pay cut over 17 years, and that medics are being driven from the NHS. The BMA is also demanding that consultants based in England have their pay boosted and hours reduced to bring them more into line with NHS colleagues in Wales, where the most senior consultants earn £166,585 and work a 37.5-hour week.
Perhaps this earns a seat at the negotiating table. It does not buy the right to undermine the care of patients.
And here we are at the moral heart of the matter. Unlike other union strikes, it will not be the profits of a company that are affected, but the care of patients. Then look at the hours. Health officials believe the BMA’s proposal to cut the standard full-time working week from 40 hours to 35 would increase waiting times and cost taxpayers more than £2b. A 2026 survey of NHS consultants in England found that just under a quarter work in the private sector on top of their hours spent within the NHS. This leaves us to question whether the cut to a 35-hour week would be used to prevent burnout, as the BMA frames it, or to allow consultants to earn more within the private sector.
Every postponed operation is somebody’s hip, somebody’s heart, somebody’s cancer scan, delayed for the sake of a consultant’s pay.
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The mandate deserves scrutiny too. The statistic that seventy-six per cent of consultants who voted backed action sounds emphatic, until you learn that just over half of eligible BMA members took part and nearly half of England’s consultants are not BMA members at all. A fifth of a workforce is entitled to be heard. It is not justified to shut down planned surgery nationwide.
The strongest parts of their case are real. The 25 per cent real-terms erosion is documented, consultant pay in Ireland runs to as much as double England’s, and burnout among senior clinicians is a genuine reality. They have a case for reform. However, this strike is not the right response. It is for a demand the country cannot afford, backed by a fifth of the profession, delivered at the worst moment of the year.
“March for the National Health Service” by Alan Stanton is licensed under CC BY-SA 2.0.
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