The National Health Service (NHS) in England faces a deepening crisis, highlighted by an array of concerning statistics that likely trouble Health Secretary Wes Streeting. Among these are 7.42 million hospital tests and treatments awaited by 6.24 million people, numbers that, despite some recent reduction, remain near historic highs. Furthermore, 18% of A&E patients across the UK are routinely cared for in non-clinical spaces due to severe hospital overcrowding. Alarmingly, the Royal College of Emergency Medicine estimates that 16,600 very unwell people in England die annually because of delays in securing a hospital bed. These grim figures underscore the severe pressures on the health service, providing a backdrop to the ongoing industrial action.

Wednesday marked the beginning of the 14th strike by resident doctors in England over the past 33 months, as they seek a 26% pay rise. These five days of industrial action bring the total strike days to 59, contributing to what NHS bosses privately fear could become a “never-ending” dispute without a significant breakthrough. Wes Streeting had previously recounted ending strikes by junior doctors in September last year, securing a 22.3% pay rise over two years. However, this period of peace proved short-lived, with medics, now termed resident doctors, resuming strikes in July under Labour, driven by their new demand for an additional 26% pay increase, phased over several years. Thousands of doctors below consultant level have engaged in five-day strikes in July, last month, and again this week.

The dispute has intensified, with Streeting accusing the British Medical Association (BMA), the doctors' union, of being unreasonable, while the BMA blames him for inadequately rewarding vital medical work. After eight strikes under the Conservative government and now three under Labour, prospects for a settlement appear as distant as ever in the 33-month-long conflict. An NHS official commented, “At this rate, this is going to drag on and on and on all next year unless something changes. It’s never-ending.” The beleaguered mood within the service is palpable, as tens of thousands of appointments and operations are cancelled, senior doctors are asked to cover junior colleagues’ shifts, and the public is urged to attend A&E only in absolute emergencies during strike periods.

Streeting has described this latest stoppage as potentially “the Jenga piece” that could lead to the collapse of the NHS, particularly given the intense pressure from winter diseases. He has repeatedly stated that the parlous state of public finances prevents him from granting the 26% pay rise requested by resident doctors. In an effort to address other concerns, he has made three offers to expand the number of training places for resident doctors to pursue their chosen medical specialty, aiming to prevent joblessness. All three offers have been rejected by the doctors, with the latest proposal seeing an 83% no vote against 17% in a recent survey.

While Streeting appears to be winning the public relations battle – a YouGov report last week indicated that 58% of voters now oppose the strikes, a shift from when a clear majority backed pay demands during the Tories' tenure – he is struggling to win the support of the doctors themselves. BMA sources suggest that Streeting’s increasingly dramatic comments, made as residents voted on his latest offer, hardened attitudes and likely contributed to the overwhelming rejection. One BMA source noted, “There’s a determination that they don’t want to be pushed around by the government or told what to do. For some time the [government’s] thinking appears to have been that the BMA is out of step with doctors. This [83% v 17%] result means they will have to reassess that and in the new year open the door to a discussion on a multi-year pay deal.”

Their 13 strikes so far have successfully pushed two governments to concede pay rises significantly above inflation. These actions have also prompted Streeting to double, and then redouble – from 1,000 to 2,000, then to 4,000 – the number of specialist training places available to doctors. Despite these concessions, resident doctors remain steadfast, especially on their demand for a 26% pay increase. The BMA’s legal mandate to strike is set to expire on January 6th. Streeting and NHS chiefs hope that when the BMA seeks members' approval for a further six-month campaign of strikes, enough doctors, weary of industrial action and lost earnings, will vote against it. However, the contentious history of this prolonged dispute suggests that such an expectation might be overly optimistic.

Exasperated NHS bosses, represented by the NHS Confederation, have now publicly urged both Wes Streeting and the BMA to agree to independent mediation to resolve the deadlock. They emphasize that patients are becoming