What the Junior Doctors strike tells us about how to organise in the public sector

Rick Lighten looks at the lessons that other public sector workers can take from how the Junior Doctors have organised and discusses how a strike in a site of ‘social reproduction’ might be different to one in an industry that makes a profit. 

Photo: Steve Eason
Photo: Steve Eason

Today Junior Doctors are taking strike action against the attempted imposition of a new contract by the Conservative Government and the Health Secretary Jeremy Hunt. The changes will mean that some evening and weekend work that was previously paid at a higher rate will now be viewed as part of doctors’ core hours. The new contracts will also bring about detrimental changes to pay progression that are discriminatory to women, or anyone who takes time out for childcare, education or research. Many doctors will see their pay reduced by 30%.

The Junior Doctors voted 98% in favour of strike action, with a turnout in the ballot of 76%. Today they’ll be turning this ballot result into action. But how does strike action work in the NHS? Is it as effective as strike action in other workplaces or industries? Can strike action in the NHS stop the government’s plans?

In industries that make profit, there’s an obvious goal to strike action – when workers stop working, a company’s profits are instantly affected, and this can force bosses to quite quickly give in to workers’ demands. Often, just the threat of strike action is enough to make bosses offer concessions.

The NHS is different, so strike action needs to be viewed differently. The NHS is not ‘productive’ in the sense that its work directly produces profit. It is involved in what you might call ‘social reproduction’ – work that helps society sustain itself. This has a dual function in a capitalist society. On the one hand it improves our quality of life; without the NHS, health problems would be unbearable for most people not wealthy enough to pay for private healthcare. On the other hand, it plays an important role in enabling the capitalist system to keep going; without healthy workers to exploit, how would profit be made? This dual nature is hinted at in the fact that government and business support for the NHS varies over time.

When the NHS was first created, those in charge of big business recognised the need for a centralised health service that would help keep workers healthy at a time of high demand for large numbers of workers. This meant that at the time, their interests aligned with those of workers and the poor, and their political organisations, to create widespread societal agreement on the creation of the NHS. Now, with the economy faltering, with high unemployment and lower wages, and with profits harder to come by, the priorities of big business have changed. Put simply, the rich and powerful no longer want government to spend money helping the poor to stay healthy, as they have less need for large numbers of healthy workers, and they want to claw back the gains that workers have made in redistributive spending by governments. The priorities of government and big business no longer align with those of most people with regards the NHS.

Unlike in the private sector, striking in the NHS doesn’t immediately harm profit. So how effective is strike action when used as a tactic in a workplace involved in social reproduction? Can the Junior Doctors win? Are there lessons for other workers in sites of social reproduction, such as education and local government?

The Junior Doctors have illustrated quite brilliantly the importance of a number of key factors that will swing the balance of this fight in their favour. The first is to get solidarity from other staff groups within the NHS. By correctly identifying the contract changes as the opening round in the government’s plans to attack all staff groups in the NHS, they’ve got the support of those staff groups and their unions. Many staff in the NHS will understand that the government will come for their own terms and conditions if the doctors lose, so they have a vested interest in seeing the doctors win.

The second is to get the public and patients on side. Taking strike action is a difficult decision to make for those working in the caring sector. The reality of taking strike action in this sector is that patients – those who you entered the profession in order to help – will be adversely affected. In posing this dispute as a fight for patient safety and as part of the battle for the NHS, and appealing to the public and to other trade unionists for help, the Junior Doctors have won the public to their side. This is a great antidote to the guilt-tripping of senior NHS managers and much of the mainstream media.

Finally, the thread running through all of this is the continued destruction of the NHS. Public feeling on this is clear. If Junior Doctors can keep the public and other staff groups on side, they can turn the contract dispute into a wider struggle for the NHS and a political crisis for the Tories. This should be the primary aim for the doctors and for the BMA, but it won’t be an easy task. This is David Cameron’s miners’ strike; if the Tories win, they’ll be closer to realising their dream of a privatised and profit-making health service. If they lose, the doctors will have forced open “the first real crack in the entire edifice of austerity in the UK,” as a statement from the BMA put it. If doctors continue to build on their terrific energy, enthusiasm and initiative, to keep protesting, striking, and building grass-roots support amongst their own ranks, throughout the NHS, and in the public, they can win this.

There are lessons here for others in the public sector. We have seen a number of disputes in schools, universities, and local government over the last five years that haven’t broken through in the way that the Junior Doctors strike looks likely to. There are a number of reasons for this, not least of which is to do with the conservatism of the unions involved in these struggles, and the inability of activists to overcome this. The Junior Doctors did this in the BMA by getting themselves organised at the grass-roots level. They organised protests via social media which attracted thousands of doctors at short notice, and they showed the BMA officials that they were serious and would not back down, or allow the BMA to back down. This organising success might look to the outsider to be almost spontaneous. But it is the expression of all the frustrations felt by Junior Doctors who see around them every day the destruction of an institution they value, and that society values. They feel this destruction and they personally deal with its effects. And a large number of them, many of whom – even now – probably don’t consider themselves activists, took this opportunity to get organised and to fight.

The ability of the Junior Doctors to turn an issue of contracts into a broader battle for the future of the NHS should give workers in other sectors hope. There is ample space to create campaigns that draw together the fight against job cuts with demands for decent public utilities; the fight against pay cuts and casualisation with the demand for a free education for all. If we can draw these demands together in a way that captures the enthusiasm of the public and encourages solidarity between different staff groups, and if we can get seriously organised at a rank and file level, then we should be able to replicate in some way the success of the Junior Doctors and start to widen the cracks that they create in the Tories’ austerity project.


  1. That sounds really shit, I’ve got friends who were until a month back (changed jobs) in the same situation.

    One of the lessons of the tube strikes is when workers who can more easily fight back they can shift the conditions of others in more difficult conditions. A defeat for the government over this could help turn the tide of privatisation and cuts in the NHS and health more generally. It is a general truth that a rising tide lifts all boats.

    The problems in a lot of the privatised care companies are most likely to be shifted by a change in the balance of forces across the health sector.

  2. I’ve worked in both the NHS and the non-stat health sector. The overriding problem for those in the non-stat sector is the outsourcing and privatisation of services. Privatisation invariably results in lower pay for front-line staff as NHS pay grades are abandoned. These charities and private companies cherry pick the most lucrative contracts and underbid to secure them with little concern over how they will provide the service. This invariably ends up in a much poorer service despite the the professionalism of the front-line staff in these services who are struggling with under-staffing and unrealistic expectations.

    In the race to the bottom a succession of charities or private companies take over these services until they fail and have to be taken in-house again. Time and again I saw this cut-price, revolving door approach to service provision ruin local services. Any profit in the privatisation pot is either going to shareholders or to the higher paid CEO’s in the private sector while the care providers endure long hours and lower pay.
    Even if it’s not possible to join junior doctors on strike due to the draconian effects of privatisation, solidarity with junior doctors and other striking health workers is the only way in the long term to undermine cuts in services, privatisation and the low pay that amoliver unfortunately endures.

    One of the key arguments the Tories are using against the strike is that patients will be put at risk but every day in the NHS and non-stat health services, staff have to organise and prioritise health care due to cuts and short staffing so if anyone knows how to provide emergency cover then it’s certainly not the Tories. The strike is also not simply or even primarily about pay as the Adam Smith rep on C4 news tonight tried to imply. The Tory propaganda about patient care and doctors pay is rich when they are presiding over the dismantling and destruction of the NHS and the impoverishment of health care workers at the expense of protecting the profits of shareholders and CEO’s wages of privatised health services.

  3. I work in the private sector in social care I can’t afford to strike for better pay and conditions there is no more money in the pot and I have to work up to 50 hours a week including weekends to make enough money to live on I have become ill and don’t have any back up only statutory sick pay try living off that for months

  4. Absolutely agree. The links across all the unions with health is crucial to the building of workplace organisation and confidence. Demands for safe staffing levels, united opposition to the endemic bullying and the eradication of the need for whistleblowers through trade unions taking up issues of poor care are central to the winning of wider patient and community support. At Mid Staffs the unions’ silence and the need for the formation and campaigning of Cure the NHS placed patients and community in opposition to the unions whose narrow demands made them complicit in poor practice. The joint staff committees need to become more like joint shop stewards committees of old. Ths Junior Doctors’ dispute could start this process using their professional codes to insist on good practice care ward by ward, incident by incident.


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