Support or opposition to strike action is often largely influenced by people’s attitudes to the people going on strike and the inconvenience it causes them. If it’s a profession that people admire and think is generally hard done by they’ll sympathise, if it’s a profession that people don’t think much of they won’t. If the inconvenience it causes people is relatively minor, people will understand; if it really puts out large numbers of people, like school or tube closures, then sympathy is less forthcoming. The specific ins-and-outs of the dispute are often impenetrable or irrelevant. It’s who we trust, who is the good guy.

The public hold doctors in extremely high regard and unless they happen to have had a hospital appointment today it’s unlikely to cause most people any direct noticable inconvenience, so you’d expect fairly high support. That’s what the polls show. Ipsos MORI had a new poll for yesterday’s Newsnight which found the public supported strike action emphatically (66% to 16%) when junior doctors would still provide emergency care, and much more narrowly (44% to 39%) if junior doctors would not provide emergency care either. Full tabs are here.

Late last year before the intitial round of strikes were postponed YouGov found a similar pattern – people clearly supported strike action by 51% to 32% when junior doctors would still cover emergency treatment, when strike action would also cover emergency care people were more evenly divided (45% to 37%). Tabs are here.

At present this breaks the way you would expect in an argument between politicians on one side, and trustworthy and overworked people who come to your rescue when you’re ill on the other. If strike action that also involves emergency care goes ahead though public opinion may become more finely balanced.


111 Responses to “Polling on the Junior Doctors Strike”

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  1. Thanks AW, like you I find the poll unsurprising at this stage. If they proceed to strikes without emergency cover I would expect public opinion to harden against them very quickly, especially after the first death blamed on such action.

  2. My small son has just been discharged this morning (c10.30am) from a minor bronchitis episode. My perspective was that the canny consultants have done all they can to support their junior colleagues, covering for them and implicitly (and in some cases explicitly) declaring their support for their actions. One mild-mannered consultant was very clear what he thought of Jeremy Hunt.

    So to the untrained eye, the service seemed unaffected (we’ve been in a fair few times over the last year!), but the warmth of public support towards the doctors was tangible in the ward.

  3. I’d say opinion has shifted quite a bit between the two polls. Not so much in terms of support if emergency cover isn’t provided, that’s actually narrowed a little, but certainly in terms of the first question, where for strike action that includes emergency cover, those against it have halved ( from 32% to 16%) and those positively in favour of the action has climbed by 7%. That sort of shift is outside the MOE and suggests to me that public support for the junior doctors has increased quite sharply. 19% lead for pro the action last year to 50% lead now. Wow!

    Plenty of food for thought for Hunt here. Government PR machine about to go into overdrive, perhaps? They won’t want to be on the wrong side of the argument on an issue like this for too long, I wouldn’t have thought. Maybe a Hunt climbdown is in the offing followed by a move in a forthcoming reshuffle.

  4. CROSSVBAT11

    “I wouldn’t have thought. Maybe a Hunt climbdown is in the offing followed by a move in a forthcoming reshuffle.”

    You maybe correct I sincerely hope not, although Cameron does tend to bend in the wind. We saw that when he moved Michael Gove, a serious mistake in my view.

  5. The Government are on to a loser here. Doctors are people that middle England can relate to, unlike tube drivers or miners.

  6. Labour could have been in a great position to take advantage of this, if “competance” and “organisation” weren’t problem issues right now for them.

  7. (I’m reminded of 1997-2003-ish, when Labour could face potentially big problems with little difficulty because the Tories were in such a mess.)

  8. “The Government are on to a loser here. Doctors are people that middle England can relate to, unlike tube drivers or miners.”

    I’d be surprised if the polling results don’t turn around after a week or so. Public opinion is usually very fickle on this sort of issue.

  9. As long as the BMA points out that the problem exists only in England, and hence it is an ideologically fuelled attack on people on whose goodwill the health care depends on (as no industrial action has taken place in Scotland and Wales), and it is about breaking solidarity within the profession and between the doctors and patients, they should be OK in terms of the polls.

    While I think such a description of the government position is correct, the situation is quite messy. The employees have taken industrial action against the shareholders and not the managers, and very little has come out of the managers’ views about this shareholder activism led by Hunt.

    So, at the end of the day it is probably a combination of budget (and hence the BMA’s negotiating partner is not Hunt) and disorganising a profession (with the ultimate aim of breaking the organisational resistance.

  10. Based on past behaviour, I expect that Hunt will receive the full confidence of the prime minister. And then either shuffled out of his position once the heat has died down, or asked to resign if the heat gets too fierce.

    There have been rumours that Boris Johnson will be offered a senior cabinet position in exchange for being the public face of the EU Yes campaign. But my money was on IDS being punted to make space, since there’s no need to keep the Eurosceptics happy once the shots start over the referendum.

    It’s also important to remember that the electoral map is still very finely balanced. The Conservatives can’t depend on an incompetent Labour party covering their flaws, when elections turn into “which party doesn’t lose” as they have for the last two.

  11. The MORI figures are for England only, obviously a sub-set of the monthly poll that normally appears at about this time. The December MORI was all-GB which might have distorted the figures a little (Scotland was most in favour). What really surprised me was the nett support even if emergency cover was withdrawn.

  12. @Alun

    You seem so keen to shoehorn the offspring meme into everything* that you’ve made a number of logical errors and introduced a number of straw men.

    There are battlefield uses for the tech., it’s not just about revenge. E.g. evening things up if outnumbered at sea. Yes, it may not be suitable for all situations, may be disproportionate etc., but no one says we actually HAVE to use it in all those situations, we have other methods, conventional, special forces, Intel, etc. Which indeed we normally use. Thus far, we haven’t needed it at all, which is partly the idea. As for the potential demise of peeps, you have to contrast with lives saved due to deterrence. As for identifying perps, the tech leaves a signature, is more traceable than some other tech.

    When someone starts off with a needless quibble over the definition of summat like insurance, you know the rest is liable to go downhill. I shouldn’t have to explain that I meant insurance in the sense of having something to fall back on. Like savings, or indeed having additional resource in being able to defend yourself.

    It might be open to a marginal or even off-the-point quibble, but to follow your line of thinking, your argument is about as much use as saying cars are only good for injuring peeps and little else and worse, are no use for climbing Everest, and worse still sometimes peeps do a hit and run sans detection, therefore what use are cars…

    * one might wonder as to why. You’re lucky, JP has taken issue with lesser candidates for the emotive before now…

  13. Good evening all from Westminster North.

    I don’t know all the details on why the docs went on strike but as a tax contributor to the NHS I would hope that I could see a doctor any day of the week. Working weekends in the NHS is classed as unsociable hours,…………..really?

    Same goes for a dentist, losing teeth ain’t a Monday to Friday phenomenon so I would also expect to see a dentist any day of the week.

    Job center plus offices!! Why are they only open Monday to Friday? Do unemployed people only look for work Monday to Friday?

    And what about people like me who don’t have an option but have to work Mon to Friday? If I want to see a doc then I have to request time off during the week and owe the time back because on my days off the docs are off and they dentists are at it too.

    I don’t have a problem with Monday to Friday working but vital services should not be a 5 day a week operation.

  14. Good Evening from a cold and windy Bournemouth East.

    BILL PATRICK.
    I agree with you about the parallels with 1997-2003.

    Going back further i see a parallel with Labour 1979-1981when the Tory Government also had problems

  15. @AC

    You will find that Doctors (especially Junior Doctors) already work weekends.

    I guarantee that if you fall ill this weekend and need to see a Doctor, one will be available.

    As regards your dentist, they are mostly private and do what they like.

    I agree that 7 day a week services would be great, but unless the NHS is given much more cash, stretching current resources that far would be a massive strain.

  16. CATMANJEFF

    “You will find that Doctors (especially Junior Doctors) already work weekends.
    I guarantee that if you fall ill this weekend and need to see a Doctor, one will be available”
    _________
    Hmm …I’m sorry but I disagree. If I wanted to make an appointment to see a doctor at my fine local surgery on Edware road on a Sat or Sun then I would be reading a sign saying “Come back Monday”

    However I take your point that I can see a doc at the weekend if I were to take ill but that’s still only provding half a service. I also take your point about dentists being mostly private but a lot of their work is on NHS patients.

    Maybe if the NHS cut the management bloat at the top then more resources can be channeled into front line care,

  17. @ Allan Christie

    While there is management waste in the NHS, in principle there aren’t enough managers. The scale of this organisation is just bewildering. BP has about 7 to 1 employees to managers. The NHS has about 1 to 33. I know that qualifications, commitment, etc. are different – still …

    Just look at the number of visits and operations that have been cancelled today. It looks frightening. Then look at the average daily, and you get the perspective.

    Walk in centres are pretty good in out of social hours for medical treatments, by the way.

  18. 33 to 1 of course …

  19. @Allan Christie

    So your GP surgery offers absolutely no evening appointments? That’s strange I’ve never come across that before.

  20. Perhaps if the public were made aware of the actual wages/ pay of “junior” doctors and the number working at weekends the polls would reflect more accurately people’s considered views.
    Doctors have used their collective power since the formation of theNHS particularly to force governments to pay them well.
    NHS managers should be negotiating not a government minister.

  21. Quite tickled by Jeremy Warner in the DT looking at the prospects for cuts to pension tax reliefs. Overall, these amount to £50B or 3% of GDP, so more than defence, foreign office and aid budgets combines, and with the vast bulk of this going to higher earners it would seem a handy target.

    Warner describes a proposal to initiate a highly redistribution plan for 50% relief for everyone, but only up to £8,000pa. This would disproportionately favour lower earners and save a lot of money.

    The funny bit is where Warner concludes “Yet whichever way you cut it, the macro-economic effect of removing such a big source of tax relief would be the same as a significant tax increase. This is not “free” money, but a substantial hit to lifetime, middle class incomes. If that helps the Chancellor meet his fiscal targets, so be it, but it is bound to be negative for the economy, resulting in less spending and/or less saving.”

    It seems cutting benefits for the well off damages the economy, but cutting spending anywhere else is the way to encourage growth.

  22. @ Alan Christie

    Your GP point is irrelevant to the issue: Junior Doctors are hospital based and employed by the NHS, GP’s are self employed individuals or partnerships providing services to the NHS under the terms of a GP contract, nothing in this strike affects that position nor, as I understand it, is there any proposal to alter GP contracts at present.
    If you attend hospital as an emergency or are an inpatient at the weekend you will likely be seen by a Junior Doctor, what is more unlikely is that you will be seen by a consultant. What is not available is the consultant appointment for outpatient services on anything other than a weekday. Again, as I understand it, there is no current proposal to alter this.
    Hunt’s justification for the change in Junior Doctor’s contracts relates to emergency and in patient treatment.

  23. @AC
    Hmm …I’m sorry but I disagree. If I wanted to make an appointment to see a doctor at my fine local surgery on Edware road on a Sat or Sun then I would be reading a sign saying “Come back Monday”

    Where I used to go in Maida Vale (just down the road from you) weekend services were available at a local walk in surgery nearby. Maybe you have something similar in Edgware Road (maybe around St Mary’s hospital)?

  24. I get the feeling that this dispute isn’t entirely about weekend working. Doctor’s pay has been falling back for years, and I think this is the “line in the sand” moment. The public debate has been a bit false I think, coming down to “do you like doctors or not?” or “do doctors work at weekends or not?”. What it really comes down to, as usual, is “do you think doctors should be paid more or not?”.

    As it happens I think they should, and unlike, say nurses pay, increasing the salaries of junior doctors wouldn’t be that expensive because there aren’t that many of them.

    Sadly, the militancy has made this a face-saving issue for the government and has made it nigh-on impossible for Cameron and Hunt to concede higher salaries. (Or alternatively, the government should have seen this coming and taken the opportunity to increase salaries at an earlier stage in the negotiations).

    On the basic point, which is that current pay structures incentivise managers to run skeleton services at night and weekends, putting lives at risk, I think most people would agree.

    I tend to agree that support for a full strike, with the hundreds of deaths that would probably follow, will be the real test. It could turn people against the industrial action, but there’s also a massive danger for the government. I wonder if they have miner’s strike style intervention plans in place (military doctors, foreign locums flown in en masse etc).

    It is probably well for the government that this is happening in year one of the parliament, rather than year three or four. But there is an opportunity for Corbyn to switch the national debate away from his week points and on to something where most people would agree with him. Of course, the corollary is that if he nails his colours to the strikers’ mast (and McDonnell appears to have already done that) then he’ll have to hope that the full strike doesn’t change the mood or he’ll risk headlines about blood on hands etc.

    Interesting times. Horrible and stupid, but interesting.

  25. It seems to be one of those disputes where simplification into a single issue of contention is not readily possible. If they wanted to maximise public support, the doctors should talk only about the removal of penalties when they are asked to work longer than 12 hours. These were put in place following scandals of junior doctors having to make life and death decisions after 18 hour shifts and longer, and were the result of demands for safety from the public. The BMA seems to be emphasising other aspects rather than this, which would garner maximum public support.

    I think they are also letting the government get away with the ‘7 day week’ argument to a large extent as well. Much of the NHS already works throughout the week, and the quoted figures regarding excess deaths from weekend admissions are patently false – as has been demonstrated repeatedly. Much of the deviation comes from members of the public taking far longer to seek medical advice at weekends, so is much more closely correlated to patient behaviour than the availability and quality of hospital care.

    Even if there is a need to expand weekend cover, which I’m sure there is to some extent, to get 7 day cover from current 5 day staffing without adding more staff doesn’t work. Divide current staff numbers by 5 and times by 7 – it doesn’t add up, unless someone works longer hours or more staff are added.

  26. @Alec

    I broadly agree, although I think there’s a bit of a catch.22 going on in that culturally people are put off seeking treatment at weekends, unless they’re dying, because they know that it will be inconvenient and not the best quality.

    Having said that, I’m sure I saw some polling about GP opening that said that people weren’t that fussed about 7 day access – which may mean that they don’t need it or just that the cultural training is very strong.

  27. @Neil A – I also wonder what the impact of alcohol related issues are at weekends – both in terms of putting people off going to A&E and also eating up valuable NHS weekend resources.

  28. @ Alec

    I suggest that reading through BMJ’s comment section on the particular issue of weekend death is a good starting point (of the related article), and of course the article itself with all the caveats that it presents. Alcohol is not a major factor.

    Essentially, the evidence is all over the place (as there is not enough details to judge the causalities behind correlations).

    My summing up: Hunt seriously misrepresented the findings (it could be because of the lack of expertise), but, in spite of this, he may well be right …

    It has been known since the 1970s that hospital deaths peak over the weekends (but also that stAtistics are seriously skewed – where does Mondays and Fridays belong to, what are the diagnoses – this latter one is a major sticking point in the whole argument) in all the advanced countries in the world. What is not shown – can it be avoided and what the measures are. There was a Norwegian article about 15 years ago which argued that any measure would just spread the hospital death to weekdays, but I can’t find the reference (but it is citEd by one of the comments if I remember correctly).

  29. @Alec,

    Oh definitely. And not just health care. Woe betide the citizen who calls the police at 8pm on a Friday with a complex and time-consuming issue.

    As an anecdote (for what it’s worth), I remember dealing with a serious GBH on a student in Holloway in around 2000 (he’d been punched in the face outside a kebab shop by a local who was wearing a knuckleduster, and had fallen over and fractured his skull on the pavement). When I caught up with him he was at the Whittington sitting on a plastic chair, surrounded by about 20 other walking wounded. His friends were really concerned about him because he kept drifting in and out of consciousness. I said why don’t you tell the medical staff, as it was a head injury. They said, “Oh we have, the doctor just said ‘Let him sleep'”. The reality of health care at weekends. And that’s under Labour, and during the economic good times.

  30. So why aren’t junior doctors in Scotland or Wales on strike?

  31. Presumably it’s only NHS England where changes are proposed in unsocial hours payments.

  32. I think short term pain here, will lead to long term gain in the future. We are more than 4 years away still from the next election and I doubt this episode will go on that long, sure people may support the doctors now not content with an 11% pay rise but in the long term when we have a fully functioning 7 day NHS the public will look on the issue more favourably.

    Interesting they didn’t poll anyone on “how do you feel that you or a loved one are more likely to die going into hospital over the weekend than during the week”

  33. There is something very odd about this dispute. According to the BBC, Hunt has increased basic pay by 11% , offsetting the cost by moving Saturday ( till 7pm) & Weekday shifts 7pm to 10 pm from Premium Pay rates to Normal Pay rates. Maximum permitted weekly hours are reduced from 91 to 72.

    And yet the BMA are majoring on “Unsafe” rather than Pay.. It seems as though the doctors losing out on this deal are those who worked most weekend & late hours. Where is the “unsafe ” element?

    Hunt has tied his colours to the User ( as opposed to Producer) mast since taking the job & I can’t see him changing course now. We will see if Patients still feel supportive of these doctors when they remove all cover including Emergency admissions.

  34. @MITM, to be fair, that’s mostly for the same reasons A&E are busier on the weekend.

  35. @Colin,

    I think there are two things at play, transposing from my experience of similar developments in the police.

    The first is that employees don’t trust offers of increases in “basic pay” to compensate for the loss of allowances. The suspicion, often justified, is that the “pay rise” will be raked back over time with miserly settlements in future years, but the allowance is gone forever.

    The second is that in any change where there are winners and losers, the winners stay strangely quiet and the losers make a hell of a racket, giving the overall impression of negativity. In fairness to doctors, there seems to be a fair degree of consensus over the changes, suggesting that even those who will gain (presumably those whose services are seldom required at evenings and weekends) think they are a bad thing.

    I don’t think the financial arrangements for doctors are remotely generous by anyone’s standards, however. They aren’t being spoiled brats. Police officers earn more than doctors do.

  36. On the NHS bureaucracy thing, from an analysis on fullfact.org

    “What we know

    1. No, half the NHS workforce are not managers

    Political figures have sometimes implied that managers make up eye-wateringly large proportions of the NHS workforce. UKIP’s Louise Bours claimed that “clinical staff are outnumbered by so-called ‘bureaucrats’, using up huge amounts of money that would be better spent on front-line services”. Her speech suggested that she was talking about managers.

    But the group she is talking about includes all staff who aren’t doctors or nurses. That means it includes not only cleaners, porters, and canteen staff, but hundreds of thousands of healthcare assistants who are actually providing care to patients. These people are not diverting money from the front line: they are the front line.

    The number of people who are employed specifically as managers is much lower. As counted up by the Health and Social Care Information Centre, it is only around 51,000 people out of 1.17 million. This includes doctors and nurses who do full-time management roles. At a total 4% of the workforce, it compares to 10% in the UK economy as a whole.

    Far from eating up large chunks of the budget, there is circumstantial evidence that the health service doesn’t have enough senior professional management capacity for such a complex system. Despite the financial pressure it is under, the NHS spends vast amounts buying in extra management capacity from consultancies. Recent surveys suggest it also has great difficulty recruiting people to senior roles as these become ever more pressurised.

    However, these jobs aren’t the whole story of management or ‘bureaucracy’ in the NHS. A study of middle-level and front-line managers in hospitals found more than 30% of all staff held some kind of management responsibility. How do we explain this?”

  37. Also…

    “A recent study also suggested that English hospitals seem to spend more on administration than those in other countries not subject to an internal market. It links this to the need for hospitals to compete for funding and to carefully set aside income to invest with. It may be that the market is working, telling hospitals they need more management and monitoring to run smoothly and deliver quality.

    The authors of the study are more sceptical about whether the extra spending adds value. But either way, according to Lord Ashcroft’s polling, the public seem keen on targets and performance management as a way to raise performance, even if their effectiveness is variable. They too require administrators and managers to record figures, report them up the chain of command, monitor them, and crack down on those not meeting standards.”

  38. Even if it was just about money, then why should that be a problem? We live in a market economy, although that gets forgotten by many of its advocates when convenient.

    Better to have a strike than not enough doctors long term.

  39. @Colin

    On the unsafe thing, bit more from fullfact…

    “Working hour safeguards—the proposed removal of penalties has also proved controversial

    The government has said that under the new contract doctors would not be allowed to work more than 72 hours in seven consecutive days, or to work more than four consecutive night shifts. There’d also be a new process for reviewing working hours on the request of either a junior doctor or their supervisor.

    The BMA argues that in practice the removal of the banding system for unsocial hours will also remove safeguards that go alongside them, including financial penalties for employers who subject trainees to “fatiguing” working patterns. That could drive up hours and put patients at risk, it says.

    The Royal College of Paediatrics and Child Health (RCPCH) agrees, saying their removal “will damage patient well-being”, while the Royal College of Obstetricians and Gynaecologists has said the proposals mean “there is now a significant chance of returning to the ‘bad old days’ of over-burdened junior doctors in danger of giving sub-standard care.”

    NHS Employers disagrees, saying that the penalties haven’t reduced working hours. It says its analysis shows credit for this should go to the European Working Time Directive.

    Last updated 5 January 2016”

  40. @Hawthorn

    What particularly amazes, is that peeps who might have issues with doctors pay and conditions (I.e. peeps who save lives and don’t trash the economy), seem far, far less concerned about peeps earning squillions for taking down the economy, even as the scandals, Libor, PPI etc. continue.

  41. CARFREW

    There is certainly distrust of employers at play. I don’t think that is a reason to put patients at risk by striking though.

    Surely they should give it a try on the understanding that any examples of abuse of overtime hours agreements by employers negates the deal.

    NEILA

    Thanks

    I think you probably have to specify what sort of “doctor” before making comparisons.

    I found this interesting :-

    http://www.bbc.co.uk/news/health-34475955

  42. @Colin,

    To put that article in perspective, it says the average salary of a “doctor in training” (meaning all doctors that are not consultants or GPs already) is £37,000. I earned more than that last year, as a constable – for which the minimum qualification is currently 5 C grades at GCSE including maths and English.

    Doctors are simply badly paid, whatever rank you look at. Even if you start looking at the better paid consultants, they’re still out-salaried by senior police officers.

    Hell, there are NCOs in the armed forces who earn more than most doctors.

  43. @MITM

    Interesting they didn’t poll anyone on “how do you feel that you or a loved one are more likely to die going into hospital over the weekend than during the week”

    The reason that more people die on weekends is nothing to do with the care patients receive, but the types of patient admitted on a weekend.

    This particular misunderstanding is sadly running free, despite not being backed by evidence.

    It also seems that those who benefit most from this misunderstanding are in no hurry to correct it.

  44. NEILA

    I wasn’t disputing your comparison, merely suggesting that perhaps it needed a little finessing.

    From what you say, an 11% increase is very appropriate then.

  45. …………..I wonder if a comparison of Military & NHS salaries needs to be put in the context of terms & conditions.

    The Soldier is essentially on call 24/7 for whatever The State calls on him to do. Including going to war & putting his life at risk for his country.

  46. @Colin

    Or maybe employers could come up with a package that doesn’t carry the risk of it in the first place. That might help with the trust thing. The “no top down reorganisation” thing was also perhaps not ideal from a trust perspective.

    From a broader perspective, how do you think it plays alongside the kinds of pay deals MPs award themselves?

    And should MPs have a trainee period like doctors?…

  47. @Colin

    The new contracts, by removing all the penalties for doing so, essentially put Junior Doctors on 24/7 call.

  48. JAYBLANC

    Perhaps they should be in their chosen profession?

    But as I understand it the maximum hours they can be asked to work is prescribed, and has been reduced.

    CARFREW

    I really haven’t got thepersonal experience to understand the BMA’s perception of this “risk”. But I’m surprised the subject isn’t merely a matter of employment contract & employment law ( UK & EU)

    MPs pay will always be controversial -and people always seem to think they are overpaid ( ?)

    I think comparison of the qualifications needed by a professional medical practitioner, and an elected parliamentary representative is unlikely to produce many common features. Though-of course-there will always be those tempted by the argument that MPs cannot legislate in respect of matters in which they are not themselves qualified.

  49. @Colin

    Across the public sector, you will find numerous peeps being expected to do the same work for effectively less pay, year on year.

    On year, on year, on year. Who knows when it will end?

    And now we have another proposal setting up the possibility of more of that in future and you are surprised at the response?

    The point with MPs is they award themselves pay rises while saying others have to have cuts for the deficit etc.

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