Doctors begin five-day walkout in England

Doctors going on strike again over pay is "inflicting pain and misery" on patients, says Health Secretary Wes Streeting.

"We could do without this reckless action," he said, adding it could harm patients.

The five-day walkout in England by resident doctors, the new name for junior doctors, runs until 07:00 GMT on Wednesday.

The doctors' union - the British Medical Association (BMA) - says they are still not paid enough and there are too few training places or jobs.

The NHS says nearly all services will keep running, and patients should attend appointments unless advised otherwise. Hospitals will come under the most strain - resident doctors make up about half their medical workforce.

NHS England says it wanted to keep 95% of non-urgent work, such as hip and knee operations, going.

The NHS aims to do this by re-deploying and offering overtime to consultants and and other senior doctors as well as relying on those not striking – around a third of resident doctors are not BMA members.

But this will come at significant cost with the NHS estimating the five-day walkout is costing £240m to cover.

Speaking on Radio 4's Today programme, Nick Hulme, the chief executive of East Suffolk and North Essex NHS Foundation Trust, said although there would be disruptions for some patients, the impact of the strike would be "at a minimum" because of staff being moved around.

He also said more resident doctors were choosing to work during this strike: "They are voting with their feet and returning to work."

Dr Tom Dolphin, BMA council chairman, said the union had "reached an impasse" with the government over pay and jobs.

"We've got pay that is still a fifth down on the value that it had in 2008," he said, adding there are "thousands of doctors who are unable to get into training posts, are unable to become the specialists and the GPs of the future that we need".

Mr Hulme said his trust was "working very hard" to make sure resident doctors were being provided with "good advance notice of rotas" and were not being expected to travel great distances to work. But he said their pay was a matter for the government and the BMA.

Meanwhile, resident doctors in Scotland are balloting for strike action over pay.

Despite the attempt to keep services going, patients like Colette Houlihan, 68, have still had to face postponements.

She was due to have a pre-surgery appointment on Monday, but this has now been pushed back to late December.

Ms Houlihan, from Cambridgeshire, who is waiting for a benign tumour in her neck to be removed, said she had had to put up with two cancellations already, but could understand those as she was told patients who were higher priorities needed to be seen.

"They could have had cancer. I didn't mind that, but this is different.

"I am furious. By striking they ignore the Hippocratic Oath - first and foremost do no harm.

"Striking causes harm by way of delaying procedures, taking senior doctors from their posts and causing chaos within the system," she said.

NHS England medical director Prof Meghana Pandit said it was frustrating and disappointing that there was another round - the 13th - of industrial action at a challenging time for the NHS, with flu cases rising earlier than usual.

"Despite this, staff across the NHS are working extremely hard to maintain care and limit disruption," she added.

But BMA leader Dr Tom Dolphin said keeping most services running would be "challenging".

He said doctors had a legal right to strike and should not be "bullied or coerced" into working.

And he warned his members would only leave the picket line if there was a major emergency – such as a mass casualty event.

The latest walkout comes after Health Secretary Wes Streeting launched arguably his strongest attack on the BMA.

Addressing a conference of health managers this week, he called the union "morally reprehensible" and accused it of acting like a cartel, attempting to hold the public and government to ransom.

He said doctors had received generous pay rises over the past three years – worth nearly 30%, bringing average basic salaries to just over £54,000.

Talks between him and the union broke down last week after the BMA turned down a fresh offer to end the dispute.

Streeting has maintained throughout the year that he could not negotiate on pay, but he proposed a deal that would see out-of-pocket expenses like exam fees and membership fees covered, along with a boost in speciality training places.

But the BMA has argued that, despite the pay rises, resident doctors' pay is still a fifth lower than it was in 2008, once inflation is taken into account.

Additional reporting by Kris Bramwell.

Sign up for our Politics Essential newsletter to keep up with the inner workings of Westminster and beyond.