Debate contribution: Industrial Action by Doctors

Debate contribution by Mr Mike Nesbitt on 22 June 2026.

MLA: Mr Mike Nesbitt
Party at the time: Ulster Unionist Party
Date: 22 June 2026
Type: Debate contribution (made as a minister)
Business: Question for Urgent Oral Answer
Heading: Industrial Action by Doctors
Assembly identifier: Official Report component 5638384

Text

With your indulgence, Mr Speaker, I may request an additional minute to respond. Following last month's ballots, Northern Ireland members of the British Medical Association (BMA) have agreed to take industrial action over two 24-hour periods: consultants and SAS doctors on Thursday 25 June; and resident doctors on Monday 29 June. My Department has been working with the five health and social care trusts and with primary care to ensure that arrangements are in place to minimise and mitigate the impact on patients. However, it is deeply regrettable for the patients who will be impacted on that it is inevitable that some services will be disrupted. Trusts have been working to quantify the level of impact and are undertaking risk assessments to ensure that emergency, cancer and time-critical interventions are protected as far as possible by involving parts of the workforce that are not participating in strike action. Trusts have agreed a regional payment rate for additional shifts, including on-call periods, and, where possible, are utilising a wider non-medical skills mix. Discussions are also ongoing regarding the potential for additional GP out-of-hours provision. Trusts will issue communications to clarify which appointments, diagnostics and treatments are affected. Let me be clear: my firm expectation of the trusts is that disruption, cancellations and delays are kept to an absolute minimum. For instance, while the BMA locally may be warning of only a "Christmas Day" service later this week, I expect and anticipate significant volumes of elective activity to still be delivered. My Department will receive further details on the level of disruption by close of business tomorrow. The requirement to be agile right up to and on the days of strike is a lesson from the 2024 resident doctors action. There will be close monitoring of the rescheduling of any patient intervention, although, as scheduling is normally undertaken six weeks in advance, there may be some patients who are delayed. Trusts will, however, risk-assess those who require prioritisation. It is regrettable that the action is proceeding. I have made it clear that pay parity is a matter for the Executive, and I apologise to the patients who will be impacted on. I urge the BMA to reflect on who is most greatly impacted on by its action. When the matter in dispute is not one that can be resolved by my Department alone, it is difficult to justify placing further pressure on many patients who are already waiting too long for their care.
First, I accept that we have around half a million people on waiting lists. I hope, however, that the Member will accept that, for the past two quarters, the overall number has begun to shrink. That is a positive and hopeful sign to send out to the population, although I accept that those who are on long waiting lists have been waiting far too long and continue so to do. The Member asked for my opinion on the pay award. In this case, the suggested award comes from the Review Body on Doctors' and Dentists' Remuneration (DDRB), which is a national body that makes recommendations for England, Wales and Northern Ireland. It is 3·5%. Look, I would like everybody who is delivering health and social care to wake up feeling good about themselves every morning, looking forward to going on shift, enjoying their work, going home feeling satisfied and feeling that their terms and conditions are reasonable, appropriate and equitable. As I understand it, however, the Member's party, my party and all the other Executive parties have bought into the idea of delivering pay parity as defined by delivering the recommendations of the DDRB and the National Health Service Pay Review Body, which is offering only 3·3% to allied health professionals and nurses. In this case, doctors are therefore getting another 0·2%. Would I like it to be more? Yes, I would, but my hands are tied, because, even if I were able to go beyond 3·5%, I would deem that to be repercussive not just for nurses but police officers, prison officers, teachers and, in fact, the entire public sector. I would therefore have to take it to the Executive. Today, I have submitted a paper to the Executive that I hope will be discussed at the next meeting.
I take the point that sectors are unhappy, but there has hardly, if ever, been a debate in the Chamber in which someone did not point out to me that I have over 50% of the Executive Budget. We will have to reform how we deliver health and social care, because the direction of travel — from 46% to over 50% of the Executive Budget — is not sustainable. A lot has been made of Sláintecare. Indeed, I was probably more concerned about Sláintecare than the statistics reveal that I should have been, because data demonstrates that, in the years since its introduction, the number of resignations of consultants aged under 60 in our health and social care system has remained consistently at under 2% of the workforce. I hope that that surprises the Member, because it surprised me. It is not just about money but about terms and conditions. Full-time consultants who are working for us can use two of their 10 programmed activities for their personal development. Our consultants are also free to work in the private healthcare sector. Neither of those opportunities applies under Sláintecare.
I, of course, want to see every single penny be spent wisely and to best effect. A pound wasted in the Department of Health is a pound that could have been spent on social housing, in the Department for Infrastructure or in any other Department. On recruitment, however, I have to say to the Member that, in the three years from March 2023 to March 2026, there are 175·6 more whole-time-equivalent consultants, 174·9 more whole-time-equivalent SAS doctors and 376 more whole-time-equivalent resident doctors working in Health and Social Care (HSC). Those represent increases of 8·9%, 31% and 17·3% respectively. It is therefore not as though nothing is happening.
I will. There are 2,300 consultants working in the HSC. The number of BMA members is lower. However, the total number of consultants is 2,300, of whom 542 voted for strike action. That is 23·6%. There are 2,600 resident doctors, again, not all of whom are members of the BMA, and 608 of them voted for strike action. That is 23·4%. There are 870 SAS doctors in total, of whom 282 voted for strike action. That is 32%. Across the three medical workforces, approximately a quarter, 24·8%, have voted for strike action.
I met the chairs of the three BMA doctor committees on 11 June. I recognised their right to take strike action, and, indeed, they were very determined in their responses to me on that. I tried to make it clear to them that I feel that to move beyond the 3·5%, which I cannot pay at the moment, because we do not have an agreed Executive Budget, but that I will pay as soon as that Budget is agreed, was beyond my vires because, as I have said, it would be repercussive, certainly in my opinion, right across the public sector. Therefore, as it would be potentially contentious, I would have to take it and, hence, the paper, to the Executive. One of the issues is the starting point, because we are going back three years and saying that, in that time, those three groups have had pay rises of between 24% and 30%. By comparison, for example, across the Agenda for Change, nurses and allied health professionals are at 14·8% and teachers are at 14·2%. However, consultants are saying, "No, you need to go back to 2008". If one does that, one sees that there has been a degree of pay erosion. We reckon it is around 8%. Therefore, it depends on where you pick your starting point. You really need the two sides to come together in the spirit of finding a resolution. There is a thing to be said about a consultant saying, "I earn £145,000 because I am at the top of the tree, but 3·5% is not enough because of the cost-of-living crisis". Well, 3·5% of £145,000 will cover the cost-of-living crisis in the way that 3·5% of £25,000 or £35,000 a year will not. I am certainly still open to talks, but they seem to be dug in.
That is not possible at the moment. The trusts continue to meet regularly, and they will meet at 4:00 pm tomorrow. At that point, I would like to think that there might be a little more clarity, but until we see the exact impact of the strike action, it is impossible to put figures on that, because, as I have already said, the majority of consultants, for example, did not vote for strike action. They may not be members of the British Medical Association, and they may decide to go for business as usual this Thursday and maybe even next Monday. It is not possible, at this stage, to put a figure on it, but the trusts have come together and communicated a single clear message to anybody with an appointment on either of the strike days: please assume that your appointment will go ahead unless explicitly told otherwise.
The Member is right to point out that there is a level of disagreement between the Department and the various BMA groups on the starting point and the comparator. We in the Department are very clear. If we take consultant pay, we see that, after the uplift to incorporate the DDRB's recommendation for 2026-27, the current maximum salary for a consultant in England is £150,569. I want to implement that recommendation locally, and, if and when we do that, the maximum pay point for consultants here will be £150,610, which is £41 more than that in England. Rather than continue to roll out statistics and disagree about where we start and how we finish, I am willing to sit down with the consultants and all the others again and continue to discuss the workforce, because, to my mind, five elements are key to delivering health and social care: buildings, beds, equipment, medicine and the workforce. If you do not have the right workforce in the right numbers in the right place with the right skills, and its members are not happy when they wake up and head off to their shift, the first four do not count for much more than a hill of beans.
All I can say is that there will be a cost, because, inevitably, there will be disruption. As I said to your colleague Mr Robinson, at this stage, it is not possible to accurately predict the level of disruption and, therefore, the associated costs.
As I mentioned to the House, when it comes to resignations of consultants in HSC under the age of 60 in recent years, we are only talking about a couple of per cent. Sláintecare is perhaps not as attractive as I thought instinctively when I took up the role, and that is not just about salary. It is about not being allowed to work in the private sector if you are under Sláintecare. It is about programmed activities being protected in Northern Ireland, whereby two out of 10 four-hour shifts can be used for personal development. We work with and listen to the workforce, and I insist that we cherish the workforce, because, of the five elements that I articulated, it is the only one that I cannot do without.

1,931 words. Text as published by the Northern Ireland Assembly.

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