This week’s doctors’ strike is another test of Wes Streeting’s mettle. He is right not to buckle | Polly Toynbee

TThe bizarre and doomed attack on Wes Streeting suggests pre-budget panic. This gives the impression that a government is losing touch and escaping the dismal circumstances of the real world. The ricochets damaged the Prime Minister and Morgan McSweeney, the man who had organized these orchestrated briefings. If the informants are not “found” and fired, No. 10 appears either weak or guilty.

The Health Secretary wittily and nimbly ignored him in a flurry of interviews and left for Manchester to speak at the NHS Providers Conference. There he spoke to somber-faced managers facing the most difficult of times. Resident (formerly junior) doctors begin a five-day strike from 7am on Friday. Their timing is aimed at maximum disruption to what will be “one of the toughest winters our staff have ever faced”, according to NHS England CEO Jim Mackey. An exceptionally virulent flu strain arrived early, with cases already several times higher than normal. Last month, flu hospitalizations increased 74% week over week.

The latest NHS figures released this week show that in October, 54,000 patients waited more than 12 hours for a bed in emergency departments, almost 10% more than the same month last year. With the waiting list for elective care now standing at 7.39 million, the Health Foundation’s analysis suggests that, given current trends, the Government will fall just short of its overall commitment to restore the elective care standard of 18 weeks by the end of this Parliament. During the 49 day strike over the past two years, 1.5 million appointments were postponed across England.

In their ballot, covering both their July action and this week’s action, 90% of doctors voted in favor of the strike, with a turnout of 55%. No one, including the Health Secretary, doubts that they have deep grievances about their working lives in a system that undermines the NHS and detaches young doctors from the hospitals where they work briefly. After hard years of study, which led to debts of up to £100,000, they have to rotate between different specialist training posts across the country, never being part of the team they work in, always worried about their next quick placement, treated harshly, often going without hot meals, chairs, beds or holidays.

But Streeting has made improvements. He committed to ease the bottleneck by giving UK-trained doctors first choice of training locations. The BMA’s resident doctors’ committee says some 30,000 doctors are applying for 10,000 places. But Streeting’s office says that now only 8% of UK-trained doctors who apply for a job don’t get one. That’s eight percentage points too many, but they were promised that new reforms would be underway.

Their salary demand is received with much less sympathy. Upon his appointment, Streeting has settled in generously with an increase of 22.3% over two years and an above-inflation average of 5.4% this year, an average increase of 28.9% over three years. Doctors received by far the most; nurses, midwives and physiotherapists are offered 3.6%. Doctors ultimately want an additional 29%, to restore their salaries to where they were before the banking crash. There is debate over which measure of inflation should be used in calculations, RPI or CPI, but either way the entire public sector has seen disastrous pay cuts since 2008. Paul Nowak of the TUC says that real wages would be £217 more per week if they had continued to rise at pre-2008 rates.

The doctors did better than the others, which is why Streeting cannot and will not give in. He’s not a headbanger who wants to prove his worth by fighting unions; on the contrary, he appeared keen to reach an agreement with them, but was snubbed by the BMA’s disgraceful rush to strike. The committee refused his request to meet with them.

Under the Conservative government, the public supported striking doctors. The polls have now swung the other way, with 51% against and 40% for. Even so, 40% is still a pretty high number, given widespread concern about waiting lists. But 51% currently believe doctors should never be allowed to strike, which contrasts with the attitude towards nurses, where 53% believe they should be allowed. But there is no general turn against unionism: attitudes towards unions remain positive, from 33% to 28% negative.

The falling support for resident doctors may come from learning about their salary, at £38,000 for starters, rising to £109,000 as a fully trained first-year consultant, which rises to £145,000, with bonuses for some and private practice for others. Given these difficult times, the cost of living and stagnant wages for most, these are not the most obvious candidates for public sympathy.

I couldn’t find anyone to speak to officially, but I spoke to the resident doctor “Martin” on Thursday between busy clinics. He will not strike. He says he knows others who won’t either, because they’re concerned about patient safety. He certainly believes that those who start in training positions are poorly treated, but that hospitals are now rushing to improve their conditions. Salary, he says, is less of an issue.

We are waiting to see how many doctors come out. There is an urgent need to find a solution to the shortage of training positions. A report published this week by the Higher Education Policy Institute suggests another route, of training fewer super-specialist consultants but many more training places for doctors and GPs in the community, thereby avoiding hospital admissions. General practitioners would solve more problems for elderly people suffering from multiple pathologies. But it will be more difficult to reach agreement on good reforms in the bitter atmosphere of the strikes.

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