Why didn’t the Government do more to stop the junior doctor strikes this week? The 72-hour walkout comes to an end on Thursday morning, but it leaves a deep scar on an already seriously wounded NHS as hospitals cancelled appointments and had to spread consultants even more thinly to ensure patients were looked after.

The doctors’ unions – the British Medical Association and the Hospital Consultants and Specialists’ Association – had joined forces over what they argued was a decades-long erosion of pay, and ministers’ refusal to engage properly with them.

The BMA launched an eye-catching advertising campaign claiming doctors can now earn less “saving patients” than Pret baristas do making coffee. Like many attention-grabbing adverts, it needed quite a lot of small print to be strictly true: the food chain only pays the higher rate of £14.10 an hour to particularly experienced staff, while doctors’ hours and shift patterns make it difficult to calculate their hourly rate. But never mind: some junior doctors can earn the equivalent of £14.09 an hour, so the point stands.

But is it really the best point to make? The BMA are asking for pay rises that don’t so much bust inflation as break the sound barrier: they want the Government to restore junior doctor pay in England to its 2008/09 levels, which means a rise of around 35 per cent. Since 2008, medics have seen a 26 per cent real terms cut in their pay. The risk for the BMA, though, is that the 35 per cent demand is so eye-watering that it blurs people’s ability to see the wider context.

That’s the problem with this august-sounding trade union for doctors: it has long been seen within political circles as a bunch of stethoscope-clad militants. The BMA famously fought (and with lurid language about Nazis that wouldn’t look out of place in a row involving BBC sports presenters) against the creation of the NHS in the 1940s. The Labour minister who set it up, Aneurin Bevan, remarked impatiently he had never found a health minister the BMA liked. That’s still true today.

The union spent the ensuing decades opposing almost every reform. When I researched my forthcoming book on the history of the health service, I regularly found archive documents in which the union would oppose a change by arguing strongly in favour of a system it had only a few years ago campaigned against, too. It opposed a huge overhaul of the structures of the NHS in the early 1970s, but by the following decade was insisting that the Thatcher government stick with those structures, rather than change again.

Like all good trade unions, the BMA wants to get good money for its members, but unlike many others, it manages to clothe its mercenary motives in more altruistic language. It appeals to doctors’ sense of duty by making disputes about safety, not cash. It also plays on the expectation that many medics – generally rightly – have that they will be respected. In an email sent to members on Sunday night, Dr Arjan Singh Nagra from the BMA Junior Doctors Committee and Executive Council wrote of Health Minister Steve Barclay: “The BMA will be walking SchoolBoySteve back to class, sitting him down and teaching him a few well overdue lessons. You do not disrespect doctors ever again.”

This call for respect is fine – to a point. But the BMA has regularly overplayed its hand to the extent that ministers don’t respect the union, regardless of how they feel about medics. In the 1970s, it militated against attempts to abolish private beds in NHS hospitals, and ended up being nicknamed the “British Money Association”.

In 2008, it was campaigning against expanding medical schools, which would have gone some way to preventing the current workforce crisis. In 2016, the union led junior doctors out on strike against a new contract negotiated by the then Health Secretary Jeremy Hunt – but many of its own members withdrew their support in horror when a cache of leaked messages revealed its junior doctors committee was prolonging the dispute because its members wanted a higher pay deal, rather than the safer conditions most doctors were worried about.

It is the conditions in the NHS that really upset doctors and patients, not the pay. Many of us are happy to work for lower pay if they have good conditions and a caring employer: it’s near impossible to say this of the NHS, which makes notoriously bad companies like Sports Direct and P&O Ferries look like yoga retreats by comparison.

In these circumstances, it’s not hard to see why doctors might leave the NHS, either to work abroad in countries that will treat them with basic respect, or to do a completely different job. The problem is that the BMA has historically been a factor in their jobs here not being as humane or well-rewarded as they should be. Its innate conservatism means it opposes even reasonable changes, alienating amiable politicians, and limiting the ability of the Government to increase the number of doctors to the level the health service requires.

Ministers have made plenty of mistakes in the run-up to these strikes. But they’re not the only ones who’ve let doctors down.

Isabel Hardman is assistant editor of The Spectator magazine. She writes a monthly column on health policy for i

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