Fighting for pay and jobs

Stormy clouds are looming above Belfast’s Royal Victoria Hospital, where resident doctors have gathered to demonstrate at the start of their latest 24-hour strike.

It is just a few days after their consultant and specialist, associate specialist and specialty colleagues staged a walk-out in the form of Christmas Day cover (ie emergencies still received care) over pay – and lest we forget, GPs in Northern Ireland are also in dispute with the Government because of the imposition of the 2025-26 general medical services contract.

But, while pay is at the heart of the complaints from secondary care doctors, there is  another issue that is having a huge effect on resident doctors – unemployment.

David Griffith is just about to complete his foundation programme and doesn’t yet know what the future holds. Medicine was his second degree – he completed a three-year course in biomedical science first – which means he spent eight years as a student, racking up significant debt. All things being equal, he should be starting specialty training this year but bottlenecks mean it is unlikely to happen.

‘I don’t actually know what I’m doing come August,’ he says. ‘Training is very competitive at the moment and managing to get enough points even to get an interview is a bit difficult – there are some consultants who probably wouldn’t score highly enough to get interviews at the moment. Hopefully, I’ll get some locum jobs, but they’re drying up too, but I don’t want to be facing unemployment.’

Many of his friends and colleagues have left Northern Ireland seeing training opportunities as well as better pay and work-life balance in places such as Australia and the Republic of Ireland but he has local ties, which would make that sort of move more difficult.

‘I’m married and have a mortgage. I’ve got a three-month-old baby. I’ve always wanted to do medicine because I enjoy looking after people and chatting to them and trying to help them the best I can but at the end of the day if I can’t get a job in a hospital I’ll have to look elsewhere.’

Rachel Millar is back in Northern Ireland after completing her foundation years in Glasgow. Although she loved Scotland, family reasons brought her back to Belfast, where she is a registrar in infectious diseases. Moving home essentially meant a pay cut.

‘We were paid more in Scotland for doing the same job,’ she says simply. ‘I’m striking today for full pay restoration. With the increasing cost of living and the amount that we work, and the work that we do, I think it’s really important to have full pay restoration to try to encourage people to stay here. I know lots of my friends have moved away to work in other places because their work-life balance is better and their pay is better.

'But I went to university here and I was always very aware as a student that I was going into hospitals and asking people to let me practise on them – I was using their time and they were helping to teach me. I always wanted to give something back to the population here.’

It’s a similar story for Stephen Ramsay, a clinical fellow in neurology. He moves back into a training post later this year and while he intends to stay in Northern Ireland, it’s impossible not to make comparisons.

‘We’re falling behind the rest of our colleagues in the rest of the UK on pay,’ he says. ‘Our MLAs [politicians] are getting a substantial pay rise but apparently it’s different for us.’

Dr Ramsay is accompanied by Sybil, a cockapoo who is sadly all too experienced in industrial action, this being her third demonstration. It’s a reminder that this dispute isn’t new, and resident doctors in Northern Ireland first voted to strike in 2023 (although the actual strike action was in 2024).

Although health minister Mike Nesbitt has said he wishes he could offer more money, he claims his hands are tied owing to budget restraint. Indeed, he can’t even commit to paying secondary care doctors the 3.5 per cent increase recommended for the current financial year.

Stephen Montgomery, chair of the BMA Northern Ireland resident doctors committee, stresses action is needed to reverse pay erosion of 20 per cent since 2008.

‘The minister says he has no way to pay us the 3.5 per cent although our colleagues across the water have already got it in their pay packets,’ he says. ‘It makes us feel completely and utterly undervalued and completely and utterly undermined and it shows us where the minister’s priorities lie, and his priorities clearly are not with staff. Without staff we have no health service.’

Colleagues are ‘absolutely furious’, he adds. ‘We’re seeing people leaving the country. We’re seeing an absolute workforce crisis here and we’ve had multiple closures recently.

For example we had a closure of an obs and gynae unit in one of our district general hospitals due to a lack of staffing. That should be a massive red flag for the public and a massive red flag for the minister that the service here is on the brink of immediate collapse.’

Meanwhile on the picket line, resident doctors and supporters (including Sybil the dog, named after the Fawlty Towers character) continue to chant and wave banners and posters. There’s audible support from passing traffic, including ambulances and other healthcare staff coming to work, with peeping horns aplenty. Whether the minister is listening remains to be seen.