Rishi Sunak has been accused of personally holding up a deal to end doctors’ strikes in England despite warnings from the health department and NHS England that waiting lists will continue to soar unless the industrial dispute is resolved. Sources told the Guardian it had been made “abundantly and repeatedly” clear to the prime minister that there would be no progress on his pledge to drive down NHS waiting lists until a deal was struck. One official said Sunak had been a “blocker” to progress during talks with both consultants and junior doctors at the end of last year because of concerns that a more generous offer would result in calls for higher pay deals across the health service, in particular for nurses. Junior doctors staged a series of strikes after talks between the British Medical Association and the Department of Health and Social Care (DHSC) broke down, with the doctors’ union saying the government had not been able to put forward a credible offer. Consultants, meanwhile, rejected the latest pay offer from the government by a narrow margin last month, urging ministers to improve the deal on offer. Talks between the BMA and junior ministers are continuing.
Sources told the Guardian that Sunak was warned the government would not meet waiting list targets during almost every meeting he held with NHS England and the DHSC. Downing Street aides were also told at their own meetings with health officials. Papers marked “official sensitive” that were sent to No 10, and have been seen by the Guardian, cautioned in bold text that “in all scenarios if industrial action continues waiting lists will not fall”. Sunak acknowledged on Monday that he had failed to keep his promise of cutting waiting lists, one of five key commitments he made when taking office and on which he said his own competence would be judged. The situation in England has actually worsened. “We have not made enough progress,” he said when asked about his pledge during an interview with Piers Morgan on TalkTV. Asked if that meant he had failed, he replied: “Yes, we have.” He later appeared to blame NHS strikes for the situation. One source suggested that Victoria Atkins, the health secretary, had been “reined in” by Downing Street, after initially indicating she was prepared to meet for further talks and had not yet made the government’s final offer. However, DHSC insiders said Atkins had only offered further talks if the strikes were called off first, adding that both disputes went beyond pay settlements to wider issues, including working conditions. Whitehall sources said Steve Barclay, who was the health secretary until he moved post in the November reshuffle, pushed Sunak to settle the dispute, but was not given the autonomy to do so himself. One senior NHS source said Atkins was being hampered by No 10 in her efforts to end the separate, but overlapping, consultants and junior doctors disputes. “NHS England have been making it clear to the government the extent to which strikes are severely hampering efforts to get the waiting list down,” the source said. “The Department of Health and Social Care knows that the PM’s pledge won’t be met unless the strikes come to an end. And while there have been some minor improvements with waiting lists, it will be impossible to make up the ground [while walkouts continue]. “It’s clear from the stop-go nature of the talks between the DHSC and BMA that the secretary of state doesn’t have a free hand to negotiate.” A second well-placed NHS source said: “NHS leaders are very clear that the delivery of [Sunak’s] pledge on the elective target would be impossible without solving the strikes. “NHS England and the Department of Health have both been arguing that if you want to meet the elective target, it will be very, very, very difficult to do that without settling the strikes by doctors. “NHS England’s leadership believes that the junior doctors’ strikes and the elective target are clearly intimately related to each other.” More than 1.3m NHS appointments in England have been rescheduled because of industrial action, according to the DHSC. Sunak has sought to blame them for the huge waiting list, which stood at 7.6m in November but fell by 96,000 that month, when there was no strikes. Unions have consistently said ministers could avoid strikes by offering better pay deals and have denied being responsible for the waiting list, pointing out it went up by nearly 5m between 2010 and 2022, when there was no industrial action to blame. Prof Phil Banfield, the chair of the BMA council, said: “Doctors are already working above and beyond. If the prime minister just allowed his health secretary to make credible pay offers instead of perpetually stalling, doctors would be free to get back to bringing waiting lists down. He cannot abdicate responsibility any longer.” Government insiders said Sunak believed every pound of taxpayers’ money should be spent carefully so he was reluctant to sign off a more generous settlement. Others said this was a false economy as the bill for NHS staffing to cover the strikes hit £2bn in early December, and is expected to rise to £3bn, more than the sum required to settle the dispute. A DHSC source said the prime minister had not personally blocked a deal, however Downing Street did not deny the claims. A DHSC spokesperson said: “Junior doctors have been given a fair pay increase averaging 8.8%. On top of that pay increase, we have also offered further investment for junior doctors during the latest negotiations. “If they come back to the table with reasonable expectations then we remain hopeful of finding a way forward. We want everyone to focus on patients and cutting waiting times for them, and urge the BMA to work with us in the interests of patients.” • This article was amended on 8 February 2024 to include reference to a DHSC source saying the prime minister had not personally blocked a deal. This was received after publication.