UK Healthcare Industrial Action: A Conflict of Sustainable Development Goals

Executive Summary

A political and industrial dispute concerning resident doctors’ strikes in the United Kingdom has brought several Sustainable Development Goals (SDGs) into sharp conflict. The standoff between the Labour government, the Conservative opposition, and medical unions highlights the critical tension between ensuring public health (SDG 3), promoting decent work (SDG 8), and maintaining strong, effective institutions (SDG 16). Conservative leader Kemi Badenoch has offered conditional support to end the strikes, contingent on the government reversing its pledge to repeal minimum service level legislation, a move that directly challenges the government’s workers’ rights agenda and the principles of SDG 8.

Impact on SDG 3: Good Health and Well-being

The ongoing industrial action by resident doctors presents a direct threat to the achievement of SDG 3, which aims to ensure healthy lives and promote well-being for all. The primary consequences for the national healthcare system include:

• Disruption to Universal Healthcare Access: The five-day strike over a 29 per cent pay demand has led to widespread cancellation of appointments and procedures, undermining the principle of accessible healthcare.
• Increased Risk to Patient Safety: Ms. Badenoch warned of potential patient fatalities resulting from the strike, a critical concern for public health. The BMA noted that senior doctors are forced to prioritize emergency care, inevitably leading to the cancellation of planned treatments.
• Workforce Capacity Challenges: The dispute is compounded by a legal challenge from the Physician Associates union (UMAPs) against Health Secretary Wes Streeting’s decision to limit their roles. UMAPs argues this move curtails the capacity of professionals who conduct millions of appointments annually, further straining a system already impacted by strikes and contributing to a “brain drain” of doctors seeking better pay abroad.

Tensions in SDG 8: Decent Work and Economic Growth

The core of the dispute revolves around conflicting interpretations of SDG 8, particularly the targets related to fair pay, workers’ rights, and collective bargaining.

1. Demand for Fair Remuneration: The British Medical Association (BMA) frames its demand as “pay restoration,” arguing that doctors’ real-term salaries have significantly declined, which contravenes the principles of decent work and fair pay. This economic pressure is cited as a key driver for doctors leaving the NHS.
2. Legislative Push for Service Continuity: The Conservative Party advocates for reinstating minimum service levels during strikes and proposes banning doctors from striking altogether, akin to the police and military. This position prioritizes the continuity of essential services over the right to industrial action, presenting a direct challenge to Target 8.8 of the SDGs, which protects labour rights.
3. Government’s Commitment to Labour Rights: The Labour government faces pressure to uphold its manifesto pledge to repeal the minimum service guarantee as part of a broader workers’ rights package, a commitment supported by union leaders.
4. Union Federation’s Stance: The Trades Union Congress (TUC) warns that imposing minimum service levels is “unworkable,” poisons industrial relations, and escalates tensions, arguing that a negotiated settlement is the only sustainable path forward in line with international labour standards.

Implications for SDG 16: Peace, Justice, and Strong Institutions

The conflict underscores challenges to the stability and effectiveness of national institutions, a key focus of SDG 16.

• Breakdown in Social Dialogue: The inability of the government and the BMA to reach a negotiated settlement signifies a failure in institutional mechanisms for peaceful dispute resolution. Mr. Streeting has accused the BMA of attempting to “hold the country to ransom,” while the TUC accuses the opposition of “cynically and opportunistically stirring the pot.”
• Legislative Gridlock: The proposed workers’ rights bill is reportedly being delayed in the House of Lords by hundreds of amendments. This parliamentary “ping pong” threatens to stall the implementation of key government policies and demonstrates institutional friction.
• Recourse to Legal Institutions: The pre-action letter from UMAPs, signaling an intended judicial review, demonstrates how stakeholders are turning to legal institutions to challenge executive decisions, testing the accountability and justice frameworks of the state.

SDGs Addressed in the Article

• SDG 3: Good Health and Well-being

• SDG 8: Decent Work and Economic Growth

• SDG 16: Peace, Justice and Strong Institutions

Identified SDG Targets

SDG 3: Good Health and Well-being

1. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services…
   
   The article highlights how the doctors’ strike directly threatens access to essential healthcare. Kemi Badenoch’s statement that “people are going to die” and the explanation that “planned-care patients are going to end up being cancelled” because senior doctors must cover emergencies, directly point to a disruption in universal access to health services.
2. Target 3.c: Substantially increase health financing and the recruitment, development, training and retention of the health workforce…
   
   The article touches upon the retention of the health workforce. The BMA chair warns that “doctors are leaving the country to find better pay elsewhere,” which is a direct consequence of disputes over pay and working conditions, impacting the long-term stability of the health workforce.

SDG 8: Decent Work and Economic Growth

1. Target 8.5: By 2030, achieve full and productive employment and decent work for all… and equal pay for work of equal value.
   
   The core of the dispute is about fair compensation. The doctors’ demand for a “29 per cent pay rise” and the justification that the dispute is about “pay restoration” because they have “lost a fifth in the value of their salaries” directly relate to the principle of decent work and fair pay.
2. Target 8.8: Protect labour rights and promote safe and secure working environments for all workers…
   
   The article is centered on a conflict over labour rights. The discussion about the government’s plan to “scrap the minimum service guarantee during strikes,” the proposal to ban doctors from striking, and the TUC’s statement about “Attacking the right to strike” are all directly related to the protection of labour rights and the right to collective action.

SDG 16: Peace, Justice and Strong Institutions

1. Target 16.3: Promote the rule of law at the national and international levels and ensure equal access to justice for all.
   
   The article mentions that the physicians associates union (UMAPs) has sent the health secretary “a pre-action letter notifying them of an intended judicial review claim.” This is a clear example of an organization using legal processes to challenge a government decision, thereby seeking access to justice through the rule of law.
2. Target 16.7: Ensure responsive, inclusive, participatory and representative decision-making at all levels.
   
   The political and legislative struggle described in the article reflects the challenges in decision-making processes. The mention of “ping pong’ between the two houses of parliament” over the workers’ rights legislation, involving political parties, peers, and trade unions, illustrates the complex, and at times fraught, nature of creating responsive and inclusive policy.

Indicators for Measuring Progress

SDG 3: Good Health and Well-being

1. Mortality/Service Disruption Rates: The statement “People die when these strikes happen” implies that excess mortality rates during strike periods could be used as a direct indicator. Additionally, the number of “planned-care patients” whose procedures are “cancelled on the day” serves as an indicator of disrupted access to healthcare services.
2. Health Worker Retention Rate: The warning that “doctors are leaving the country to find better pay elsewhere” implies that the emigration rate of medical professionals can be used as an indicator to measure the retention of the health workforce.

SDG 8: Decent Work and Economic Growth

1. Wage Growth vs. Inflation: The doctors’ claim that they have “lost a fifth in the value of their salaries” and their demand for “pay restoration” implies that the change in real wages (adjusted for inflation) for healthcare workers is a key indicator of decent pay.
2. Frequency of Labour Disputes and Strikes: The article mentions this is the “11th strike that we’re seeing since 2023.” The number and duration of strikes can serve as an indicator of the state of industrial relations and the protection of labour rights.

SDG 16: Peace, Justice and Strong Institutions

1. Number of Judicial Reviews Against Government: The action by UMAPs to send a “pre-action letter notifying them of an intended judicial review claim” provides a specific, measurable indicator: the number of legal challenges filed by civil society groups or unions against government policies.
2. Legislative Delays and Amendments: The description of the workers’ rights bill being held up by “more than 600 amendments proposed” and the “delay by so-called “ping pong” between the two houses of parliament” can be used as a qualitative indicator of the efficiency and responsiveness of legislative institutions.

SDG Analysis Summary

Source: ca.news.yahoo.com