Junior doctors in England started six days of consecutive strike action Wednesday in the latest round of their fight to reverse 15 years of real terms pay cuts with a 35 percent rise.

The 144 hours of industrial action from 7am January 3 until 7am January 9 by thousands of members of the British Medical Association (BMA) is the longest strike in the history of the National Health Service (NHS).

It follows three days of industrial action in the third week in December, bringing the total strike days held by junior doctors since the start of the dispute in March 2022 to 34. As throughout the dispute, junior doctors in the BMA will be joined by those in the smaller Hospital Consultants and Specialists Association (HCSA) who voted recently to renew their strikes on a 96 percent mandate.

Emergency care will be provided by transferring senior doctors from routine appointments and operations.

Negotiations between the government and the BMA junior doctors committee (JDC) broke down in December after five weeks. Health Secretary Victoria Atkins delivered an ultimatum that the BMA call off further action as a precondition for further talks, offering only an additional 3 percent on the below inflation award of 8.8 percent already implemented for 2023/4.

Starting pay for these doctors is as low as £15 an hour for providing life-saving treatment. Their fight is as much against the devaluation of public health care and understaffing as it is for a pay increase.

JDC co-chairs Dr Robert Laurenson and Dr Vivek Trivedi tried to justify the previous suspension of industrial action for talks described until recently as “productive”:

“It is extremely disappointing to be in this position. We had hoped that after a much-improved tone and approach from the new Health Secretary, Ms Atkins, we were close to a solution to this dispute. We were encouraged by her insistence last week that even after our mutually agreed deadline had passed and we were forced to call new strikes, we had still not heard her ‘final offer’.”

Atkins rewarded this goodwill the next day by rounding on junior doctors as the “last cohort” not to accept the government’s NHS pay policy and dismissing them as “doctors in training.”

A deeply reviled Tory government is only able to denounce junior doctors’ pay demand as unaffordable thanks to the collaboration of all the major health unions in sabotaging the NHS strike wave of the past year. The 5 percent award enforced on nurses by the government and the Royal College of Nursing (RCN) to end an historic strike set the benchmark for a rout involving ambulance and other hospital workers and senior doctors.

Prime Minister Rishi Sunak made the most of the sellouts, telling Parliament, “We have now reached a resolution with every other part of the public sector and every part of NHS, so over a million workers… The only remaining people who have not settled are the junior doctors.”

Sunak made clear the government is relying on the BMA to follow through on the rest of this divide and destroy the NHS strategy. The leadership is already peeling away consultants and other doctors from a fight against the government.

For the first time in NHS history, junior doctors and consultants took joint strike action over four days in September and October, receiving widespread public support. The response of the BMA consultants committee was to demobilise the joint fight and end the action of 59,000 senior doctors by balloting on an average additional 4.95 percent to the pitiful 6 percent already enforced for 2023-4, which will not be backdated.

The deal has been widely condemned by consultants whose take-home pay has declined by more than a third over the last 14 years. The determination the BMA is sitting on was shown by the consultants 90 percent vote on a 60 percent turnout to renew a six-month strike mandate on December 18. No further action will be called until the result of the ballot is announced on January 24.

The BMA also spiked action by 12,000 speciality and specialist (SAS) doctors. They voted by 93 percent for strike action, for the first time in 60 years, on December 18. On the same day as this result was delivered, the BMA announced they would be balloted on an additional 6-9 percent from January on top of the miserly 5 percent already agreed.

The JDC is treading a similar path with repeated calls for a “credible offer” from the government which can be used as a pretext to wind up the dispute. Trivedi told the BBC’s Today program, “We’re not asking for any uplift or pay restoration to happen overnight. We are not even saying it has to happen in one year. We’re happy to look over the deals that would span a number of years.”

The conditions exist for junior doctors in England to be joined by a second front in Wales against a 5 percent pay offer for the new year made by the Labour-run devolved assembly. Over 3,000 fellow members of the BMA voted overwhelmingly to strike. But their 72-hour walkout has been scheduled by the union to begin January 15, excluding any joint action with the six-day stoppage in England.

As part of its attack on the junior doctors, the government is scapegoating them for the backlog of 1.2 million operations and appointments built up since December 2022. Atkins had the gall to state, “The new strikes will result in more disruption for patients and extra pressure on NHS services and staff as we enter a busy winter period, risking patient safety.”

The risk to patient safety and services is the result of the government’s crippling underfunding of the NHS combined with regular surges of COVID, flu and norovirus against which all public health measures have been dismantled.

Tal Ellobogen, a member of the JDC who spoke to Sky News from the picket line on December 20, explained that hospital waiting lists had grown to 4.5 million before the onset of the pandemic, and 7.2 million before the strike action by junior doctors started—referring to 500 deaths a week last Christmas in A&E because of ambulance and emergency room delays.

Ellobogen still framed his remarks within the BMA’s appeal to the government responsible for this catastrophe: “What we want is for the government to restore our pay, work with us, work towards a better NHS.”

The Tory mantra that even restoring junior doctors’ pay to the level of two decades ago is “unaffordable” must be challenged. This requires a fight against the Labour Party which is just as hostile to health workers and the NHS.

Shadow Health Secretary Wes Streeting made clear to BBC Breakfast on December 18 that a Labour government would not meet the doctors’ demand, stating, “I don’t want to set expectations in the wrong place, and 35 percent is a high number” adding “So we are going to have to make some hard choices.”

Streeting has become one of party leader Sir Keir Starmer’s key attack dogs against the NHS, calling for tight budgetary restraints. At the last Labour Party conference in October, he proposed a pitiful £1.1 billion funding package when the estimated deficit for NHS England for 2022/3 was £7 billion. In an interview Streeting gave to the Sunday Times on December 10 he compared the Singapore health system favourably to the NHS, indicating Labour’s support for dismantling the public health system, free at the point of use, in favour of a privatised or semi-privatised model.

The maintenance of the NHS is incompatible with Labour and the Tories’ shared agenda of cutting taxes for business and the wealthy and slashing spending on social services to fund the military.

We encourage junior doctors to share and distribute the statement of the NHS Fightback which “calls on doctors to form rank-and-file committees to campaign for a rejection of all below inflation deals. A call must go out for a renewed industrial offensive of all NHS workers sold out by the health sector unions to secure the wages and conditions needed by a modern 21st century health care service paid out of the fortunes of the super-rich.”