Who Is The Man The BMA Is Up Against?

An inside look at Wes Streeting’s promises, priorities, and professional appeal

Much of how the latest trade union dispute plays out will be down to this man, someone who is inextricably linked with our profession. Wes Streeting holds the most consequential job for doctors in the UK: Secretary of State for Health and Social Care. So for doctors, there are fairly important questions we should ask: Who is he? How does he compare to his predecessors? …and should doctors put their faith in him?

Council Estates To Cambridge

Streeting’s election to Ilford North in 2015 was no easy feat. He was responsible for the largest nationwide Conservative to Labour swing at the 2015 election, winning by just 589 votes. Labour paint him as the quintessential example of meritocracy in Britain as he made it from the council estates of East London to Selwyn college, Cambridge. He frequently invokes this background when explaining that he is someone who understands the necessity of good public services.

His self-description on Labour’s official website is notable. He writes '“You may not always agree with me, but you’ll always know where I stand”. Make no mistake, Streeting wants to distance himself from those evasive politicians that have defined recent times.

Streeting is an incredibly astute character. The navy suit, ironed white shirt and neatly parted hair bring a polished image supported by excellent communication skills. He is often placed in front of cameras by his party as he rarely uses jargon and doesn’t sound like your typical politician. He is relatable and straight talking.

This is of course all great when he’s making a case for you, but when, like the BMA, you find yourself on the opposite side of this, it’s a skillset that makes things difficult.

He finds himself amongst the moderates in the party and has often been labelled as a Blairite due to his relaxed stance on the private sector, which he has objected to on many occasions. He is on record as being one of the most open advocates for using the private sector to cut waiting lists.

He frames this as a matter of necessity, not ideology: “What matters to patients is getting seen faster, not who owns the MRI machine.” There can be no doubt that Streeting may have his eyes on the top job as Starmer’s successor. To put it candidly, he needs this role as health secretary to be a success - something only possible with doctors onside.

Does Wes Actually ‘Get It’?

There’s no question that Streeting has offered a different tone from his Conservative predecessors. He has tried to side with doctors through the acknowledgement of poor working conditions and the resolution of the last pay dispute. The last health secretary, Steve Barclay adopted a confrontational stance during the last dispute from the outset.

Streeting may have also labelled doctors as unreasonable in this dispute, but he is on record making statements such as: “I’m angry about the way junior doctors are treated. There’s a lot we can change”. Understandably, doctors have grown skeptical over political words, but nevertheless they suggest a different tone from what we’ve have been used to.

Streeting’s other early moves are not insignificant. He has endorsed the Leng’s reviews recommendation to rename Physician Associates to “Assistants”, and has been the first minister to openly say he wishes to prioritise UK medical graduates. These are all positions that align with the majority consensus in the profession.

Streeting’s Political Decisions

Now he faces tough decisions and he is being pulled in two directions. Streeting is bound by his party’s fiscal rules. Labour has promised no Income Tax, National Insurance, or VAT rises for “working people” — a term it continues to use while struggling to define. Recent reports also suggest Rachel Reeves is not too keen on a wealth tax meaning any major increases in NHS funding would likely need to come from cuts within existing departments or private sector outsourcing.

So Streeting faces an internal battle: Does he take on the treasury and his own party’s fiscal policies? This would not only challenge his own party’s economic message but could force a rift with the chancellor. Streeting will also know that significant concession to doctors at the first sign of industrial unrest may open the eyes of other public sector unions?

Railway workers, teachers and nurses will all be watching closely. This calculation will be a key one for Streeting as he knows the public want the NHS fixed, but he will be vary of not portraying the unions as too powerful or the government too weak.

Is Student Loan Forgiveness an Option For Wes?

If Wes Streeting wants to avert future strike action, his options are limited. One potential proposal under discussion is student loan reform. This idea of student loan forgiveness is not a new one - for example, take this 2023 proposal by the Nuffield trust that suggested writing off 30% of a graduate’s loan after three years in service, 70% after seven years and 100% after ten years. Aside from the financial incentives for the doctor, this would also address the additional problem of workforce retention.

Crucially, this reform would not lead to an immediate increase in take-home pay for the doctor unless loans are written off entirely up front. This is because student loans are tied to income, with repayments made at 9% from income above a given threshold.

There will also be a substantial group of doctors that this reform would not benefit. A minority of UK graduates did not take out a student loan, and others, such as the 30% of resident doctors in 2021 who trained abroad, will not see any benefit. This could be framed by the health secretary as further evidence of his pro-UK graduate attitude. However, for the majority of doctors, such reform would reduce the length of time that they would be making student loan repayments and therefore the total they would pay over a lifetime.

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The Art of the Constructive Cut-In

Why interrupting your patients is not always a bad thing…

A glance up at the clock tells you that this clerking has taken 20 minutes and you haven’t even reached the examination. The patient’s story continues endlessly, only interrupted by the bleep that clings onto your scrubs whilst vibrating. You try your best to steer the conversation, but the monologue continues on. How much of this has actually been clinically useful? you ask yourself.

Time pressure is ever-present for doctors. The above example is not about impatience or poor listening. It’s about the persistent tension doctors find themselves between: How do we deliver safe and empathetic care under the reality of NHS time constraints?

The Ideal vs Real

Our medical training strongly advises against interruptions as they can inhibit a patient’s ability to participate freely in the conversation and give information regarding their symptoms. It has been found that doctors interrupt their patients after an average of just 18-36 seconds.

However, what can’t be ignored is the context in which these interactions happen, with time pressures and competing priorities.

Open, patient-centred communication is lauded as an indication of good care. The “golden minute” is that sacred 60 seconds of uninterrupted patient speech. It is often taught as an unbreakable principle, as many medical students have found out the hard way in their OSCEs.

Like most general rules however, context is needed. A patient’s ability to tell their story effectively in that minute varies widely. Some patient’s interpret questions differently.

Take the question: “What brought you in today?” - responses to this can focus on different time frames, from the last couple days to stories that span decades; and some patient’s may even take the question literally and begin talking about how the patient transport or the No.205 bus arrived late.

Defining Interruption

Interruption is often treated as synonymous with rudeness but not all interruptions are created equal. Interruptions are not inherently bad. Rather, we need to ask how and why they occur.

Within constructive interruptions, a doctor may interject mid sentence in an attempt to request clarification before the patient switches topic. This type of interruption does justice to the discussion by acquiring additional information or even expressing agreement.

This differs from intrusive interruptions where doctors may finish sentences or highlight disagreement mid-history. Evidence shows that patients are much more forgiving of interruptions that seek to clarify, as it shows doctors are engaged and trying to understand.

And let’s not forget, that despite the emphasis on the doctors’ interruption, evidence also suggests that patients’ interrupt doctors far more frequently than vice versa.

It’s easy to feel frustration when a patient seems overly verbose. But sometimes, long-winded answers are the product of past experiences. A missed diagnosis, a miscarriage, or a history of being ignored can condition patients to over-explain or to colour every symptom with detail to make sure it is heard.

Teach Me How

Needless to say, even constructive interruptions need to be done with respect and politeness.

One effective technique is mirroring and is done through echoing or repeating the last few words the patient sad as a way of showing you are listening, whilst gently guiding the conversation. This isn’t manipulation, it’s communication back by psychology. Mirroring tells the patient you are actively listening. It is difficult to repeat back dialogue if you haven’t listened to it in the first place.

The idea that ‘good’ doctors never interrupt is simplistic and only works in the realm of the ideal, where time constraints do not exist. Effective clinicians known when to let the patient speak and when to guide the conversation away from the tangential roads.

“If you aren’t a doctor but are involved in any form of clinical activity that involves making a plan, do not discuss patients with the SpR or SHO, then come to me, the Consultant, presenting the plan as your own without mentioning that you have discussed it with the relevant doctor. You may think we don’t realise, but we do.”

“About to finish FY2 now and I can safely say that I loved foundation training. Worked with some great people and learned things I genuinely found enjoyable. I would tell any prospective F1 that it is far better than being a medical student”

“Before the FRCA, I was just blissfully & peacefully bolusing milkshakes of amnesia followed by a red syringe. After the FRCA, I am now teaching the F2 the difference between Boyle’s Law, Charles’ Law, Gay-Lussac’s Law, Ideal-gas Law, Dalton’s Law and Henry’s Law”

“At my trust, we have an incredibly clear colour-coded lanyard system to show a doctor’s grade. I don’t understand why this isn’t used everywhere in the NHS”

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Some things to review when you’re off the ward…

Of all NHS staff eligible for the NHS pension scheme, 13% or 237,000 employees, had opted out of the scheme in the last data set, with an increasing share of resident doctors opting out. The number of employees joining the scheme, however is 2.9 times greater than the number leaving the scheme.

Wes Streeting has defended the use of the private sector to cut NHS waiting times. He frames this as a matter of necessity and not ideology. His position is outlined in an article in The Guardian.

Nurses have rejected the government’s pay award of 3.6%, whilst the Royal College of Nursing tells the government to get their chequebook out or risk strike action.

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Doctor Strikes And The UK’s Anti-Work Taxation System

Every year, we await the DDRB recommendation and subsequent government pay deal, comparing this to annual inflation figures. This is in recognition that a sub-inflationary pay ‘rise’ leads to a reduction in purchasing power. Whilst these pay rises (and the strikes that may arise from them) take the headlines, far too many people forget that since 2021 governments have frozen income tax thresholds and they will remain frozen until at least 2028.

This concept, where more people are drawn into higher income tax bands as wages rise with inflation is known in the economics world as ‘fiscal drag’. Collectively, the UK is set to pay £298.6 billion in income tax in 2025-26. With stagnant headline income tax thresholds for many years now, this is a handsome £89 billion more in revenue for the treasury than just four years ago. The higher-rate 40% income tax band which is applied to earnings above £50,270 is now welcoming Foundation Year 2 doctors into its remit.

Compile this with another added sting. If one parent earns above £60,000, they have to repay 1% of their child benefit allowance for every £200 earned over the threshold. By £80,000 a senior registrar has lost all of their child benefit allowance. Consider then, through a hypothetical, that we have a taxation system where a senior registrar may reduce their working hours or refuse additional shifts worth £2,000 to ensure they are eligible for child benefit which is worth £2,250.

We have created a taxation system that disincentivises working and picks the wrong target by squeezing the middle class. Reeves… You have some work to do.