The resident doctors are striking again. The 14th strike since 2016. This time the demands are more pay, better working conditions, and more training posts.
Here is what will happen, as it happens every time. Emergency departments will hit waiting time targets because the patient gets to the right person immediately, without crawling through layers of variable decision-making. Consultants manning the front doors. Waiting rooms empty. Corridors empty. Inpatient beds emptied and kept empty. Performance improves. Quality improves.
Fewer people die during a doctors' strike.
This is counterintuitive. But the evidence is consistent. Hospital data during strikes shows no increase in mortality. In some analyses, mortality decreases. During the 2000 Israel doctors' strike that lasted 127 days, undertakers reported up to 40% fewer burials than expected. Undertakers collect data. Deaths equal revenue.
The explanation is straightforward. When consultants, the most experienced and capable decision-makers, move to the front of patient flow, unnecessary admissions are prevented, discharge decisions are made faster, and futile interventions on the frail and dying are avoided. Care becomes reliable. As Atul Gawande wrote in Being Mortal: when you get old, try not to fall, or go see a doctor.
The Hunt Hiccup
The current training post crisis traces directly to a 2016 decision. After the junior doctors' strike, Jeremy Hunt established a plan to double the number of medical schools. The graduates surged predictably in 2023, needing foundation year posts. Hunt had forgotten to create them. Two years later, those graduates predictably need specialty training posts. Hunt forgot about those too.
One decision in one part of the system, with the system consequences deferred to a later date. He kicked the can down the road. Meeting the demand for more training posts now runs into several billion pounds annually. There is no money for it.
The teenagers who competed to enter medical school somehow forgot that medicine is a competitive profession. The anger is real. But the solutions being demanded (more posts to match graduates) assume the 20th century model of training and deployment is correct. It is not.
The operating model, again
At STRASYS, the Decision Intelligence engine for healthcare, we have been making this argument through data across every article in this series. The Consultant Workforce Optimisation System exists because the evidence from every strike demonstrates the same thing: when consultants are deployed at the point of greatest clinical impact, the system produces better outcomes at lower cost.
The current model puts junior doctors at the front, learning on the job, with consultants behind layers of escalation. The strikes temporarily reverse this. The results are immediate and measurable. Then the strikes end and everyone goes back to how things were.
The real fix is not more training posts within an unchanged model. It is reforming the model so that senior decision-making sits permanently at the front of patient flow, with training redesigned around genuine apprenticeship within consultant-led teams. That is what team job planning delivers when properly implemented.
Naeem Younis, STRASYS CEO, has argued consistently that without system thinking, we are in for a lot more strife and many more strikes. The consultant model needs reform. The training model needs reform. The funding model needs reform. How we organised the NHS in the 20th century no longer works for those who need it in the 21st.