The government has just lost one of its bargaining chips in the long-running junior doctors’ strikes: hospital consultants have narrowly voted against the pay deal that they were offered. The BMA had put to its members the offer of an additional 4.95 per cent, on top of the 6 per cent raise already given to them in April, and 51 per cent voted against it. The union’s strike mandate lasts until June this year, which means there could be further damaging walkouts from senior doctors. So far, the union has said ‘we have decided not to call strike action at the current time but instead enter discussions with government to see whether we can secure improvement to address our members’ concerns.’

But it’s not just the potential for industrial action from the consultants themselves that’s the problem. It’s the fact that ministers were using the deal they had managed to strike with the BMA on consultant pay to try to shame junior doctors in their own pay dispute. Consultants are generally less militant than the junior doctors when it comes to both their mass membership and their representatives in the BMA. But this shows that even the consultants are unhappy. It also shows how difficult the line is for the BMA itself: it had put this deal to its members as a ‘credible offer’, while saying it did not deliver all that it had asked for.

There is a suspicion in government that both the BMA’s committees and its wider membership are holding out for a Labour government to negotiate with. But it’s worth pointing out that Labour hasn’t suggested there will be any more money available for pay – or for the NHS more widely – if they are elected. The main argument Keir Starmer and Wes Streeting are making is that they wouldn’t have let things get to this stage, which is very much easier said in opposition than done in government. No health secretary has ever enjoyed dealing with the doctors’ union. Victoria Atkins has the displeasure of handling its latest surprise.