£1.7 billion isn’t really the right figure for the total cost of NHS strikes

The price of not settling the pay dispute has seen catastrophic impacts not just on the country’s economy—with NHS strikes costing the taxpayer almost £1.7 billion since April last year—but to patients and the nation’s health, with over 1.5 million appointments cancelled.

In a statement last month following the end of the junior doctors’ strikes in England, the Department of Health and Social Care (DHSC) said that NHS strikes in general had cost the taxpayer almost £1.7 billion since April 2023.

The same figure was also widely cited in different forms elsewhere, including by the health secretary Wes Streeting, BBC News and the Daily Mail. The DHSC had also used the figure in a statement in July.

The DHSC has since confirmed that this figure comes from the 2023/24 financial directions to NHS England, and refers to the cost of all NHS England strikes in 2023/24. 

As a result, it doesn’t include the cost of the junior doctors’ strikes in June and July 2024, meaning the true cost since last April, if calculated on the same basis, would be slightly higher.

However, a calculation using a broader definition of the cost to public funds might produce a different figure—although it’s hard to be precise about this, or even to say whether the ‘true’ cost is higher or lower.

Politicians, the media and the government should take care to use correct information about industrial disputes so that voters can get an accurate picture of the issues involved.

Some of the claims in this fact check were identified with the help of Full Fact’s AI tools.

This article only considers the strikes that affected NHS England, which is the part of the health service that the UK government controls. Junior doctors are now also known as “resident doctors”.

How much did the strikes cost?

The overall cost to public funds as a result of the NHS strikes that ran from late 2022 until July 2024 is too complex to estimate precisely.

We know that the government under Rishi Sunak provided NHS England with £1.74 billion to “mitigate the impact of industrial action” in 2023/24. A large part of this was reportedly to cover the cost of employing extra staff. 

This was the figure cited by the current Labour government, which means it did not include the cost of the strikes before or after the 2023/24 financial year.

The DHSC was therefore not quite right in a post on Facebook, shared by a number of Labour MPs, which said: “This brings an end to strikes which have cost patients 1.5 million cancelled appointments and taxpayers £1.7 billion.”

Nor was BBC News, when it said “Industrial action in the NHS is estimated to have cost taxpayers around £1.7 billion during 2023 and 2024”, assuming this is a reference to the same figure.

But there’s more

Although paying for staff cover on the day was a large part of the NHS cost calculation, it is not the only cost of strikes. 

As the health think tank the King’s Fund explained in a blog in February, some NHS staff may have cancelled annual leave in order to cover shifts on strike days, meaning they leave behind a workforce that may need “to be paid in lieu or carry their extra leave into future years.” 

Or there are the patients who missed treatment on strike days, who in many cases will need to be treated later instead, adding a burden to the NHS in future—and possibly a greater burden than before, if their health deteriorated while they waited. Or there’s the work not done because existing staff were covering or administering those days—work that will also need to be done in future.

The King’s Fund cites an estimate of £2 billion from NHS Providers for all these costs together, just in the year to December 2023. And the NHS Confederation has cited an estimate of £3 billion for the 18 months to June 2024.

One important caveat to bear in mind with these figures is that any extra cost that involves paying more money to staff will also mean those staff have to pay more money back to the government in tax.

The exact amounts involved are hard to calculate, and the DHSC told us that it is not standard practice to include this in government calculations, but it may significantly reduce the actual cost to public funds. We’ve written about this issue before, when the government and the BMA, a union representing many of the striking doctors, used different estimates for the cost of raising doctors’ pay.

What about the cost of preventing strikes?

Looking more widely, industrial action can also give rise to a range of other costs, and perhaps even savings.

In one sense, this is because settling a dispute may itself cost money. Indeed the financial directions document that contains the £1.7 billion figure also says that the government provided funding to cover the pay agreement it had reached in a different dispute, with NHS consultants.  

If the total cost of the strikes is lower than the total cost of settling them, then allowing the strikes to continue might therefore lead to lower spending overall. 

Looking at an even bigger picture, it is also possible to argue that settling strikes with pay rises may lead to further strike action from other groups, thereby indirectly raising costs. 

On the other hand, the BMA has also estimated that the cost of replacing doctors who left the NHS prematurely was £1.6-2.4 billion in the year ending September 2023, and says that this could rise in future. It argued that “only by valuing doctors appropriately in the UK can we hope to prevent them from leaving for more competitive roles abroad or outside the NHS”.

Longer term, any strikes that led to increased pay and a change in conditions and thereby effectively retained more doctors might therefore, arguably, save the NHS money overall.

These are some, but not all, of the wider factors worth bearing in mind when considering the costs of strikes.