Breakthrough for nurses - but doctors’ strikes could hit NHS even harder
When it comes to NHS strikes, the mood has shifted.
An offer to nurses, paramedics and other NHS workers (on what is known as the Agenda for Change contract) that most unions are recommending, felt like a breakthrough - a thawing of frosty relations.
But those I speak to in government are by no means optimistic across the board and here is why.
First on the Agenda for Change workers (all NHS apart from doctors and dentists), I'm told the health secretary Steve Barclay is concerned that the memberships themselves may not back the deal.
If so, we would be back to the beginning. But the bigger worry in Whitehall right now is doctors.
Sources tell me negotiations with the BMA (British Medical Association) over junior doctors - who are highlighting a 35% cut to their pay - are far from any breakthroughs.
Sources say the two sides couldn't even agree the starting point that was a condition to other unions to maintain confidentiality during the talks.
As for the pay rises being demanded, the health secretary is not going to be given the money to come anywhere close to that by the Treasury.
And so, junior doctors will go out again for a 96-hour strike starting on April 11, straight after a double bank holiday weekend that will drive up demand.
One health source said told me that Easter weekend is already one of the most stressful points of the year for the NHS.
And while we've had huge focus on nurse strikes, the impact of doctor's strikes has been much more marked.
Just consider this analysis of NHS England data, by NHS providers, that I showed on ITV's Peston.
In a rolling count of appointments postponed as a result of strikes (over 300,000 in total), the worst single day when nurses and ambulance workers were out was February 6.
On that day, 27,000 appointments were postponed.
But in the three days that junior doctors went out earlier this month, over 180,000 were postponed.
That's more appointments affected in three days than in all the other health strikes since December put together.
And to add to that - there are no derogations agreed by doctors to cover emergency care.
A terror attack scale crisis would bring them back, but beyond that doctors are walking out in all areas including intensive care.
Consultants will be there to cover, of course, but resources will be stretched.
In a way "junior" is misleading, as this is all doctors below consultant grade.
This explains the mild panic in some parts of the NHS - and it's not clear Labour would have a quick solution either.
Wes Streeting, the shadow health Secretary, told Peston last night that he sympathised with the doctors' argument but that he wouldn't have 35% to give them overnight, or even over a whole parliament, either.
Presumably the government are gambling on doctors having less public sympathy, but in the end strike disruption is often blamed on ministers.
Yesterday Saffron Cordery, deputy CEO of NHS Providers, gave me a stark analysis of the potential impact.
“Trust leaders are extremely concerned about the looming four-day junior doctors’ strike," she said.
“Not only will it be the longest yet, but it will follow a four-day bank holiday weekend, which means demand will have piled up before the walkout even begins.
“We’re also expecting a significant number of staff to be on leave during this time as it falls so soon after Easter.
“There is no question this will have a major impact on patient care, adding to the disruption already caused by industrial action."
She warned that it threatened "serious long-term damage to the NHS and will hinder trust leaders’ efforts to ensure safe care for patients and bear down on backlogs".
She called on both sides to re enter pay negotiation, adding: "Any settlement agreed must be fully funded by the government."
And then there are teachers.
The biggest Union, the NEU, is urging its members to reject the deal and sources in the Department for Education are clear - they think all unions (others are consulting members) will ultimately vote against.
Gillian Keegan says there isn't another offer and this means teachers will simply lose a £1,000 one off payment for this year.
But whatever the threat - the prospect could be of more schools strikes, alongside doctor walk-outs.
Not quite the easing of industrial tension that Rishi Sunak might have hoped for.
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