Ban strike action by doctors: calculation note

Central fiscal result

-£0.1bn - Net fiscal impact in 2028-29

Low case: -£0.5bn. High case: +£0.4bn. Positive numbers are fiscal costs or borrowing pressure. Negative numbers are Exchequer savings or receipts.

Scenario and baseline

• Model doctors' strike restrictions by 2028-29.
• Central fiscal effect is £0.1bn saving.
• Baseline includes legal right to strike with industrial-action rules.
• No assumed reduction in underlying NHS pay claims.

Affected population

• Affected population is doctors, NHS patients and hospital managers.
• Direct effect is lower strike disruption if disputes occur.
• Indirect exposure includes recruitment, retention and agency staffing.
• Savings depend on future industrial-action frequency.

Gross impact

• Central avoided disruption costs: £0.3bn.
• Retention and legal costs offset £0.2bn.
• High case assumes workforce costs exceed savings.
• No waiting-list productivity gain is booked.

Fiscal build-up, central case

• Avoided strike disruption: -£0.3bn
• Retention and agency costs: +£0.1bn
• Legal and administration: +£0.1bn
• Pay pressure effects: £0.0bn

Central net impact: -£0.1bn in 2028-29.

Behaviour and pass-through

• Low case assumes frequent strikes are avoided without retention damage.
• Central case assumes small saving and some workforce offset.
• High case assumes morale and retention costs exceed disruption savings.
• Disputes may shift into overtime refusal or exit.
• Patient benefits are tracked separately from fiscal savings.

Phasing

• 2026-27: £0.0bn. Preparation or partial implementation.
• 2027-28: -£0.1bn. Main ramp-up year.
• 2028-29: -£0.1bn. Target-year central estimate.
• 2029-30: -£0.1bn. Continuation at steady-state assumptions.

Main source groups

• Department of Health and Social Care, "Half a million appointments and operations saved by ending resident doctor strikes" (2025): Government data linked strikes to large numbers of rescheduled appointments and waiting-list pressure; anchors potential service-disruption savings.
• Department of Health and Social Care, "Minimum service levels in event of strike action: hospital services" (2023): The consultation proposed minimum service levels to preserve essential and time-critical care during strikes; defines the policy mechanism being extended.
• Office for Budget Responsibility, "Economic and fiscal outlook: March 2026" (2026): The OBR forecast sets the macro, borrowing and receipts baseline used for broad fiscal context; prevents treating tax cuts or spending changes as self-financing.
• Botero, Djankov, La Porta, Lopez-de-Silanes and Shleifer, "The Regulation of Labor" (Quarterly Journal of Economics, 2004): Stronger labour regulation is associated with less informal work protection trade-off simplicity varies by country; supports caution: rights can transfer surplus but may reduce flexibility.
• Ramey, "Can Government Purchases Stimulate the Economy?" (Journal of Economic Literature, 2011): Evidence on government spending multipliers is mixed and depends on slack, monetary policy and financing; useful for defence, policing and public-sector cuts.
• Conservative Party, "Our Plan for Britain" (2026): Used to define the pledge wording, policy scope and implementation scenario being modelled.