Tens of thousands of junior doctors walked out Monday in the first of three days of strike action across England, ending on Thursday at 7am.

This is the longest sustained strike action by frontline National Health Service (NHS) staff since a wave of action began last December by nurses and ambulance workers over crippling below inflation pay awards.

The strike involves members of the British Medical Association (BMA) and the smaller Hospital Consultants and Specialist Association (HCSA). Both professional bodies received emphatic mandates for action with the BMA membership of 48,000 returning a majority of 98 percent in favour on a 77 percent turnout and the HCSA representing around 900 junior doctors a majority of 97 percent on a 74 percent turnout.

The action is against a miniscule pay award of just 2 percent for last year. It is the first strike by the HCSA since its founding in 1948 and only the second in the 72-year history of the BMA. The sell-out of the 2016 strike by 50,000 junior doctors by the BMA has contributed to a situation in which real terms pay has declined by around 26 percent since 2008. Both unions are calling for “full restoration of pay” without elaborating on a time frame for this to be implemented.

The attempt by the right-wing media to present junior doctors as pampered and greedy is a slander. The BMA noted that in the first year of training junior doctors can earn as little as £14.09 an hour based on a full-time salary of £29,384. They start their working life with £100,000 of student debt to pay off from medical school.

As with nurses, ambulance workers and physiotherapists junior doctors have foregrounded the crisis of patient care, understaffing and underfunding.

Fresh evidence of the lethal impact of the cuts was provided this week by a report in the Guardian showing that deaths caused by delays in ambulance response times and handovers increased to 511 over the last year. Even this figure, more than double the known deaths last year, is an undercount as only three of the 10 ambulance trusts in England responded to enquiries for full year figures for the past two years.

Junior doctors face a situation in which their action has been isolated by the main health unions—Unison, Unite and the GMB, and the Chartered Society of Physiotherapists (CSP)—which agreed to close down all strike action and follow the example of the Royal College of Nursing (RCN). RCN leader Pat Cullen publicly rowed back from the nurses’ mandate of inflation + 5 percent (19 percent in total) to agree to talks with the Sunak government a fortnight ago, after cancelling what would have been the largest strike by nurses to date with a 48-hour stoppage in England from March 1.

Unison, Unite and the GMB suspended strike action by over 50,000 ambulance workers last week and the CSP suspended strike action for March 22. Talks have continued behind a wall of secrecy. From what has been leaked they include only an offer of a lump sum top up payment for last year’s pay offer of around 4 percent and 3.5 percent for this year. Rather than being seen as a provocation against NHS workers, the unions have welcomed this as grounds for a deal and even agreed to discuss productivity enhancements.

Everything possible is being done to dissipate opposition to the Conservative government ahead of its budget announcement on Wednesday, expected to plough more money into a military build-up against Russia and China as austerity measures are tightened on health and social spending.

Health Secretary Steve Barclay used a column in the Daily Telegraph to denounce the call by junior doctors to restore a quarter of lost wages as “simply unaffordable”, citing a figure of £2 billion to meet the cost. This is less than half the £5 billion Prime Minister Rishi Sunak announced on Monday to increase defence spending by equalling 2.5 percent of GDP over the next two years.

Sunak made this pledge on his way to the AUKUS summit, the military pact between the UK, US and Australia framed around deploying nuclear powered submarines to confront China in the Indo-Pacific. Underscoring the connection between war abroad and the need to police social opposition at home Sunak cited positively the role of the health unions and the Rail, Maritime Transport union in calling off strike action at Network Rail to work with the government. He told reporters as he boarded a plane to the US, “As you have seen with rail… they have put an offer to their members, we are having constructive dialogue with the nurses’ unions and all the other healthcare unions and I would urge the junior doctors to follow suit and accept the government’s offer to come in and have talks. The other unions have done that and we are making progress.”

The “progress” cited is the willingness of the union bureaucracy to demobilise hundreds of thousands of workers to accept a further round in the destruction of their living standards.

The WSWS spoke to junior doctors on the picket lines who expressed their determination to reverse the decades long erosion of pay and dismantling of the NHS.

At Royal Bournemouth Hospital, Mehtaab and another junior doctor member of the BMA held up a homemade placard addressing the miserly £14.09 hourly rate for a junior doctor, with the caption “Reduced to Clear.”

“Our pay has been eroded since 2008, we are here to try and get some pay restoration to where we were in 2008. Successive governments have underfunded and undervalued the NHS. It’s wrong. One of the best things about the country is the NHS. We need to fight to keep it and it make sure it is functioning.”

At the Royal Hallamshire Hospital in Sheffield we spoke to members of the HCSA on the picket line.

Annette said, “Junior doctors are voting with their feet and leaving to go abroad or because of depression and stress and you can’t even pay for your overheads at home on these wages.

“There is burn out and stress. We are unable to arrange the treatment patients need because of the lack of resources. The figures have just come out about over 500 patients dying last year because of ambulance delays and queuing in car parks just to get into A&E.”

Phil said, “There was a big strike vote for the first ever strike action by the HCSA. We’ve been getting below inflation pay deals since 2008. It’s also about conditions and patient care. In the past we could manage and get x and y for patients, but now it is no longer the case. I have never known the type of crisis we have with the ambulance service, particularly in the last four years.

“If you believe ideologically in austerity then this is a great result. I don’t agree with the other unions calling off the action for what the government has offered, just 3 percent. It is down to the members to reject this. We were offered talks [by the government] but only if the strike was called off. That is not negotiations. They have not got money to pay us a cost of living increase but £20 billion was spent on test and trace which was not fit for purpose. It would cost around £1 billion a year to settle our pay demand.”

At Leeds General Infirmary junior doctors and BMA members spoke up about the severity of the crisis.

Paul said, “It’s gotten to a crisis point. We've been shouting for years and years that this needs change. And no one's really listening. I feel like we've been driven into a corner here. No one wants to strike. Everyone would rather be at work providing care for our patients. But unfortunately, we feel like we've got no other choice.

“It’s getting more dangerous by the month, as waiting lists are getting longer. It's getting harder and harder to provide the care that you need to give people.

“Inflation for me is a big part of it. The whole of the country is struggling with it. For me, the issue is mainly the erosion of pay is causing people to go abroad. What I'm seeing year on year is the amount of staff leaving to go to Australia, New Zealand, other countries with better pay, better conditions. This leaves us with fewer and fewer people on the front line.”

Jane added, “We're out here today because we've suffered a massive pay cut in real terms since 2008. Being unable to afford things in the current cost of living crisis means that staff are leaving the NHS in numbers that we've never seen before. And we need to do something about it, if we want to save our NHS.”

Joseph, a junior doctor working on the Respiratory Care Unit, said, “Staffing has been pretty poor since I started work. Often, you've got twice as many patients, as you should, per doctor. The nurses are facing similar problems looking after 15 or 16 patients on a shift. I think it's dismal. The bedding situation is bad. We've got patients in corridors being looked after where they shouldn't be. You can see around the country that there's a lot of people that are upset about how things are at the moment.”