Consultant doctors join a picket line outside the University College London Hospital

On Thursday, many of England’s senior hospital doctors walked out at the start of a 48-hour strike over pay.

Although they’re still providing emergency care, thousands of routine appointments for things like planned surgery and outpatients clinics will have been cancelled.

Hospital trusts, which deliver publicly-funded healthcare across the country, are spending more money on staff from medical agencies during the strikes, as well as performing extra costly administration work to rearrange tens of thousands of appointments.

The strikes — the latest round of industrial action for public health service staff in what has been eight months of walk-outs — are costing some large hospital providers up to $645,000 (£500,000) a day, according to industry figurehead Matthew Taylor.

Taylor heads up NHS Confederation, which represents much of the U.K.’s healthcare sector.

He told the Guardian the overall cost of months of staff strikes to hospitals could run into the billions of pounds.

He urged ministers and union leaders to resolve their disputes as soon as possible to reduce the costly burden on hospitals.

“Several [health leaders] have estimated that each previous round of industrial action from junior doctors has cost them around half a million pounds, so there is an increasing financial toll to this which could run into many billions the longer the walkouts continue,” he said.

“The longer these strikes continue, the more money the NHS will have to spend on their eye-watering costs as waiting lists rise further and vital shifts need to be covered at higher rates.”

Why are doctors striking?

Many staff in the U.K.’s public sector have walked out over the last eight months in disputes over pay and working conditions. This includes rail workers and border staff as well as many National Health Service employees.

In healthcare, nurses, ambulance staff, physiotherapists and doctors have all performed strikes. Union leaders say pay has risen far slower than inflation, leaving employees out of pocket, and making it harder for hospitals to recruit and retain staff.

As the population ages and demand for services increases, maintaining a health workforce will become ever more crucial. Patient safety, unions argue, is a risk without a sustainable supply of staff.

Ministers argue significantly increasing pay is unaffordable, and will itself potentially drive inflation.

Rebecca Fish, a consultant colorectal and peritoneal surgeon in Manchester in England’s north-east told the Guardian pay rises were necessary as working conditions become tougher. “The conditions that we work under have become increasingly tough coming out of the pandemic and the underfunding of the whole system has made me concerned about who’s going to look after me when I’m old if no one wants to be a consultant any more,” she said.

Shevantha Rosa, a neuroradiology consultant in London, told the paper that his fellow doctors were considering moving abroad, “not only because of pay but also the work-life balance”.

“It does feel like there is just this slow attrition of doctors,” he added. Medicine, he said is “becoming a less attractive career”.

Some groups’ disputes have now largely come to an end following pay uplifts. But for some staffing groups, industrial action may just be starting.

Junior doctors — qualified physicians with up to eight years’ experience in hospitals — walked out last week, leading to the cancellation of thousands of planned appointments.

This week’s action from senior doctors — known as consultants in the U.K. — is the first in a decade from this group of staff. They plan to strike again next month if no agreement is reached.