What’s the off-ramp? When I ask one of the negotiating team close to the health secretary, the bleak answer is, “I don’t know.” Resident doctors in England are on another strike, for six days this time. Labour arrived in office bearing a 22.3% pay rise to end the strike it inherited – and it thought it was all over. But within a year, doctors were out again.

This time, negotiations over many weeks seemed to go well, but fell at the last fence: the doctors claimed there was a last-minute watering down and they returned to their fixed stand – restore their pay to its 2008 level, another 26%. “Impossible” is Wes Streeting’s line. He says resident doctors are “by a country mile the standout winners of the entire public sector workforce when it comes to pay rises”. Everything looks stuck, no pasaran on both sides. Why?

Because few involved are losing out right now. Streeting’s system now delivers 95% of treatments during a strike, so waiting times have not increased. Senior consultants step up to do juniors’ jobs at pay set by the British Medical Association (BMA) rate card, some £4,000 for a weekend. The Royal College of Emergency Medicine reported that during some of the strikes “everything works better than usual” in A&Es when specialists instead of juniors see patients.

In most industrial action, strikers suffer from loss of pay, but most of these doctors can recoup........

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