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Doctors are “inflicting pain and misery on patients” and holding them to ransom by going on strike, the Health Secretary has said.

Wes Streeting told LBC radio the five-day resident doctors’ strike in England is “going to set us back” as he accused British Medical Association (BMA) “activists” of “damaging” NHS recovery.

In a heated conversation with a doctor, Niraj, from Harrow in north London, Mr Streeting said doctors should “own” the damage being done to patients by the strike, which began on Friday morning.

Niraj told Mr Streeting that “we all care about patient safety, none of us wants to be on strike, I would rather be at work today” as he made points regarding a lack of training places and other workforce issues.

Mr Streeting hit back, saying: “On every single one of those fronts, on pay, on specialty training, places, on improvements to conditions, I have been working to address every single one of those issues. These are not the conditions in which people go out on strike.

“Strike should be a last resort, and I’m sorry, but when you say ‘I don’t want to be out on strike today’, yes, you do, because you have made that choice.

“You have done so having had a 28.9% pay rise, the highest in the public sector, two years in a row, and on those things that you’ve just mentioned, you say they take time.

“Yes, they do, because it is complicated.

“So, to hold patients to ransom and to be out on strike, setting back the NHS, because you don’t think we’re going fast enough, and because the leadership of your union are not honest enough that some of this change takes time, is extremely irresponsible.

“It is extremely unnecessary and the other listeners to this show who have not had a 28.9% pay rise, whose taxes are paying for our National Health Service and who are receiving a substandard service, not least because of the damage that these rounds of industrial action are doing, I think they will be quite shocked, actually, that against the backdrop of a Health Secretary that wants to work with you, who acknowledges these are challenges and wants to address them, and has given you the biggest pay rise in the public sector two years in a row, I think people will be shocked by the BMA’s reprehensible behaviour.

“Don’t tell me you don’t want to be out on strike, because that’s exactly where you are. You made that choice, own it and own the damage it will do to your patients.”

Mr Streeting said the BMA “should have had the courage to put the offer I made them to their members”, which includes extra training places and cash for out-of-pocket expenses such as exam fees.

He added: “I don’t believe the BMA are speaking for their members. I think they’re speaking for their activists.

“Those activists are damaging the NHS recovery, disrupting patients’ lives and they need to own the consequences of their actions.”

Earlier, Mr Streeting told how he was proposing changes to improve doctors’ lives, including more training places and changes to international recruitment.

He acknowledged that two-thirds of the 30,000 doctors applying for 10,000 training places are international medical graduates.

He said: “One of the things that I’m doing is putting an end to the absurdity where homegrown talent are having to compete for the same training places on equal terms against people who’ve trained overseas.

“I think it’s crackers. I think it’s unfair to our own doctors. I also think it doesn’t help this country with unmanageable levels of net migration.

“So, I’m working as fast as I can and hopefully that will be by 2027, but I’m actually looking at whether I can do something much more urgently.

“The challenge is a legal one. I’m looking at whether there are things I can do more quickly.”

Later, he told the PA news agency the “grossly unfair” doctor strikes will affect patients and NHS finances.

He said: “There are consequences for these strikes, as much as the BMA wants to try and ignore them.

“It means disruption to patients despite our best efforts, and I don’t take lightly the fact that people will be having appointments, tests, scans and treatments delayed because of this irresponsible action. I think that’s grossly unfair.

“It will also have an impact on NHS finances. These rounds of strike action cost around a quarter-of-a-billion pounds.

“I’d rather be investing that in frontline care for patients.”

The five-day action is the 13th walkout by doctors since March 2023, with the last strike in July estimated to have cost the health service £300 million.

Resident doctors make up around half the medical workforce in the NHS and have up to eight years’ experience working as a hospital doctor or three years as a GP.

Nick Hulme, chief executive officer of the East Suffolk and North Essex NHS Foundation Trust, said on Friday it was running 99% of elective operations and 97% of outpatients, and was seeing signs of staff choosing not to strike.

He told BBC Radio 4’s Today programme: “We are just checking this morning with both hospitals to see what the numbers are, but we are seeing a higher level of (resident doctors) coming back, and I think it reflects a kind of changing mood both for other clinical staff, but also for our resident doctors, that I think their sense is that they are obviously frustrated in terms of the ongoing dispute, but I think they are voting with their feet and returning to work.

“We haven’t got the absolute numbers yet, but I get the sense, and certainly in the last strike, we saw more people coming back than seen in previous industrial action.”

Dr Tom Dolphin, BMA council chairman, was asked if the union was closer to a settlement with the Government.

“We hoped that we might be getting into that direction,” he told the BBC.

“The Secretary of State appeared to be showing willing to move towards something that we thought might be more appropriate to reflect the situation both on pay and on jobs as well.

“But, unfortunately, we reached an impasse, which is why we’re where we are now.

“We’ve got pay that is still a fifth down on the value that it had in 2008 – pay packets are still missing a fifth of their value.

“We’ve also got thousands of doctors who are unable to get into training posts, are unable to become the specialist and the GPs of the future that we need. And that’s a serious situation that needs addressing.”

Mr Dolphin said there was a big difference between what doctors can earn in the UK and other countries like Ireland, Australia and Canada, adding: “We’ve got to make sure that we are investing in staff in the UK so we can retain them in the UK and provide specialists and GPs that people need.”

He said the BMA was “hoping to pick up communication again” with the Government once the strike has ended.

“We want to negotiate, we want a settlement to this. We don’t want to be on strike. We’d much rather be looking after the patients.”

The NHS is aiming to continue with at least 95% of the planned activity over the five days.

The last time resident doctors went on strike more than 54,000 procedures and appointments needed to be cancelled or rescheduled, despite the NHS maintaining 93% of planned activity.

Professor Meghana Pandit, national medical director of the NHS, told BBC Breakfast there would be an impact on patients, adding: “Every strike is devastating, really, for the NHS.”

But she urged patients to keep coming forward for care and to attend appointments unless told otherwise.