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Junior doctors working for England’s National Health Service kicked off a six-day strike over pay on Wednesday — the longest the NHS has ever faced. But it’s the latest sign of despair in a demoralized NHS, floored by towering workloads, understaffing and a lack of investment.

It follows a series of strikes involving health care workers in Britain, who since 2022 have been demanding pay hikes to keep at pace with inflation. It is also the expression of a wider feeling of dissatisfaction among staff, who feel overworked and undervalued, especially in the wake of the COVID-19 pandemic.

By all measures, U.K. health care is struggling. There are fewer doctors per capita than any other country in Europe for which data is available. Health care providers and think tanks have repeatedly sounded the alarm over staff shortages, the impact on patient care and the workforce.

In addition, decades of underinvestment in infrastructure left the NHS ill equipped to face emergencies and reeling after the pandemic hit, especially compared with some European neighbors.

This perfect storm is taking a toll on staff morale. Doctors are increasingly unhappy with their work, report high levels of stress and burnout, and feel discouraged from pursuing their profession in the future. More than 70 percent of British GPs, for example, report being stressed, far higher than European peers.

Pay is a key issue for junior doctors. The British Medical Association (BMA), whose members include junior doctors, say they have faced a “steep decline in pay” since 2008-2009. Meanwhile, the government’s proposed salary adjustments are inadequate, it says.

The government has refused to negotiate with junior doctors unless they call off the strike. But so far, that seems unlikely to happen.

Lucia Mackenzie contributed data analysis to this story.

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