Patient care “rests on a knife-edge” ahead of the most significant round of NHS strikes in a decade next week.
NHS leaders are working at full pelt to make sure emergency and other life-saving care can continue safely during the walkouts. However, huge uncertainty remains over the level of cover they will be able to secure in time from other professionals to fill key shifts: so much so that even providing “basic patient safety” is a worry for some.
The NHS Confederation is calling for an urgent resolution to the standoff between the junior doctors’ trade unions and the government and for the risks to patient care to be clearly explained.
While the last junior doctors’ strikes in March saw thousands of consultants provide cover, health leaders do not expect a repeat performance as many consultants either have annual leave booked due to the holidays or are more reluctant to put themselves forward.
One hospital leader said that “where consultants covered last time, they have built time in lieu, additionally the next strike falls over Easter, when a lot of consultants had booked annual leave. This is all impacting on elective waiting lists.”
Also, other professionals, such as some pharmacists and nurse consultants could be reluctant to provide additional cover due to the same reasons and because their rates of pay for this non-salaried work are lower than what the BMA recommends consultants ask for.
This means that health leaders are having
to plan for the worst to protect patient safety, including by cancelling more appointments and elective procedures than they would like to, so that they can keep hospital bed occupancy levels, currently standing at over 95%, as low as they can and support staff working next week to focus on urgent and emergency care services.
This is particularly needed as holiday seasons tend to see increased demand for frontline services. For example, last Easter there were over 70,000 more calls to NHS 111 from Good Friday to Easter Sunday compared to the previous Friday to Sunday (a 37% increase).
Also, the South West of England expects to see over 16 million tourists and other visitors over Easter, which services expect will lead to increased demand on the frontline.
One hospital leader told the NHS Confederation that they are facing a “catastrophic risk” with the escalated strike action and that while it will officially last for four days, its impact will be felt over 11 days due to reduced cover during the preceding Easter weekend and then during the weekend that will follow the end of the strike. They said they have never worried more about the impact a strike could have on patients than this one.
The latest national guidance asks leaders to opt for “rolling day-to-day cancellations” for elective procedures and outpatient appointments; however, some feel they have no choice but to cancel in advance. They are keen to give their patients as much certainty as they can over when they will receive their planned care and manage the huge administrative and logistical challenges of instigating cancellations and re-bookings with 24 hours’ notice, at a time when staffing levels are expected to be lower than usual.
The three-day walk-out last month saw more than 175,000 appointments and procedures having to be postponed. Based on this, the figure from next week’s strikes could be as high as a quarter of a million.
NHS England warned in its public Board meeting last week that it cannot fully mitigate the risk of patient harm during the strikes, which is a sentiment felt by many working across the health service.
One health leader told the NHS Confederation that “basic patient safety will be compromised” with emergency departments, and particularly likely to be “utterly overwhelmed.”
Another said that “the main worry is safety” and that elective activity next week seems “near impossible”.
This will be a blow to the NHS, which has been working hard to clear the 7.2 million elective care backlog that has ballooned during the pandemic, with the number of patients waiting more than 18 months for a procedure falling by more than four fifths since the peak.
Several members have raised their concerns of the cumulative impact of industrial action on planned care, with one saying: “We are dreading it. We had to cancel 1700 electives and 170 urgent cancers last time”. Another added: “The impact of industrial action resulted in cancellation of circa 2,000 appointments”. Similarly, a leader of a mental health provider said: “This action will further impact on mental health waiting lists and there is concern that, given the bank holiday preceding the strikes, there will be a significant gap in mental health care delivery for over a week.”
While health leaders accept that the chances of next week’s strikes being called off are slim, they continue to call on both the British Medical Association (BMA), Hospital Consultants and Specialists Association (HCSA) and the government to do everything they can to find common ground and negotiate constructively.
Also, they are calling on the government to significantly ramp up its communications urgently to explain to the public the extreme pressure facing the NHS around the strikes.
They have said that their staff did not notice the same level of understanding about the junior doctors strikes from the people who used their services in March, compared to the previous strikes involving nurses and ambulance workers.
Dr Layla McCay, director of policy at the NHS Confederation, said:
“Health leaders are bracing themselves for the most significant strikes in a decade with many aspects of patient care resting on a knife edge.
“They want to send a reassuring message to their local communities, but they are deeply concerned about not being able to provide safe care as they cannot rely on the same staffing levels as they have done with previous strikes. They are doing their best to mitigate any risks, which unfortunately means making the difficult decision to cancel more planned treatments and appointments than they would have liked to have done, so that they can prioritise the most life-critical services.
“The NHS will be open for business but this will not mean business as usual
“We urge the Government and trade unions to do everything they can to call off these strikes and to step up public communications urgently so that people who need healthcare understand what is available and at stake.”
The four days of strikes will come immediately after the four-day Easter bank holiday weekend. They will run from 6:59am on Tuesday 11 April until 6:59am on Saturday 15 April, as organised by the BMA and HCSA.
NHS England has set out information for the public on what to expect next week. This includes only calling 999 if it is an emergency and prioritising NHS 111 if it is not, taking advice on whether it might be suitable for people to make their own way into hospital, and for the public to take “simple steps” during to look after themselves and loved ones, including checking in on vulnerable family members and neighbours.
There are around 75,000 junior doctors in the NHS in England. They represent nearly half of the medical workforce and include those who have just graduated from university, through to those with a decade of experience. Previous action by junior doctors saw approximately 28,000 staff off each day of the strikes.
We are the membership organisation that brings together, supports and speaks for the whole healthcare system in England, Wales and Northern Ireland. The members we represent employ 1.5 million staff, care for more than 1 million patients a day and control £150 billion of public expenditure. We promote collaboration and partnership working as the key to improving population health, delivering high-quality care and reducing health inequalities.