The last time the country had to face the consequences of health staff striking was in 2016 when the junior doctors walked out over the renegotiation of their contract. Seven years later junior doctors have announced their intention to join the nurses and ambulance staff on the picket line. But what direct impact, if any, are the strikes likely to have on patient safety? What about the underlying reasons behind the strike action, already serious before the pandemic but that have gone critical since? And, stuck in the middle, patients worry that they will end up as collateral damage as continuity of care and elective treatments are disrupted and / or cancelled.
Impact of strikes
A 2018 research study from Imperial College* assessed the effect of the four junior doctors’ 2016 strikes, and concluded that, although the provision of day to day patient care was significantly disrupted, this did not necessarily result in worse patient health outcomes. Previous studies on the effect of strikes, both in the UK and abroad, have come to broadly similar conclusions; for instance, a 2015 study, reported in the BMJ, from Harvard Medical School and Brigham and Women’s Hospital, Boston, USA suggested strikes have a marginal effect on patient safety. A further, more recent, study into the impact of strikes globally on patient morbidity by the University of Greenwich reached a similar conclusion. Although the number of health workers striking is considerably greater than in 2016, with nurses also striking for the first time, the provision of emergency help for a serious or life-threatening injury and continuing care for those who would suffer if their treatment was withdrawn, such as cancer care, should help to mitigate any lasting damage.
Strikes are the manifestation of deeper malaise
When interviewed about why their members felt impelled to strike, all union leaders referred to the knock on effects of low staffing levels across the health service and the lack of social care that prevents acute hospitals from moving patients to a more appropriate care setting. Staff shortages have resulted in almost unmanageable workloads in some areas of the health service leading to high absence levels due to fatigue and stress-related illness. Although the policy decision to restrict the number of medical training places and remove nursing bursaries has been reversed, there will be a time lag before the newly trained doctors and nurses are ready to join the front line. Thus, the NHS will remain heavily reliant on recruiting overseas (raising both ethical and logistical questions) to fill the breach. A recent Healthcare Safety Investigation Branch (HSIB) report illustrates the rock bottom morale of NHS staff, noting that they have ‘faced “significant distress” and harm over the past year’ [BBC Report, 27 February 2023]. Many of the scenarios described by ambulance, nursing and other medical staff has left many feeling traumatised and suffering from exhaustion and severe anxiety.
It is inevitable that patience confidence in the health service will be knocked, particularly for those who have had appointments and elective procedures cancelled, sometimes for the second or third time. To date, public support for all the health workers taking strike action has held up and, even with the junior doctors deciding to strike, looks likely to be maintained. As union leaders and striking staff have clearly articulated, low staffing levels and pay that has not kept pace with inflation, has not only damaged staff directly employed but is also having a negative impact on recruitment and retention. Of course, the people most directly affected are the patients. Those needing emergency care are unlikely to suffer providing Trusts have put a proper action plan in place to cope; it is those with long term conditions and those still on post-Pandemic waiting lists who are likely to feel the real impact of the strikes.
Where does this leave patients?
Support for striking NHS staff remains in place with most people understanding, and sympathising with, the reasons behind the walk-out. Staff interviewed by the HSIB expressed fears that overwork and stress will lead, sooner or later, to them making a mistake and causing patients to suffer. The main worry will be the raft of non-urgent cases that become, due to delay, more pressing as time goes on. A backlog of cancelled elective procedures and outpatient appointments, potentially leading to long term complications, may result in hospitals that fail to put contingency plans in place facing negligence claims from patients who believe that their long term welfare has been severely compromised by their delayed treatment. However, a successful medical negligence claim is a high hurdle to clear and relies on a reasonable body of medical opinion concurring that they would have pursued a similar course of action.
Although there have been dire warnings from government and elsewhere that patient safety will be severely compromised by the ongoing strikes, so far the system appears to be holding up – just – under the strain. How long this can last remains to be seen.
* Furnivall; Bottle; Aylin ‘Retrospective analysis of the national impact of industrial action by English junior doctors in 2016’; School of Public Health, Imperial College