The impact of successive doctors’ strikes is now ‘causing significant disruption and risk to patients’, including to those needing urgent heart and cancer treatment, NHS England leaders have told the BMA in their strongest warnings yet.
A letter to the union’s council chair on Tuesday evening, leaked to HSJ, said: “We are increasingly concerned that the cumulative impact of this action is causing significant disruption and risk to patients…
“We are extremely concerned that Christmas Day cover is insufficient to ensure appropriate levels of patient safety are being maintained across local health systems. This is particularly the case in the current period of industrial action, with three consecutive Christmas Day levels of service.”
Consultants and junior doctors are in the middle of a combined strike, from 2 to 5 October, during which they have agreed to only provide basic “Christmas Day” levels of medical cover.
Although Christmas Day includes cover for emergency care, the officials said that in practice – with demand above Christmas Day levels, and with successive days and repeated strikes – it was not protecting patients needing urgent care.
The letter, signed by NHSE leaders including chief medical officer Sir Steve Powis, and chief nurse Dame Ruth May, goes on: “Secondly, we are becoming increasingly concerned that combined periods of industrial action are impacting on our ability to manage individuals who require time-sensitive urgent treatment, for example cardiac, cancer or cardiovascular patients, or women needing urgent caesarean sections.”
The officials called for “further discussions… on strengthening the derogation process” – under which doctors can be called back in to work during strikes under certain circumstances – stating that it is “not currently working as it should”.
In particular they called for “the inclusion of specific triggers around patient flow, such as handover delays, delayed admissions from A&E and delayed discharges” – which could effectively mean that hospitals could call medics back in when emergency departments and wards fill up and are becoming overwhelmed.
Not Christmas Day pressure
Explaining the problems being experienced in hospitals during the strike, the letter to Phil Banfield, which was copied to local NHS leaders, says: “The reasons for this are twofold: we are not experiencing Christmas Day levels of pressure, when demand falls by around a third, nor are we seeing the drop in bed occupancy levels that occurs immediately prior to Christmas.
“In addition, successive days of Christmas Day cover are significantly impacting on the ability of systems to maintain flow throughout our emergency pathways, which in turn is resulting in delayed ambulance handovers, deteriorating ambulance response times and long waits for patients in emergency departments.
“Local systems are also finding it harder to put in place normal mitigations used to maintain flow in adults and children’s emergency care, such as additional ward rounds to facilitate timely discharge.”
It said urgent care was in particular being compromised “when periods of industrial action occur in close proximity – such as during the last month, where two of the four weeks have been impacted”.
The letter was signed by NHSE chief workforce officer Navina Evans and interim chief operating officer Sir Jim Mackey and, as well as Sir Stephen and Dame Ruth.
The BMA consultants committee this morning offered to suspend strikes if the government was willing to hold pay talks facilitated by the conciliation service ACAS, which ministers have refused to do.
NHS ‘made repeated planning failures’
Meanwhile, in an angry response published later in the evening, Professor Banfield indicated it was open to possible changes to the derogation process, but that the NHS had made “several planning failures including that some NHS trusts had not appropriately rescheduled non-urgent elective activity in the days leading up to strikes which has directly impacted the ability to prioritise more urgent care needs”.
He said that this week “across the whole of England we have had derogation requests from just two trusts during the current period of industrial action”. HSJ understands that during previous rounds of strikes, more derogations have been requested, and virtually all have been rejected, leaving many trust leaders frustrated with the process.
The BMA has argued it will not agree any “derogations” at trusts unless and until all non-urgent planned care is cancelled; while NHSE and government are keen to make any progress possible on elective treatment.
Professor Banfield added: “The BMA is aware that some trusts have continued with significant amounts of elective activity during industrial action and have failed to reschedule non-urgent elective care in an attempt to meet political targets. This is causing unnecessary risk of harm.”
He suggested the BMA sought to agree revised guidance with NHSE on planning and safety for strikes last month, but that NHSE had “instead, unilaterally issued guidance days before – without our agreement – that has caused confusion, leading to trusts planning elective activity during strikes that could have been used to generate bed capacity or additional medical cover”.
He added: “We will happily work with NHS England again on clearer guidance to trusts to prevent any safety issues arising.”
On the BMA’s Christmas Day staffing offer, Professor Banfield added: “I do not agree that the Christmas and Boxing Day model of industrial action is unsafe or that it is the reason for the issues you have detailed in your letter.
“This model only applies to consultants and junior doctors eligible to strike. Consequently, actual staffing is higher than Christmas and Boxing Day, given SAS doctors, various non-striking consultant and junior doctors, as well as allied health professionals continue to work as normal. Instead, there is clear evidence of the failure by some trusts to adequately prepare for industrial action.”
He also suggests NHSE should raise its concerns with the prime minister as “it is now incumbent upon the government to come to the table, drop their refusal to negotiate on pay and settle its dispute with doctors”.
Updated overnight to reflect Professor Banfield’s response.