Intended for healthcare professionals


Strikes, patient outcomes, and the cost of failing to act

BMJ 2023; 380 doi: (Published 10 March 2023) Cite this as: BMJ 2023;380:e072719
  1. Ryan Essex, research fellow1,
  2. Sorcha A Brophy, assistant professor of health policy and management2,
  3. Veena Sriram, assistant professor of global health policy3
  1. 1University of Greenwich, London, UK
  2. 2Columbia University, New York, USA
  3. 3University of British Columbia, Vancouver, Canada
  1. Correspondence to R Essex r.w.essex{at}

Ryan Essex and colleagues consider whether patients have more to gain than to lose from healthcare worker strikes in poorly functioning health systems

Growing demands on healthcare workers have seen them become more vocal about their dissatisfaction with the conditions of the health systems in which they work. In the first year of the covid-19 pandemic, there were at least 6500 protests by healthcare workers globally, a 62% increase from 2019-20 in countries where continuous protest activity data are available.1 In the UK nurses, ambulance workers, and other NHS staff staged a series of strikes in 2022-23, and consultants have voted to follow junior doctors in taking strike action.2 Strikes have also been seen across Europe.3

Strikes by healthcare workers often prompt passionate and polarising debate. Staff concerns about working conditions and compensation are pitted against the risks of strikes for patients. Government and regulatory bodies commonly raise concerns about patient harm when trying to avert planned industrial action. Strike action by healthcare workers has been likened to “airline pilots threaten[ing] to parachute from their planes and leave their passengers without a pilot in mid-air.”4 In 2016, the General Medical Council instructed junior doctors in the UK to call off their planned strike, citing the potential harms to patients. The GMC went as far as threatening sanctions, reminding junior doctors they could be “struck off, for unprofessional conduct” if they participated in the strike.5 Similarly, in Australia, the government “repeatedly used ‘patient safety’ to name, blame and shame the nurses for their action and to falsely attribute the ‘everyday’ deficits and failings of the health care system to the industrial action being taken.”6 In response to the 2022-23 national nursing and ambulance worker strikes in the UK, health secretary Steve Barclay accused unions of …

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