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I read with a deep sense of sadness and anxiety your news item on the continuing strike by junior doctors (1). The NHS was established in 1948 with the noble aim of relieving money worries at the time of illness (2). Our beloved NHS is renowned for its high standards of care and commitment to patient well-being. A unique service which delivers care, free at the point of delivery and in the eyes of the NHS all are equals, be it the prince or the pauper, all receiving the same level and quality of care. In its 75th year the NHS is facing one of its gravest challenges in the form of industrial action by doctors. Although every trade union has the right and moral duty to get the best possible rewards for its membership, industrial action can cause its own adverse impact. When doctors take industrial action there is potential for impact on patients and the healthcare system as a whole.
Some of the potential impact of industrial action by health professionals include reduced access to health care, increased strain on remaining healthcare staff, disruption to elective care and knock on effects on the waiting lists, dent in the public confidence in the NHS and strained doctor patient relationships. A recent study (3) assessing the impact of doctors’ strike in the NHS found that “there was larger reductions in elective volumes, but did not affect volumes, average mortality, or readmission rates for emergency patients. However, greater exposure to the strike did lead to higher readmission rates for black emergency patients” (4). It is very likely that as the risk is greatest in patients needing emergency care all available resources were directed here as the NHS is doing in the current phase of industrial action (5) and hence the emergency care outcomes were maintained. This study findings indicate that there is potential for widening health inequalities as the readmission rates went up in certain groups who are already disadvantaged.
According to the NHS “Industrial action has impacted approximately 600,000 hospital appointments across the NHS with over 365,000 staff absences due to industrial action during this time” (5). Following the industrial action by nurses the deputy chief nursing officer stated (6) “across the NHS we have now seen more than half a million appointments and procedures rescheduled over the last six months as a result of strikes from staff in a range of NHS roles – and with each strike, it is becoming harder”. Junior doctors make up around half of all doctors in the NHS. One can only hypothesise the anxiety among patients when this expert workforce stops providing care.
During a strike by one group of health care professionals the remaining healthcare staff are burdened with additional responsibilities. This increased workload can lead to burnout and has the potential to compromise quality of care. Strikes can disrupt the continuity of care for patients with ongoing treatment plans. Doctors' strikes however valid can erode public confidence in the healthcare system. The strikes can strain the doctor-patient relationship, which is based on trust, open communication, and continuity of care.
Across the Atlantic something of a preamble to the NHS’s obituary has already appeared (7) which is very painful to read, and the current dispute only adds to the sceptical view that the NHS is unlikely to survive. Both the government and the profession have a duty to protect patients, and everything must be done to the end the acrimony and find an amicable solution in the interest of our patients, the public and our dear NHS.
Dr Padmanabhan Badrinath, Freelance Consultant in Public Health Medicine, Colchester, UK badrishanthi@hotmail.com
Conflict of interest: The author is a member of the British Medical Association and is a supporter of the unions’ right to take industrial action with the parameters of the law.
Disclaimer: The views expressed here are the professional views of the author and in no way represent the views of any organisation the author has been associated with at present or in the past.
Competing interests:
The author is a member of the British Medical Association and is a supporter of the unions’ right to take industrial action with the framework of the law.
Doctors strike - Let us end the acrimony and sense and (patient) safety prevail
Dear Editor
I read with a deep sense of sadness and anxiety your news item on the continuing strike by junior doctors (1). The NHS was established in 1948 with the noble aim of relieving money worries at the time of illness (2). Our beloved NHS is renowned for its high standards of care and commitment to patient well-being. A unique service which delivers care, free at the point of delivery and in the eyes of the NHS all are equals, be it the prince or the pauper, all receiving the same level and quality of care. In its 75th year the NHS is facing one of its gravest challenges in the form of industrial action by doctors. Although every trade union has the right and moral duty to get the best possible rewards for its membership, industrial action can cause its own adverse impact. When doctors take industrial action there is potential for impact on patients and the healthcare system as a whole.
Some of the potential impact of industrial action by health professionals include reduced access to health care, increased strain on remaining healthcare staff, disruption to elective care and knock on effects on the waiting lists, dent in the public confidence in the NHS and strained doctor patient relationships. A recent study (3) assessing the impact of doctors’ strike in the NHS found that “there was larger reductions in elective volumes, but did not affect volumes, average mortality, or readmission rates for emergency patients. However, greater exposure to the strike did lead to higher readmission rates for black emergency patients” (4). It is very likely that as the risk is greatest in patients needing emergency care all available resources were directed here as the NHS is doing in the current phase of industrial action (5) and hence the emergency care outcomes were maintained. This study findings indicate that there is potential for widening health inequalities as the readmission rates went up in certain groups who are already disadvantaged.
According to the NHS “Industrial action has impacted approximately 600,000 hospital appointments across the NHS with over 365,000 staff absences due to industrial action during this time” (5). Following the industrial action by nurses the deputy chief nursing officer stated (6) “across the NHS we have now seen more than half a million appointments and procedures rescheduled over the last six months as a result of strikes from staff in a range of NHS roles – and with each strike, it is becoming harder”. Junior doctors make up around half of all doctors in the NHS. One can only hypothesise the anxiety among patients when this expert workforce stops providing care.
During a strike by one group of health care professionals the remaining healthcare staff are burdened with additional responsibilities. This increased workload can lead to burnout and has the potential to compromise quality of care. Strikes can disrupt the continuity of care for patients with ongoing treatment plans. Doctors' strikes however valid can erode public confidence in the healthcare system. The strikes can strain the doctor-patient relationship, which is based on trust, open communication, and continuity of care.
Across the Atlantic something of a preamble to the NHS’s obituary has already appeared (7) which is very painful to read, and the current dispute only adds to the sceptical view that the NHS is unlikely to survive. Both the government and the profession have a duty to protect patients, and everything must be done to the end the acrimony and find an amicable solution in the interest of our patients, the public and our dear NHS.
Dr Padmanabhan Badrinath, Freelance Consultant in Public Health Medicine, Colchester, UK
badrishanthi@hotmail.com
Conflict of interest: The author is a member of the British Medical Association and is a supporter of the unions’ right to take industrial action with the parameters of the law.
Disclaimer: The views expressed here are the professional views of the author and in no way represent the views of any organisation the author has been associated with at present or in the past.
References
1. Iacobucci G. Strikes are set to continue after government’s “final offer” of 6% pay rise, says BMA BMJ 2023; 382 :p1624 doi:10.1136/bmj.p1624.
2. Nicholson K. 75-Year-Old Pamphlet Reveals What The NHS Originally Promised To Brits. Internet. https://www.huffingtonpost.co.uk/entry/nhs-75-promise-pamphlet-brits_uk_... accessed 14 July 2023.
3. Stoye G, Warner M. The effects of doctor strikes on patient outcomes: Evidence from the English NHS. Journal of Economic Behavior & Organization 2023; 212: 689-707. Full text available at https://www.sciencedirect.com/science/article/pii/S0167268123002184 accessed 14 July 2023.
4. Institute of Fiscal Studies. Journal of Economic Behavior and Organization. The effect of doctor strikes on patient outcomes: Evidence from the English NHS. Internet. https://ifs.org.uk/journals/effect-doctor-strikes-patient-outcomes-evide... accessed 14 July 2023.
5. NHS England. Information for the public on industrial action. Internet https://www.england.nhs.uk/long-read/information-for-the-public-on-indus... accessed 14 July 2023.
6. NHS England. NHS publishes data following nurses strike. Internet. https://www.england.nhs.uk/2023/05/nhs-publishes-data-following-nurses-s... accessed 14 July 2023.
7. Hunter DJ. At Breaking Point or Already Broken? The National Health Service in the United Kingdom. New England Journal of Medicine July 13, 2023 389(2):100. https://www.nejm.org/doi/full/10.1056/NEJMp2301257 accessed on 14 July 2023.
Competing interests: The author is a member of the British Medical Association and is a supporter of the unions’ right to take industrial action with the framework of the law.