New year, same industrial dispute. We were just three days into 2024 when junior doctors embarked on a six-day strike – the longest ever in the NHS.
The timing could not have been more challenging for trusts, already wrestling with seasonal pressures and staffing shortages. Turnout was high, reflecting the strength of feeling that remains among junior doctors. But the impact of this walkout, compounded by a surge in flu and Covid-19, has whipped up a perfect storm for the NHS. It is one that trusts will find increasingly hard to weather until both sides of the dispute – the government and the British Medical Association (BMA) – break through their impasse.
During this historic strike, as with all strikes, patient safety remained trusts' number one priority. But the escalated length and timing proved especially tough for trust leaders, who worked hard to safeguard emergency and critical care services for the most vulnerable patients.
The full extent of the disruption, demoralisation, and financial strain resulting from this walkout is yet to be fully realised.
Interim Chief Executive
Owing to their substantial worry over patient safety and having exhausted all other avenues, multiple trusts resorted to making derogation requests of the BMA. Two of these were granted, meaning many trusts had to face unprecedented challenges posed by this walkout without the flexibility they sought. Trust leaders' chief concerns at this time were around the potential disruption to urgent and emergency care, maternity services, and overnight staffing – critical components of the NHS' ability to provide high-quality, comprehensive care.
The full extent of the disruption, demoralisation, and financial strain resulting from this walkout is yet to be fully realised. This is true, too, of the impact on team dynamics, workforce cohesion, and staff discretionary effort – all of which are casualties of this prolonged industrial action. Patients have borne a heavy burden of this dispute, with 116,000 appointments across hospital, mental health, and community services pushed back due to the last strike alone. That's 1.4m appointments now rescheduled due to industrial action in the NHS since it started in December 2022.
Delayed care and treatment, however, only tell one part of the story: there is growing concern about the health and wellbeing of patients who opted to forego seeking care during the strike period. The ramifications of delayed or deferred medical attention could have far-reaching consequences for individuals and the NHS as a whole.
As of December 2023, industrial action has also cost the NHS around £2bn in lost income through delayed operations, scans, and procedures as well as the direct costs of providing cover for striking staff. The figure will have increased even more after the last two walkouts from junior doctors – a cost the NHS can ill afford when budgets are so stretched.
As the NHS grapples with the aftermath of this last strike, with no other walkouts in the diary – at time of writing – there is a resounding call for negotiations between the government and the BMA to resume without delay. The hard-won progress achieved in previous talks between the two parties must not be lost. The sustainability of the NHS and the wellbeing of its patients hinge on a collaborative effort to navigate these uncharted waters.
Trust leaders are hoping desperately that an agreement can be reached and that it paves the way for subsequent resolutions.
Interim Chief Executive
Soon we will learn the outcome of the consultants' and SAS doctors' votes on the pay offer made to them by the government. Trust leaders are hoping desperately that an agreement can be reached and that it paves the way for subsequent resolutions. Until then, ongoing strikes by junior doctors combined with winter pressures and the persisting threats of flu and Covid-19 will make the already-formidable challenges facing the NHS worse.
Over the near-70 full days of industrial action, trust leaders have prioritised patient safety, but the strains on essential services and the potential long term impact on patients and staff cannot be understated. To resolve this dispute, the government and the BMA – both of whom share the aim of safeguarding the future of the NHS and the wellbeing of its patients – must resume their pay talks in haste. The alternative will come at too high a cost.
This article was first published by The BMJ.
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