Thousands of junior doctors in England will begin an unprecedented four days of strike action on Tuesday, forcing an estimated 350,000 appointments and operations to be cancelled as the NHS focuses on urgent and critical care.
Around the country, hospital trusts are scrambling to fill gaps in rotas, deploying consultants, nurses and other health professionals to maintain services. But thousands of patients have already had planned treatment cancelled, swelling waiting lists that were already at record levels.
Dr Layla McCay, director of policy at the NHS Confederation which represents health organisations in England, Wales and Northern Ireland, said health leaders had been doing all they could “to plan for what will be the most significant set of strikes the NHS has seen in the last decade”.
However, many aspects of patient care, including emergency care would be “hugely impacted and NHS leaders are very concerned that they will not be able to provide safe services to patients”, she said.
Matthew Taylor, chief executive of the NHS Confederation, said separately that it was “depressing” the two sides did not seem to have moved any closer together and suggested mediation.
“We should consider asking the government and the trade unions to call in Acas, the conciliation service, to provide some basis for negotiations, because, if anything, the positions seem to have hardened over the last couple of days,” he told the BBC.
The British Medical Association, the main doctor’s union, said it had asked Acas in December “if they could play a role in bringing the government to the table”. It hit out at preconditions for negotiations it said had been set by Steve Barclay, health secretary, which it said were “the obstacle to Acas-organised talks as they have been throughout this dispute”.
On Tuesday, Barclay said he had hoped to begin formal pay negotiations with the BMA last month but criticised its “unreasonable” demand for a 35 per cent pay rise for junior doctors that they say is needed to compensate for 15 years of pay erosion.
If the BMA was “willing to move significantly from this position and cancel strikes, we can resume confidential talks and find a way forward, as we have done with other unions”, he added.
Responding to Barclay’s comments, Dr Vivek Trivedi, the BMA’s junior doctors committee co-chair, said: “We were knocking on the health secretary’s door, asking to meet with him to negotiate a settlement to this dispute, long before the current strike got underway. We have been in a formal dispute since October. He refused to respond and meet us until we had a strike ballot result. He has had months to put a credible offer on the table and avert industrial action so for him to say ‘it’s disappointing’ is at best disingenuous.
“We would still be willing to suspend strike action this week if the secretary of state makes a credible offer that can be the basis of negotiation,” he added.
Daghni Rajasingam, deputy medical director at Guy’s and St Thomas’s NHS Foundation Trust in London, which includes the Royal Brompton and Harefield hospitals that specialise in heart and lung conditions, said some consultants had voluntarily deferred annual leave. She said they would work with non-striking juniors, nurses and other health professionals to run a “fairly lean” rota focused on urgent and emergency care.
However, she estimated that around 10,000 outpatient appointments and between 800 and 1,000 admissions for surgery or other procedures would have to be postponed across the trust.
While urgent operations, such as those for cancer, would go ahead, “slightly less [urgent] care” was being cancelled on a case-by-case basis, Rajasingam said.
She added: “Given the situation, we have had to prioritise patients as best as we can. But it would be remiss of me to say that we are not worried, as clinicians.” By delaying care for some people, “we’re potentially not optimising their health outcomes.”
Adrian Boyle, president of the Royal College of Emergency Medicine, said during the first junior doctors’ strike in March, “the consultants rolled up their sleeves and managed to provide a service”, defying fears that emergency departments, urgent treatment centres and minor-injuries units might have to close.
He said the real concern was “the hangover after industrial action”. It would be harder to discharge patients during the stoppage, so hospitals would end up fuller, with more beds occupied, in turn creating pressure on emergency departments and leading to ambulance handover delays.
Boyle said: “We tend to cope well during the actual ‘hot’ event, but it’s the pent-up demand and the delayed and diluted care afterwards which is not as obvious but it’s no less dangerous.”