Critically ill patients “will inevitably die” because hospitals are having to cancel surgery as a direct result of next week’s junior doctors’ strike in England, leading heart experts have warned.
There were bound to be fatalities among people with serious heart problems whose precarious health meant they were “a ticking timebomb” and needed surgery as soon as possible, they said.
They added that patients would face an even greater risk than usual of being harmed or dying if their time-sensitive operation was delayed because NHS heart units would have too few medics available during the four-day stoppage by junior doctors to run normal operating lists.
The trio of cardiac experts are senior doctors at the Royal Brompton and Harefield specialist heart and lung hospitals in London. Those facilities, plus the cardiac unit at St Thomas’ hospital in the capital, have between them postponed between 30 and 40 operations they were due to conduct next week on “P2” patients, whose fragile health means they need surgery within 28 days.
“One of our trust’s core values is to put patients first and so I feel it is only right to warn that some patients will inevitably die due to the cumulative impact of delaying hundreds who are on the waiting list,” said Dr Richard Grocott-Mason, a cardiologist who is also the chief executive of the Royal Brompton and Harefield hospitals.
Those cancellations would mean that many of the 300 “P2” patients waiting for heart surgery at the three hospitals would have to wait even longer before they finally got it, he added. “P2s” are the NHS’s second-highest priority group of patients who need surgery of any sort, behind emergency cases who need it immediately as their life will otherwise be at risk.
“It is no exaggeration to say that delaying surgery for this group [P2s] will result in harm. For some, this may be life-changing. For others, it may mean premature death,” Grocott-Mason said.
Dr Mark Mason, a cardiologist who is the medical director for heart, lung and critical care at the Guy’s and St Thomas’ NHS trust that runs all three hospitals, said: “It’s a cliche but these [P2] patients really are sat on a ticking timebomb.”
The risk of them suffering a cardiac arrest rose the longer they had to wait for surgery, he added. “If they do, it’s then a question of how lucky they are to have a bystander perform CPR on them, and how quickly the ambulance gets to them. These patients are sat waiting for an unpredictable and potentially fatal cardiac event to happen.”
Last month’s first three-day strike by junior doctors in England over their demand for a 35% pay rise led to 175,000 outpatient appointments and operations being cancelled.
NHS bosses fear next week’s four-day stoppage, which starts at 7am on Tuesday 11 April, will force them to reschedule as many as 250,000 appointments.
Grocott-Mason, Mason and their colleague Mario Petrou, the Brompton and Harefield hospitals’ clinical director for cardiovascular services, decided to speak out to raise concerns – widely shared by senior doctors and NHS doctors – about patients with a range of serious health problems, including cancer, potentially coming to harm next week because their surgery is cancelled.
“We cannot, in all conscience, stand by and just let this happen without advocating for our current and future patients,” said Grocott-Mason, referring to his team’s cardiovascular patients.
Heart patients across the country will face the same risks, as most heart units are taking the same type of action and postponing operations listed for next week. “Sadly this [increased risk] is going to be true for patients needing planned heart surgery not just in London, but across England,” said Grocott-Mason.
The British Medical Association’s junior doctors committee decided not to offer any “derogations”, or exemptions, for any areas of life-or-death care next week, including A&E and intensive care and maternity services, in an attempt to ramp up pressure on the government.
The three surgeons urged the government and the BMA to hold talks to try to avert a strike, and asked the BMA to rethink its stance on derogations and instead allow junior doctors to keep working next week in critical care units and cardiovascular surgery.
Grocott-Mason said the BMA should follow the lead of the Royal College of Nursing, which exempted many areas of life-or-death care from the strikes it has held since December.
A BMA spokesperson said: “Ahead of the first round of industrial action NHS England worked with trusts across England to assess their readiness for the planned industrial action. In addition, a joint communication from NHS England’s medical director and Prof Philip Banfield, BMA chair of council, was shared with all trusts in England explaining the process to request a derogation.
“We met with NHS England four times per day during the strikes and not a single request was made over the course of three days of action. The same arrangements will exist this time and it will be up to NHS England to decide if they want to use them.”
