So here we go again – another junior doctors’ strike in England. But where is the noise and the fury?
We have been through this recently. On 13 March, almost all of our junior doctors went on strike for three days and nights. Junior doctors are all those below consultant grade, usually with several in each hospital ward. The consequence of that strike was that all consultants were forced to cancel all elective [planned] work – outpatient clinics, operations, investigations – so we could muck in to keep inpatient and emergency care safely staffed.
The most notable thing about the first strike to me was how few people I spoke to realised it was even happening. There was very little media coverage as Gary Lineker provided a convenient distraction, and many of my non-medical friends hadn’t noticed these strikes in among all the other industrial action.
My inpatients were almost universally surprised when I said goodbye on the Wednesday afternoon as most had not twigged that having a consultant providing every aspect of their care was unusual. Our emergency department was actually busier than usual; there was nothing to suggest that people were staying away in the way that they did during Covid, for example.
We did well for the most part. There were enough consultants to make sure inpatients were well looked after and the hospital ran pretty much as usual. The damage caused by cancelling routine care will only become clear over time.
I found myself enjoying getting stuck in again to the practical stuff. Spending all day on the ward meant I got to know my patients and their relatives better than I usually do by flitting in to do a ward round, then running off to clinic in the afternoon.
This will not be the case this week when the junior doctors again walk out. The timing of this strike has been calculated to cause maximum impact and I suspect it will succeed. So what is different this time?
We will have a 96-hour walkout, immediately after the four-day Easter weekend, which then runs into the next weekend. This will leave a total of nine days without the usual levels of staffing. The NHS has never been able to maintain anything like normal service at the weekends and, in our hospitals that routinely run at over 100% bed occupancy, even these two-day slow-downs are enough to cause regular bed crises and full emergency departments.
Not only this, but more inpatients are known to die during the weekends than during the week. There are fewer staff to respond to emergencies, as patients are seen less frequently and problems are detected late; many important services such as scans, endoscopies and specialist opinions are not available during the weekend; and usual social care stops, meaning patients cannot be discharged and hospitals fill up. Our service is currently built on a rapid resumption of usual service following these periods just to stop people dying and to make space for new admissions.
This time around, however, we will have at best a skeleton service on the wards during the strike. The Easter holidays are when many consultants, especially those with children, take their annual leave. In our hospital, as in most others, we have just over half of our medical consultants available to work as compared with almost all who were available for the last strike. From Tuesday onwards we will mostly have only one consultant, working alone, on wards usually staffed by a team of three- to four minimum.
These individuals will be hard pressed just to keep the sicker patients safe, let alone manage the routine work such as arranging discharges to allow for the new admissions. Many of the usual “admission avoidance” mechanisms – emergency clinics, procedure lists, outpatient treatment units – will not be staffed, exacerbating the problem. The system will have clogged up over the long weekend and emergency departments will be full. Consultants will arrive at the start of the strike on Tuesday to overflowing hospitals that are already unsafe with no ability to reset the situation. It is hard to overstate how dangerous this week is likely to be.
What I cannot understand is why nobody is shouting more about this. To my knowledge, no trusts have broken rank to acknowledge the risk that patient safety will not be maintained and that there will inevitably be harm caused. If you are unlucky enough to fall ill during this time, you may not be able to access safe healthcare. I have been told that communications from hospitals have to follow the NHS party line that hospital care will be maintained, but given the general lack of awareness and publicity about these strikes I feel we have a duty to outline what people should expect.
I also feel that the government and the British Medical Association have to acknowledge that some people will die as a direct result. We don’t know who, or where, and we may never be certain, but it will happen. That is in contrast to the first strike, which achieved its stated aim; almost all elective care was stood down. Cancer diagnoses were delayed, long-awaited operations cancelled, waiting lists lengthened, all of which will, of course, happen again. What that strike did not do, however, was directly threaten the safety of the most vulnerable patients, people so sick they require hospital care.
There is clearly a balance to be struck. Without doubt, the situation for junior doctors is bad enough that there is an existential threat to healthcare and the NHS as they leave or reduce their working hours. I have not yet spoken to a consultant who does not support them taking industrial action, even where patient care is affected, and I certainly do. However, the danger inherent in the timing and duration of the walkout is such that I see cracks beginning to appear in this support. There is a feeling among some that calling such a devastating strike may be too much to stomach.
And yet the government must ultimately hold the responsibility here. Without the steady erosion of services and working conditions over many years we would not have been led to this point. Their intransigence in reopening talks with the BMA and the duplicitous handling of information has been shameful, and has caused the current escalation. Even now I can’t see any real efforts being made to try to avert further action.
Presumably their expectation is that with so much other industrial action ongoing this will continue to evade people’s attention. But this is different; people do not generally die with transport or teacher strikes, damaging though they are. Perhaps they are hoping that any excess deaths will be swallowed up in the expected Easter mortality spike and that the thousands of patients having their care cancelled will barely register against the millions already on our waiting lists.
Surely we cannot allow this to happen. Without more awareness and more noise, the only way to force change will be further strikes and further harm. It is time to act now.
