At any other moment in the 74-year history of the NHS, thousands of nurses staging their first ever strike would represent the single biggest threat to patient care.
Last Thursday’s stoppage by nurses resulted in the cancellation of 16,000 appointments, procedures and surgeries in England, with more set to be postponed this Tuesday.
These are unprecedented times, however, and this week striking nurses will not pose the biggest problem. Nine ambulance trusts in England and Wales are expected to be affected by industrial action on Wednesday, coordinated by the GMB, Unison and Unite unions.
The ambulance strikes will involve paramedics as well as control-room staff and support workers. The threat to patient safety on Wednesday will be exceptional.
Under trade union laws, life-preserving care must be provided during the strikes. But there remains a lack of clarity about what will be offered. Even at this late stage, NHS leaders say negotiations are continuing between unions and ambulance services to agree which incidents will be exempt from strike action.
All category 1 calls – the most life-threatening cases – will be responded to, while some ambulance trusts have agreed exemptions with unions for specific incidents within category 2 calls.
However, in some cases, elderly people who fall during the strikes may not be sent help until they have spent several hours on the floor. Heart attack and stroke patients may get an ambulance only if treatment is deemed “time critical”.
There is no doubt that many of those patients making 999 calls on Wednesday will not get the care they need. Some will probably die as a result.
The government says anyone in an emergency should still call 999, with military personnel due to be drafted in to cover, but such is the complex nature of urgent and emergency care that there will be no substitute for the ambulance workers.
NHS leaders believe Wednesday’s strike will present a completely different magnitude of risk. Quite simply, patients not getting emergency treatment quickly enough can mean the difference between life and death.
Some hospitals are braced for many more patients to turn up at emergency departments in taxis, which will add to the chaos. Even if ambulances cannot quickly drop off patients, they can liaise with hospital staff before arriving so emergency departments know what is coming.
But a surge in seriously ill patients arriving in taxis or private vehicles will leave hospital staff with less time to prepare or make plans to triage patients.
Hospitals have been ordered to put measures in place for Wednesday to ensure ambulance patient handovers are kept to no more than 15 minutes, in order to maximise capacity across urgent and emergency care.
However, NHS data from last Thursday showed ambulance handover delays at hospitals in England already at a new high, a week before the ambulance strike, with one in six patients waiting more than an hour to be passed to emergency department teams. One in three waited at least 30 minutes.
Ambulance crews could not respond to almost one in four 999 calls in October – the most ever – because so many were tied up outside A&Es waiting to hand patients over.
An estimated 5,000 patients in England – also the highest number on record – potentially suffered “severe harm” by waiting so long either to be admitted to A&E or just to get an ambulance to turn up to help them.
The alarming data underlines what many in the NHS have been saying for months. Strike action will probably be lethal this week, and beyond, but parts of the system have been broken for some time.
Paramedics are striking because they are being asked to do more and more, to extreme and unsafe levels, and for less and less. Patient safety is already being put at risk, they add, because of the government’s failure to retain and recruit staff over many years.
Immediate action is needed from ministers to fix the health service, and first on the agenda must be a workforce plan that ensures more staff are retained and recruited. Without action, more staff will quit, fewer will be left on the frontline, strikes will continue – and patient harm will become a daily reality.
