The British Medical Association has accused NHS chiefs of bowing to political pressure in a patient safety row over striking junior doctors being called back to work.
The doctors’ union criticised NHS England, saying the process by which medics may be called back to the frontline in “extreme circumstances” risked total collapse because of a failure by health bosses to follow it.
NHS England hit back on Thursday evening, defending local hospital chiefs and saying they were only making genuine requests for help in order to protect patients. It called the BMA’s attack “regrettable” and accused the union of calling into question the “integrity” of local clinical leaders – some of whom it said were likely to be BMA members.
Rishi Sunak also waded into the row on Thursday, giving his backing to the requests. “It is right the NHS does absolutely everything it can to ensure patient care,” he said. “These strikes are disrupting people’s lives and causing an enormous amount of concern.”
The clash came as a senior doctor warned on Thursday that patients will experience “degrading” care and “significant harm” on the NHS for several weeks, amid a “perfect storm” of strike action, winter viruses and dangerously overcrowded hospitals.
The 144-hour stoppage – due to end at 7am on 9 January – is the ninth time junior doctors have stopped working since last March and the longest strike to hit the health service since it was founded in 1948.
The BMA and NHS England have a long-held agreement for derogations, in which junior doctors return to work when there are safety concerns about emergency care. Under the deal, hospitals are supposed to show they have “exhausted” all other sources of staff before recalling striking medics.
The BMA said this had always worked well in previous stoppages. But during the current strike some trusts had refused to provide evidence that they had undertaken these steps, it said.
“This refusal to provide the information necessary to take well informed decisions is fundamentally undermining the derogation process as we are being asked to take decisions about our members’ right to strike without the requisite information,” said BMA chair, Prof Philip Banfield, in a letter to NHS England chief, Amanda Pritchard.
He said: “NHS England, it seems, is wilfully placing the BMA in an impossible situation.
“A number of local negotiating committee leaders have told us that their employers decided to apply for a derogation well in advance of strike action and before alternative solutions could be pursued. In addition, consultants on the frontline in several of the departments we have received requests from, have expressed surprise that a derogation request has been submitted, telling us they are staffed safely.
“We are increasingly drawing the conclusion that NHS England’s change in attitude towards the process is not due to concerns around patient safety but due to political pressure to maintain a higher level of service, undermine our strike action and push the BMA into refusing an increasing number of requests – requests, we believe, would not have been put to us during previous rounds of strike action.”
The Guardian understands about 25 derogation requests had been submitted by NHS chiefs to the British Medical Association by Thursday afternoon, calling on doctors to return to work. Almost all of the requests were rejected, with some still being considered by the union.
Several trusts have declared critical incidents during the strike, and others reported “extreme heightened pressure” and being “exceptionally busy”. One cited A&E waits of “up to 11 hours”.
An NHS England spokesperson said: “The NHS has a robust process in place for seeking derogations from the BMA to prioritise the safety of our patients and this has involved providing strong evidence where the most challenged systems need support.
“Nationally, we will continue to support local medical directors and other clinicians as they work hard to deliver the safest possible services for patients.”
Meanwhile, Dr Tim Cooksley, immediate past president of the Society for Acute Medicine, warned NHS patients would suffer “significant harm and trauma” for several weeks as the health service faces a “perfect storm” of pressure.
Patients would be subject to degrading corridor care and those in ambulances could face long waits outside hospitals, he added. Cooksley also said patients would face “significant harm and trauma due to delayed ambulance responses”.
The dire situation on top of the long-term workforce crisis had brought the health service in England to the brink of collapse, he added, but it “will take at least a decade to return to the delivery of high quality acute care”.
On Thursday night Victoria Atkins, the health secretary, said the NHS “doesn’t just belong” to the BMA’s junior doctors’ committee and that the health service “cannot be switched on and off on whim”.
She said the walkouts were having “very serious consequences” for patients and other NHS workers, and promised to start talks in 20 minutes if the strikes were called off.
