Doctors’ strikes can have surprising benefits – but are they sustainable?

Doctors’ strikes can have surprising benefits – but are they sustainable?

During the December 2023 strike in England, one hospital administrator shared a perspective that highlighted a surprising outcome: “We sighed with relief – strikes act like a firebreak.” This comment reflects a broader sentiment among NHS trust leaders who have observed that the system sometimes runs more efficiently during walkouts, with some reporting smoother operations compared to regular days. Despite initial fears of disruption, the strike period saw notable improvements, including shorter wait times and quicker decisions, according to those who spoke to BBC News.

Impact of Reduced Staffing

The absence of around 25,000 doctors during the five-day walkout, organized by the British Medical Association (BMA), was initially seen as a setback. However, in at least one hospital, the situation proved beneficial. With flu cases on the decline, the trust’s chief executive described the strike as a “gift,” noting that lower bed occupancy before Christmas helped streamline patient flow. “Decisions are made faster when consultants are at the front door, and admissions drop,” they explained.

“The enhanced presence of consultant colleagues in A&E, with their additional experience, can mean quicker, less risk-averse decision-making, which is good for patients.” – Dr Layla McCay, NHS Alliance

Researchers at King’s College Hospital found that during the 2023 strikes, patients were processed more rapidly, even with fewer staff. Discharges occurred swiftly, and there was no increase in deaths or readmissions. Similar trends were noted at the Royal Berkshire Hospital, where the four-hour A&E target was met in 82% of cases during the strike, compared to 73% the prior week. While other factors may contribute, the timing of the strike aligned with these positive outcomes.

Sustainability Concerns

Despite these benefits, experts caution that the strike’s success relied on temporary fixes. Dr Damian Roland from the University of Leicester explained that when consultants assume front-line roles, decision-making becomes more direct. “The more doctors involved in a patient pathway, the longer everything takes,” he noted. This dynamic, however, highlights a critical issue: the need for ongoing training of resident doctors to sustain the consultant workforce of the future.

“When the consultants of today retire, we have no one to replace them as [trainee doctors] have left due to inadequate pay and conditions, and a lack of jobs.” – Dr Jack Fletcher, BMA

Some hospitals are now experimenting with new strategies on non-strike days. For instance, cardiology consultants are stationed at the front door each Friday at one trust, inspired by the efficiency seen during industrial action. “Junior doctors are more cautious,” said Nick Hulme, former chief executive of East Suffolk and North Essex NHS Foundation Trust. “After observing the impact of the strikes, we realized this was a smart way to reduce weekend admissions.”