The junior doctors’ strikes in England two years ago had a ‘significant impact’ on patients – with thousands of appointments cancelled, a study shows.
The worst effects were when emergency care was withdrawn during the last periods of industrial action – the first time this had ever happened in the history of the NHS.
There were over nine percent (31,651) fewer admissions and nearly seven percent (23,895) less A&E attendances compared to the weeks before and after.
The number of expected outpatient appointments also fell by six percent (173,462), according to the findings published in BMJ Open.
Junior doctor strikes in England two years ago had a ‘significant impact’ on patients – with thousands of appointments cancelled, a study shows
There was no obvious change in the mortality rate – but this does not mean it did not cost lives.
Deaths caused by poor care aren’t likely to show up immediately – nor is it clear whether patient health might have worsened as a result of delayed appointments and procedures.
But these issues – along with the financial impact – might be ‘fertile avenues’ to explore in future research, said the researchers.
‘The major outcome we investigated was mortality’
Dr Paul Aylin, of Imperial College London, said: ‘The four junior doctors’ strikes between January and April 2016 resulted in significant negative impacts on patient care as measured by hospital activity.
‘Significant increases in outpatient appointment cancellations by hospitals were paired with decreases in admitted patients and A&E visits.
‘The major outcome we investigated was mortality, which showed no measurable change.
‘However, this is likely to be the least sensitive outcome for quality and safety concerns.’
Junior doctors across the NHS took unprecedented industrial action in 2016 in opposition to the Government’s decision to impose a contract reclassifying weekends and evenings as core hours.
The contract significantly cut the evening and weekend hours that qualified for unsociable hours payments despite the study used to justify the Government’s changes being contested.
In the first four months of the year young medics from all specialties staged four strikes. There had been only one other strike in the previous 40 years – in 2012.
Each lasted 24-48 hours: on January 12, February 10, March 9-10 and April 26-27. The latter was the only one where emergency care was withdrawn.
Deaths caused by poor care aren’t likely to show up immediately – nor is it clear whether patient health might have worsened as a result of delayed appointments and procedures
The study by Dr Aylin and colleagues is the first of its kind into the effects. They said gaps in routine care offer an opportunity to assess the effectiveness of current systems – and pinpoint weaknesses in response to staff shortages.
So they compared hospital activity the week of each of the strikes with that from the preceding and following weeks – focusing on numbers of admissions, outpatient appointments and A&E attendances.
Fewer appointments, less care
During the 12 weeks of the study there were 3.4 million admissions, 27 million outpatient appointments and 3.4 million A&E attendances.
April’s strike had the largest impact on services with over 15 percent (18,194) fewer admissions.
This included nearly 8 per cent (3,383) fewer emergency admissions and almost 20 per cent fewer planned admissions.
Hospitals scheduled 11 percent (109,915) fewer outpatient appointments during this strike – while patients kept 134,711 (just over 17 per cent) fewer of them.
The number of outpatient appointments cancelled by hospitals also rose by almost 67 percent (43,823).
During all four strikes hospitals cancelled nearly 300,000 outpatient appointments – 52 percent more than expected for this period – possibly to protect more critical services, said the researchers.
Certain regions seemed to be disproportionately affected. The proportion of cancelled appointments increased to between 66 and 68 percent in Yorkshire and the Humber, South East Coast, and London.
These regions also had the largest proportions of missed appointments. The impact on emergency admissions was greatest in the South West and the West Midlands.
‘Significant impact on the provision of healthcare’
The researchers didn’t assess the impact of the strikes on patients who didn’t attend A&E, or the potential impact on the so-called ‘weekend effect,’ or how patients felt about their delayed care.
But Dr Aylin said: ‘Industrial action by junior doctors during early 2016 caused a significant impact on the provision of healthcare provided by English hospitals.’
He added: ‘This is the first UK study that looked at the effects of striking junior doctors, as well as the first to evaluate the impact of withheld in-hospital emergency services.’
The findings may also suggest NHS Trusts responded effectively to the industrial action by cancelling outpatient appointments to protect higher risk services.
Dr Aylin said: ‘Future work in this area should focus on how the strikes affected waiting times and similar quality outcomes.
‘Strike-related morbidity (such as disease progression in the time between rescheduled operations/appointments) would likely be a fertile avenue for investigation.
‘Delays will also be likely to have an associated cost burden in terms of worse patient outcomes and hence costlier treatment, which should be accounted for.
‘Finally, it should be determined whether quality of care was negatively impacted in the period immediately following the strikes.’