Doctors’ strikes can have surprising benefits – but are they sustainable?
Doctors’ Strikes Can Have Surprising Benefits – But Are They Sustainable?
When news of the December 2023 walkout by resident doctors in England broke, one hospital administrator described the relief felt as “like a firebreak.” Now that the strike has concluded, NHS trust leaders reflecting on the event suggest the healthcare system operated more efficiently during the disruption, with some reporting smoother operations than on regular days. Previous strikes, they note, often led to unexpected outcomes—shorter patient wait times, quicker decisions, and calmer environments in corridors.
Despite these positive effects, the improvements relied on temporary fixes that come with financial implications. According to NHS England, around 25,000 doctors were absent each day during the strike, reducing staffing levels significantly. The five-day walkout, orchestrated by the British Medical Association (BMA), was criticized by ministers as “irresponsible and dangerous.” Yet, within at least one hospital, the situation unfolded differently. A trust chief executive, citing eased flu activity, remarked to the BBC: “Lower bed occupancy before Christmas was a gift.” This reduction in patient numbers, they argued, allowed for faster processing and improved flow through emergency departments.
“We have heard, anecdotally, that the presence of consultant colleagues in A&E leads to quicker, less risk-averse decision-making, which benefits patients,” said Dr Layla McCay of the NHS Alliance. However, she emphasized that such a strategy is not a long-term solution, as it creates ripple effects across the system.
On non-strike days, emergency departments are typically staffed by early-career doctors in training, who often follow more conservative protocols. Dr Damian Roland from the University of Leicester explained that each additional step in the decision-making process delays patient care. During strikes, consultants assume front-line roles, streamlining operations. “The more doctors involved in a patient’s pathway, the longer everything takes,” Roland noted.
King’s College Hospital highlighted this dynamic during its first junior doctor strikes in 2023. Researchers observed that patients were seen, treated, and discharged more quickly on strike days, even with fewer staff. Importantly, there was no increase in deaths or readmissions. Similar trends emerged at the Royal Berkshire Hospital, where the four-hour A&E target was achieved in 82% of cases during the strike, compared to 73% the prior week.
While other factors might influence efficiency, the data aligns with the impact of the strike. Dr Jack Fletcher of the BMA warned that the aging consultant workforce faces a challenge. “When today’s consultants retire, we’ll have no one to replace them,” he said, pointing to trainee doctors leaving due to poor pay, working conditions, and job shortages.
Hospitals are now experimenting with new strategies inspired by the strike. At one trust, cardiology consultants are stationed at the emergency department entrance every Friday. Nick Hulme, former chief executive of East Suffolk and North Essex NHS Foundation Trust, shared that this approach helped reduce weekend admissions. “Junior doctors are more cautious, but cardiologists rarely admit patients with chest pain,” he explained. The move, he added, was a direct response to lessons learned during industrial action.
Patient experiences also reflected these changes. One visitor called the strike-day visit “a blessing,” while a mother noted her son received the fastest asthma treatment he’d ever had, thanks to an experienced consultant. NHS England confirmed that thousands of patients were safely discharged ahead of Christmas, despite the strike. Yet, the question remains: can these efficiencies be maintained without compromising the training of future doctors?