Would an NHS strike be a risk to patient safety?

Previous studies have suggested healthcare worker strikes have little effect on rates of patient deaths, writes Rebecca Thomas

Junior doctor on picket line during previous strike of NHS staff (PA)

This week the Royal College of Nursing (RCN) and Unite union have launched ballots for their healthcare worker members over pursuing strike action after the government failed to meet requests for an above-inflation pay rise. Unite represents at least 100,000 NHS workers, while the RCN represents almost 500,000 nurses, midwives, healthcare assistants and nursing students throughout the UK. As the NHS faces the prospect of unprecedented strike action from healthcare workers, what would the impact be?

Should the RCN members vote to strike it would be the first action taken since 1988 by nurses in England – and comes after the profession took to the picket line in Northern Ireland in 2019. The government may also face threats of strike action from consultants and junior doctors, although the latter is more likely.

The issue is contentious, with some already suggesting possible risk to patient safety should the strikes occur during winter. On the other hand, there is the argument that strikes are valid as the level of staffing shortages in the NHS are a risk to patient safety.

Speaking with The Independent, Ken Spearpoint, a former consultant nurse and principal lecturer, said: “When we took strike action in ’88 we ensured that patient safety wasn’t impacted and [I] would expect the same approach this time.” He said there was a potential difference this time around because “the underlying staffing levels are lower”.

However, he added: “My concern is that with no action the situation will continue to deteriorate, particularly in primary care where things seem considerably worse than in secondary care. Whilst I work in higher education I wouldn’t hesitate to strike in favour of not only pay and conditions, most importantly for patient safety.”

The last time the NHS in England faced widespread strikes was the junior doctors’ strikes in 2016. A key feature of the strikes was the increased presence of senior doctors who were brought in to fill rotas.

Studies following the strike suggest that although healthcare services were disrupted, the strikes did not lead to significant increases in patient deaths. A study published in the British Medical Journal in 2018 said it found “no measurable” effect on mortality during the strikes. During the period, however, there were fewer A&E admissions and fewer A&E attendances.

In January 2022 a review of research into strike action in healthcare, by academics at the University of Greenwich, found: “While strikes should be planned carefully and while careful consideration should be given to patient wellbeing, this review provides similar evidence to what is often found in relation to mortality, that is, that strikes have a negligible impact on patient wellbeing.”

Although the academics said further research was needed to examine a wider range of outcomes for patients during strikes and to understand how patients use services.

Another study in April 2022, looking at strike action in Portugal between 2012 and 2018, suggested operations were “partially disrupted”, and found a “modest” increase in mortality for patients admitted during physician strikes and an increase in readmission rates. However, the study found a slight reduction in death rates for patients already in hospital during strikes.

In an article last month the Royal College of Nursing said any industrial action would follow a “life-preserving” care model.

This means care would have to be provided within “emergency interventions”, for services where life could be jeopardised or a permanent disability would occur, or where urgent diagnostic procedures would be required.

During the Northern Ireland strikes entire services, such as intensive care units, were exempt from striking, and a night staffing model was run where night staff agreed to cover daytime shifts.