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A number of hospitals call on junior doctors to return to work

Junior doctors are staging the longest walkout in NHS history.

Ella Pickover
Wednesday 03 January 2024 21:05 GMT
Picket line outside St Thomasā€™ Hospital, London (Jonathan Brady/PA)
Picket line outside St Thomasā€™ Hospital, London (Jonathan Brady/PA) (PA Wire)

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A number of hospitals have called on striking junior doctors to return to work due to patient safety concerns, during the longest walkout in NHS history.

Services across England are facing ā€œsignificant demandā€ on the first day of a six-day walkout by junior doctors, health leaders have said.

Two hospitals have declared critical incidents while others reported significant waits in A&E departments ā€“ with one hospital saying patients may need to wait ā€œup to 11 hoursā€.

A number of hospitals have submitted so-called derogation requests, calling on doctors to return to work.

It is understood that just over 20 requests have been made by hospitals, but some may have submitted more than one request.

The British Medical Association (BMA) said that the derogation process was being ā€œunderminedā€ by the health service, with a number of the requests being submitted well in advance of the strike and a number of hospitals not illustrating what steps they have taken to mitigate the need for junior doctors to work.

All but one of the requests have been rejected, and the final one is being considered by the union.

The BMA said such requests should come as a ā€œlast resortā€ and only be used in ā€œunexpected and extreme circumstances unrelated to industrial actionā€.

In a letter to NHS boss Amanda Pritchard, BMA chairman of council Professor Philip Banfield said: ā€œIt is, therefore, astonishing that during this current round of industrial action, NHS England and some Trusts have refused to evidence any efforts to source alternative staffing or demonstrate rearrangements or cancellation of less urgent work.ā€

He added: ā€œWe are increasingly drawing the conclusion that NHS Englandā€™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.

ā€œThe change in approach also appears to be politicisation and weaponisation of a safety critical process to justify the minimum service level regulations.ā€

An NHS spokesperson said: ā€œThe 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.ā€

It comes as:

ā€“ Queen Alexandra Hospital in Portsmouth said its A&E department was ā€œfullā€ as it declared a critical incident.

ā€“ A critical incident was declared by NHS Nottingham and Nottinghamshire Integrated Care Board due to ā€œsignificant pressures on servicesā€.

ā€“ Bolton NHS Foundation Trust said it was facing ā€œextreme pressureā€ with waiting times in A&E of ā€œup to 11 hoursā€.

ā€“ Warwick Hospital warned that it is under ā€œextreme heightened pressureā€ while Airedale Hospital said its emergency department is ā€œexceptionally busyā€.

ā€“ Health officials in Wigan said emergency services were ā€œvery busyā€ and that doctors were seeing ā€œa lot of minor illnesses that could have been treated elsewhere such as a GP surgery or pharmacyā€.

ā€“ Leeds Teaching Hospitals warned that its hospitals are ā€œunder significant pressureā€.

ā€“ Health officials in East Sussex, South Tees, Gateshead, Greater Manchester, Berkshire, Rotherham and The Princess Alexandra Hospital in Harlow, Essex, have also reported being ā€œbusyā€.

But NHS officials said that people should still seek care when they need it.

This latest round of strike action will not only have an impact on this week but will have an ongoing effect on the weeks and months ahead

Professor Sir Stephen Powis

Professor Sir Stephen Powis, national medical director for the NHS in England, said the strike coincides with ā€œone of the busiest and most challenging weeks of the yearā€ as the NHS grapples with increased pressure from winter viruses and a rise in people coming forward who delayed seeking help over the holidays.

Sir Stephen said: ā€œAs the longest strike in the history of the NHS begins during one of the busiest and most challenging weeks of the year ā€“ the health service is experiencing the winter pressures of flu and Covid, combined with the huge disruption of industrial action.

ā€œWe know hospitals are already experiencing significant demand, with other NHS services also under immense pressure, and although staff are doing the very best for patients with extensive preparations in place, there is no denying the NHS has started the year in a very difficult position.

ā€œThis latest round of strike action will not only have an impact on this week but will have an ongoing effect on the weeks and months ahead as we struggle to recover services and cope with heavy demand.

ā€œOur message for patients remains the same, continue to come forward for care using 999 and A&E in life-threatening emergencies and 111 online for everything else.ā€

Dr Vin Diwakar, medical director for transformation at NHS England, told the PA news agency that officials had spent weeks doing ā€œintensive preparationā€ for the strike.

ā€œWe have been prioritising emergency care as we have done during previous industrial action,ā€ he said.

ā€œSo we have emphasised to the public that if they have got a life-threatening illness they should continue to call 999, if they are worried that they are unwell but it is not an emergency then to use 111 online or 111 or to make an appointment with your GP or use your community pharmacy.

ā€œItā€™s likely that the impact is not just going to be for the current period of industrial action, it is going to go on for several weeks afterwards.ā€

He said that the impact could go on for weeks due to lost doctor time, booking in rescheduled appointments and consultants catching up on their normal workload, which they were unable to do while covering for striking colleagues.

Health and Social Care Secretary Victoria Atkins said: ā€œJanuary is typically the busiest time of the year for the NHS and these strikes will have a serious impact on patients across the country.

ā€œI urge the BMA junior doctors committee to call off their strikes and come back to the negotiating table so we can find a fair and reasonable solution to end the strikes once and for all.ā€

Dr Vivek Trivedi, co-chairman of the BMAā€™s junior doctors committee, told the PA news agency: ā€œI hope they (the Government) come back to the table now, but from all of the signals they are sending it wonā€™t be until our strike action finishes. And I hope at that point we can come to a resolution.ā€

Chief executive of conciliation service Acas, Susan Clews, said: ā€œAcas remains in contact with all parties to the junior doctorsā€™ dispute.

ā€œThey are aware of the value that third-party assistance can bring, and that we have a team of experts who are well prepared and ready to help with the dispute.ā€

Of the 1,219,422 acute inpatient and outpatient appointment cancellations since the current period of strikes began, more than three-quarters (77%) have been on days where junior doctors have taken industrial action either by themselves or with other groups.

The BMA said junior doctorsā€™ pay has been cut by more than a quarter since 2008.

Last summer, the Government gave junior doctors in England an average rise of 8.8%, but medics said the increase was not enough and ramped up strike efforts.

Late last year the Government and junior doctors entered talks, but after five weeks of negotiations they broke down and more strikes were called.

Junior doctors from the Hospital Consultants and Specialists Association union will join colleagues on picket lines.

Consultants and speciality and associate specialist (SAS) doctors have agreed on a deal with the Government, which is being put to members.

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