Doctors to be forced to work during strikes

Members of the British Medical Association (BMA) on the picket line outside University Hospital Bristol and Weston
Members of the British Medical Association (BMA) on the picket line outside University Hospital Bristol and Weston

Doctors would be forced to work during strikes under government plans to tackle the dangers caused by successive walkouts.

Ministers are proposing the introduction of “minimum service level” regulations, meaning that some medics and nurses would be compelled to work during industrial action if public safety was at risk of being compromised.

The plans come amid fears of widespread NHS chaos as a result of strikes this week.

Steve Barclay, the Health Secretary, said such measures were required in the face of “co-ordinated and calculated strike action” by junior and senior doctors.

Consultants will embark on a two-day strike on Tuesday. They will be joined on Wednesday by junior doctors – the first time both groups have held a strike on the same day – in what senior NHS leaders have described as a “nightmare” scenario.

Both groups will return to picket lines again on Oct 2-4, in strikes timed to coincide with the Tory party conference.

‘Relentless and escalating’ action

Writing for The Telegraph, Mr Barclay said: “My top priority throughout ongoing industrial action is to protect the life and health of patients” and warned of the dangers posed by the “relentless and escalating” action of the British Medical Association (BMA).

He added: “In the face of ongoing and escalating strike action, we will continue to take steps to protect patient safety and ensure the health service has the staff it needs to operate safely and effectively.”

Even during the most extreme strikes, hospitals are still supposed to offer basic emergency and urgent care in what is known as “Christmas Day” cover.

But there are concerns that too many gaps are left unfilled, with too much left to local agreements and patients being left to deteriorate.

A consultation, launched on Tuesday, considers extending anti-strike laws and introducing minimum service levels that would cover “time-critical hospital-based health services”, as well as emergency and urgent care.

Officials said this could cover hospital staff, including nurses and doctors, and would bring the UK into line with countries like France and Italy, whose services continue in times of industrial action.

Health service leaders said NHS patients were this week at “the highest level of risk in living memory”. They warned that cancer patients are increasingly seeing their treatment delayed by strikes, with some having appointments cancelled three times.

A Bill for minimum standards for passenger rail services, ambulance services and fire and rescue services was passed in July, to ensure essential services remain in place.

Initially, ministers discussed including doctors and nurses within its scope. But they decided against it, meaning the Strikes (Minimum Service Levels) Act does not cover most hospital services, which largely rely on a system of “derogations” – agreements between unions and NHS employers about which services will be protected.

As a result, any extension of legal powers to protect patients during doctors’ strikes is unlikely to take effect until the start of next year at the earliest.

During recent strikes, even when agreements have been made, some have broken down – with particular concern about cancer patients, who should have been prioritised for treatment.

Freedom of Information disclosures suggest that around 30,000 cancer patients have already had appointments and treatments delayed.

NHS leaders are deeply concerned about the safety risks ahead. One hospital trust, which intends to deploy volunteers to ensure that patients are able to get fed and hydrated, said it was the first time such measures had been taken.

On Monday, health service leaders raised concerns that the latest move could jeopardise any hope of an end to strikes.

Saffron Cordery, the deputy chief executive of NHS Providers, said the move “risks worsening industrial relations at a time when we need government and unions to get around the table and enter into talks to avert further escalation and disruption to patient care”.

She added: “We’re in uncharted territory. It’s all hands on deck in trusts across the country.”

‘Worst case scenario’

Health service leaders warned of growing “public frustration” over the strikes, with hospitals often unable to tell patients when their operation or appointment will be rescheduled.

Matthew Taylor, the chief executive of the NHS Confederation, said: “The worst case scenario of NHS consultants and junior doctors walking out together has become a terrible reality.

“This is likely to be the biggest walkout the NHS has ever seen, will cause serious disruption, and will put patients at the highest level of risk in living memory.”

The NHS Confederation has warned that “many hospitals are having to routinely cancel operations that have already been cancelled at least once – sometimes as many as three times”, adding: “The clear risk is that the health of some patients will deteriorate the longer they are left to wait.”

Mr Taylor said the “dangerous situation” ahead was being underestimated by the Government and would mean huge numbers of operations and appointments being axed, as he urged ministers and the BMA to open talks.

“This is much worse than before as we’re now seeing patients who have already had an operation cancelled due to industrial action be hit again with a cancellation to their rescheduled appointment,” he added.

“Leaders have also told us that this time round a higher number of operations and appointments for cancer patients are being cancelled, meaning that some of the very sickest patients may be suffering the most.”