A “militant” doctors’ union has blocked patients from getting care during strikes on 17 occasions, the Health Secretary has said.
It comes as the NHS braces for the most extreme strikes in its history, with junior doctors due to join consultants on picket lines on Wednesday.
On Tuesday, health chiefs said industrial action planned for coming weeks would set the health service back as much as five Christmases.
Senior leaders expect the official total of operations and appointments cancelled during strikes to exceed one million, with 100,000 cancellations expected this week alone.
However, they have warned that the true picture is far worse, with few appointments with medics even being scheduled for strike days.
Ministers are proposing minimum service level agreements to protect time-critical services such as chemotherapy and dialysis during walkouts by doctors.
Steve Barclay said the proposals were necessary because attempts to make local agreements to keep patients safe had been repeatedly thwarted by the British Medical Association (BMA).
He told BBC Radio 4’s Today programme: “We did want to rely on voluntary arrangements. We thought this was a proportionate and reasonable approach to take.
“But let me give you an example of why this legislation is necessary. If I take August … there were 17 examples where local NHS leaders and BMA local representatives in August agreed exemptions that they locally felt was necessary in the interest of patients – but then those were vetoed by the national BMA committee, which has decided to take a much more radical approach.”
Mr Barclay said the “militancy” of the national BMA committee had stood in the way of local agreements.
During the four-day strike by junior doctors in August, the union initially granted a request by Cambridge University Hospitals NHS Trust to send some medics to work a night shift in maternity amid concerns over short staffing. But it later reversed the decision, saying it had “new information” about the situation.
Around the same time, the Royal Free London Foundation Trust began seeking an exemption to bring doctors back into work because of concerns about pressures on its renal and acute medicine departments, but no derogation was granted.
BMA local leaders said it was “deeply disingenuous” of Mr Barclay to claim the union had blocked locally agreed strike derogations, saying such exemptions could not be agreed without national agreement from it and NHS England.
In a joint letter, five local negotiating committee (LNC) chairmen involved in 12 of the requests said: “While derogation requests may be discussed at a local level, it is not the responsibility of LNCs to come to any agreements with NHS leadership during strike action.
“It is categorically untrue that any agreements were made locally. Derogation requests are subject to a national process which has been agreed by both the BMA and NHS England.”
The BMA said that despite requests from trusts for derogations, urgent and emergency services continued to be delivered, with other doctors providing cover for those absent.
For the first time, thousands of junior doctors and consultants will hold coordinated strikes on Wednesday, meaning hospitals are only able to offer a “Christmas Day” service service covering emergency care.
On a normal day, around 273,000 appointments and operations take place across England. But health officials said a fraction of that activity is expected to go ahead, with many hospitals deciding not to schedule most appointments once they were made aware of the strike dates.
Wednesday’s joint strike by consultants and junior doctors will be followed by two more days of walkouts by junior doctors, their sixth round of strikes.
Both groups will return to picket lines again for three days on Oct 2, 3 and 4, in strikes timed to coincide with the Tory party conference.
Prof Sir Stephen Powis, the NHS national medical director, said: “The NHS is set to experience the equivalent of five Christmas Days in the next three weeks, where many routine services and appointments may not be delivered.
“While colleagues are working hard to ensure we keep patients safe and prioritise emergency and critical care, the collective impact of this on patients and staff cannot be overestimated.
“The level of ongoing disruption to services caused by many thousands of rescheduled appointments is an enormous challenge, and we’re very grateful to the public for using the NHS wisely during this unprecedented period by using 999 in life-threatening situations and 111 online and community services like pharmacies and GPs for everything else.”
Matthew Taylor, the chief executive of the NHS Confederation, which represents NHS organisations, said Wednesday’s walkouts were an “awful scenario”, which health leaders had long feared.
“It is inevitable that patient safety is compromised, and we believe that the level of risk is the highest we’ve seen for a long time,” he said.
“We suspect that, despite our members preparing thoroughly in advance, we may see more than 100,000 operations and appointments cancelled this time around, taking the total to well over a million.”
The BMA is calling for a 35 per cent pay increase for junior doctors, saying pay has been eroded since 2008/9. Consultants say their pay has fallen by at least one third and are calling for “a credible pay offer”, although they have not put a figure on it.
The strikes are estimated to have cost the NHS at least £1 billion so far.