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Junior doctor strikes had 'significant impact' on healthcare

Almost 300,000 cancelled outpatient appointments during 2016 strikes

Adrian O'Dowd

Tuesday, 20 February 2018

Junior doctors who went on strike four times in 2016 had a 'significant impact' on healthcare provision with thousands of appointments cancelled and far fewer admissions and A&E attendances, suggests research* published today in the online journal BMJ Open.

In the first four months of 2016, junior doctors from all specialties across England went on strike in protest against changes to their contract brought in by the government.

Each of the four strikes lasted 24 to 48 hours taking place in January, February, March and April of that year.

Researchers led by Daniel Furnivall from the department of primary care and public health at Imperial College London decided to carry out what they described as the first UK study to look at the effects of the strikes, as well as the first to evaluate the impact of withheld in-hospital emergency services (the April 2016 action was the first ever UK strike to include emergency care).

Using official hospital episode statistics (HES) data, they compared hospital activity the week of each of the strikes with that from the preceding and following weeks. They focused on numbers of admissions, outpatient appointments, and A&E attendances.

Results showed that during the 12 weeks of the study, there were 3.4 million admissions, 27 million outpatient appointments, and 3.4 million A&E attendances.

Compared with the weeks preceding and following the strikes, there were 9.1% (31,651) fewer admissions, 6.8% (23,895) fewer A&E attendances, and 6% (173,462) fewer outpatient appointments than expected.

April’s strike had the largest impact on services, during which there were 15.4% (18,194) fewer admissions, including 7.8% (3,383) fewer emergency admissions, and 19.9% (14,811) fewer planned admissions.

Hospitals scheduled 11.1% (109,915) fewer outpatient appointments during this strike, while patients kept 134,711 (17.1%) fewer of them. The number of outpatient appointments cancelled by hospitals also rose by 66.8% (43,823).

Collectively, during all four strikes, hospitals cancelled 294,844 outpatient appointments – 52% higher than the volume expected for this period – possibly to protect more critical services, suggested the researchers.

Certain regions seemed to be disproportionately affected with the proportion of cancelled appointments increasing to between 66% and 68% in Yorkshire and the Humber, South East Coast, and London.

The researchers said the number of recorded deaths did not change significantly during the strikes and was not higher than expected, due to relatively small numbers.

However, hospital mortality was likely to be the least sensitive outcome for quality and safety concerns in this context, they argued, because deaths caused by poor care were not likely to show up immediately, nor was it clear whether patient health might have worsened as a result of delayed appointments and procedures.

The researchers acknowledged that their study did not assess the impact of the strikes on patients who did not attend A&E, or the potential impact on the so-called ‘weekend effect,’ or how patients felt about their delayed care.

Nevertheless, they concluded: “Industrial action by junior doctors during early 2016 caused a significant impact on the provision of healthcare provided by English hospitals.”

A BMA spokesperson said: “The decision to take industrial action was based on genuine concerns from junior doctors about the impact of proposed changes on patient care.

“In recent weeks we’ve seen large numbers of patients being affected by the cancellation of operations because the health service is unable to cope with demand. This highlights the scale of the pressure the NHS is operating under, which was a key concern of junior doctors during the dispute.”

*Furnivall D; Bottle A; and Aylin P. Retrospective analysis of the national impact of industrial action by English junior doctors in 2016. BMJ Open 2018;8:e019319. DOI:10.1136/bmjopen-2017-019319.

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