13.09.16
Junior doctors’ strikes will be ‘enormously difficult’ for hospitals over winter
The winter pressures inquiry by the Health Select Committee has been told that planned junior doctors’ strikes will make it even harder for hospitals to cope with increased pressures.
In the first session of the inquiry, senior figures in the NHS said that emergency services are ready to cope with the strikes, but they could have a severe impact on elective care.
The BMA called off the first strike, planned for this week, because of concerns about the impact on the NHS, but it is still due to hold strikes on 5, 6, 7, 10 and 11 October, 14-18 November and 5-9 December.
Pauline Philip, national urgent and emergency care director at NHS England, said that while hospitals will be able to “maintain safety” during the strikes, there would be a “significant” impact on hospitals overall.
“In previous strikes we have been able to maintain most of our elective work and we have been able to properly risk assess any work that has been cancelled or delayed,” she said. “I think our concern is that if we are losing 15 days of elective work before Christmas, with every hospital running as hot as it is, that will be enormously difficult.”
Health minister Philip Dunne, who also appeared before the committee, said it was “perplexing” that junior doctors had voted to strike after rejecting a contract that BMA leaders had agreed on.
“Those three actions over five days each will put very considerable pressure not just on the emergency departments but on the hospitals as a whole,” he said, “and that will be much harder than the previous strike actions to manage.”
When asked about the circumstances in which junior doctors will be required to return to work, Professor Keith Willett, director for acute care at NHS England, said that will only take place if hospitals face “exceptional and sustained” pressures.
He said the hospital would have to contact NHS England, who would then approach the BMA’s national co-ordinating centre, which would inform the regional co-ordinating centre and get an agreement with the BMA for doctors to go to work.
When asked if he was concerned that this process was too long, Professor Willett said junior doctors were working closely with their trusts and he was confident they would return to work if asked to do so.
In addition, junior doctors will automatically return to work if a major incident, such as a road accident, is declared externally.
The NHS is already anticipating unprecedented challenges for urgent care this winter as its performance measures continue to decline. However, the interviewees said they thought reforms planned elsewhere in healthcare would help the NHS deal with pressures.
Philip said that the promised funding increase for GPs as part of the GP Forward View would make them better placed to treat patients, reducing unnecessary visits to A&E.
“We are all very much aware of the challenges, but I think by working together as a health system we can maximise the benefits of what we have today,” she said.
In addition, she said that patients would be encouraged to use community pharmacies for minor illnesses through a ‘Stay Well’ campaign. The recent forward view from Community Pharmacy said that the role of pharmacies should be “radically enhanced.”
Professor Willett said that different emergency healthcare providers should communicate more closely so that they “never have to make a decision in isolation”.
“We do need to broaden our thoughts about what the health service will look like in the next five, 10, 15 years,” he added.
Lyn Simpson, executive regional managing director at NHS Improvement, said trusts should use support from the regulator and the new sustainability and transformation plans (STPs) to “tackle some of those issues” affecting A&E services.
When asked about concerns that hospitals will close as part of the STP process, Dunne said: “It’s far too early to be talking in terms of closure at the moment.”
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