The NHS is bracing for an influx of patients between now and Christmas after thousands of people delayed seeking treatment during the ambulance workers’ strike on Wednesday.
Senior doctors have warned that the decision by many people in England and Wales not to seek help while paramedics stage a 24-hour shutdown will leave the NHS struggling to cope at a time when hospitals traditionally cut services for the festive break.
The warning came amid signs that ministers, dismayed that nurses and midwives in Scotland rejected a 7.5% pay rise, now believe there is no deal with health unions and are now preparing for a prolonged winter a battle of wills interrupted by strikes.
Thousands of ambulance staff, paramedics and others across England and Wales went on strike on Wednesday, leaving the NHS unable to respond to many 999 calls. Eight out of 10 ambulance trusts in England have declared ‘critical incidents’ due to the pressure on resources.
Hospital bosses have praised the public for heeding NHS advice to avoid risky activities in case they are left helpless and unable to reach 999 and only call 999 in life-threatening emergencies.
But the leader of Britain’s emergency doctors has expressed concern that widespread downtime on Wednesday could lead to patients’ health deteriorating, in the same way that people who don’t contact the health service when Covid-19 strikes, resulted in injury and even death to patients.
Calls to 999 seeking an ambulance fell by as much as 25%, while A&E attendances were also much lower than usual, in a dramatic – but temporary – reduction in the normally intense strain on ambulance services and hospitals.
“We are concerned that people are not seeking help when they should. We saw this in lockdown,” said Dr Adrian Boyle, president of the Royal College of Emergency Medicine. “We are particularly concerned about the rebound effect, which means things could be much worse in the coming days.”
Dr. Tim Cooksley, president of the Society for Acute Medicine, echoed that concern. “The festive period is going to be extremely difficult,” he said, referring in particular to hospitals, which typically try to send as many patients home as possible for Christmas.
NHS chiefs told the Guardian that hospitals could be much busier and fuller than usual at Christmas, when there are usually only a limited number of staff on duty, with patients staying in hospital for most of the festive period.
“After the end of the strike, we will have [ambulance] teams picking up the people who have been home on the floor for a long time, plus the people who didn’t try to come in on Wednesday because they knew about the strike,” said the CEO of one emergency hospital. “We think we will see more people coming on Thursday and Friday, before the Christmas weekend, and with little hope of getting people home if they need support from social or community care.” And then we’re into Christmas and New Years, when nothing much moves.
Saffron Cordery, acting chief executive of NHS Providers, said hospitals were facing a backlog of operations and postponing clinic appointments because of the ambulance withdrawal.
She said: “Leaders across the NHS also know that as strike action draws to a close this week, disruption is far from over. The fallout from strike action is likely to spread over the coming days due to the knock-on effect on various parts of the health and care system, the need to reschedule routine and outpatient appointments and the expectation of a return to very high numbers of emergency calls. There is particular concern about patients who may have delayed seeking help and whose condition has worsened now coming for treatment.
The NHS Confederation said senior leaders were worried patients would face increasing risks to their health and speedy access to treatment in what looks likely to become a protracted fight between unions and the government in the coming months.
Matthew Taylor, chief executive of the organisation, said: The worry is that this is just the beginning and that the full impact of today’s [ambulance] the strike, along with the first two nurses’ strikes, will be felt not only today, but in the coming days and weeks. Their fear is that the risk to patients will increase with future strikes planned and no sign of a resolution to the disputes.
He blamed the growing campaign of industrial action in the NHS and subsequent service disruptions on the government’s offer of a £1,400 pay to staff and refused ministers to take part in negotiations that could have increased that amount.
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“In what is perhaps the tumultuous healthcare winter this country has faced, the Government must reach an agreement with the unions. We cannot afford for this to turn into a protracted winter of strike action and a destructive war of attrition.”
That prospect appears to have moved closer, with ministers hardening their stance on health unions after members of the Royal College of Nursing and the Royal College of Midwives in Scotland rejected what the Scottish Government said was its “best and final” 7.5 offer for % pay.
“The government won’t blink after that. They think, “Well, if they’re going to reject 7.5% in Scotland, then they’re going to reject whatever we’re going to offer them [above the existing £1,400 offer]”so there’s no point in raising the offer – there’s no deal to make,” said a source familiar with ministerial thinking.
However, Stephen Dorrell, who was health secretary under John Major, criticized the government’s refusal to raise its offer – which equates to around a 4 per cent rise for most staff – or to open talks on a potential increase.
Dorrell, who has since joined the Liberal Democrats, told the Guardian: “The government played their cards really, really badly. The only thing they had to try to do was avoid taking over the entire public sector at once.
“There is a review process for health services. It would not have undermined it if ministers had simply asked the review body to look again at the NHS’s annual settlement, given the exceptional circumstances of 11% inflation.
But Steve Brain, the Tory MP and former health secretary who now chairs the council’s health committee, backed Rishi Sunak’s refusal to renegotiate this year’s pay deal – the £1,400 figure that sparked the strikes.
Breen urged ministers to stand firm in not offering more money than recommended by the pay review body. But he suggested next year’s pay review process could be sped up to give ambulance workers the promise of another pay rise.
“There is no way ministers are going to trample on this process and there is no way they will,” he said. “But they can tell the pay review body they want a shorter piece of work building on the big report they did last year. This can be reported before next summer and we will be in a better place by then. But in the meantime, the unions must stop the strikes.
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