'Tip of the iceberg': NHS cancellations due to strikes to pass one million soon

NHS appointments cancelled due to strikes will soon pass one million, but that is thought to be the "tip of the iceberg" and the true number could be double that, health service leaders have said.

So far, almost 835,000 appointments have been postponed as a result of industrial action since December across the health service in England, according to NHS figures.

But in a “worst-case scenario”, industrial action in the NHS could have caused double the number of cancellations than that being reported, the NHS Confederation said.

Many hospitals have stopped booking in routine activity on potential strike days to prevent causing more disruption to patients on waiting lists, it said.

And making room for rescheduled appointments means that those further down the waiting list also face delays.

After speaking to hospital operations managers and other NHS staff, the NHS Confederation also said the action is heaping increased pressure on the service, hampering efforts to reduce the record backlog of care and leading to a hefty financial cost to the NHS.

Strikes are also causing a significant administration burden, with senior operations managers spending around a third of their time on strike activities.

It called the government’s “business as usual” approach to strike action “dangerous” as it urged ministers to reopen negotiations with doctors.

It comes as NHS England said that coming strikes by junior doctors are likely to cause “significant disruption” to patients.

NHS England warned that thousands of appointments, operations and procedures are likely to be postponed as a result of the four-day strike, which starts at 7am on Friday.

Meanwhile, NHS leaders highlighted not being able to use agency workers to cover striking medics.

A High Court ruling in July concluded that employers could not use agency workers to fill in for striking staff.

The NHS said the ruling means some of the cover arrangements used during previous strikes will not be possible, though hospitals will still be able to use ‘bank’ staff.

Professor Sir Stephen Powis, said: “This latest round of junior doctors strikes will again significantly disrupt services for patients and the additional challenge this time is that organisations are unable to use agency workers to cover staff out on strike.

“It is also a period of time where NHS staff often take annual leave, so there are already gaps in the workforce.

“We will continue to prioritise emergency care, but it inevitably means that many thousands of appointments will need to be postponed.”

Matthew Taylor, chief executive of the NHS Confederation, said: “Industrial action damage control has become a dangerous ‘business as usual’ for the NHS – the very situation we warned the government to avoid – and nine months into strike action we are as far away from a solution for doctors as we have ever been.

“The long-term impact of strike action is starting to be felt. Some leaders have told us that staff have had to experience understandable frustrations from patients who have had their procedures cancelled, often multiple times.

“We fear this might get worse before it gets better, as the number of cancellations due to industrial action will soon reach one million.

“This is a huge number, but we know this is the tip of the iceberg as the official figures don’t fully take into account all the planned elective activity that would otherwise have been delivered.

“Our members have suggested that these cancellations may actually be having a two for one effect as when these operations are rearranged, they are knocking out other – usually less urgent – operations to accommodate them, meaning that a second patient suffers a further delay to their care.

“But strike data just isn’t recording that so we could actually be seeing, in an absolute worst-case scenario, industrial action causing double the number of cancellations than what is being reported.”

He added: “We need to understand how much of an issue this is as it puts key elective targets at risk, and has implications for winter plans with additional pressure put on primary care and urgent and emergency care as a result of these ‘hidden’ patients waiting longer.”

Dr Robert Laurenson and Dr Vivek Trivedi, co-chairs of the British Medical Association’s junior doctors committee, said: “This dispute should never have gone on so long.

“It has now been almost three months since the government was last willing to talk to junior doctors about their pay.

“Since then, we have stated repeatedly that our door remains open for talks at any time, as long as we could be presented with a credible offer that would address pay erosion of more than a quarter over the last fifteen years."

They added: “Instead of acting responsibly and coming to the table, the government has wasted time by first saying nothing and then having the prime minister declare an end to talks without first having stepped into the room with doctors.

“He then adds insult to injury by blaming those same doctors for rising waiting lists. Sooner or later the government will accept that they need to work with doctors rather than against them. We are here to talk when they do.”

The latest round of strike action from British Medical Association (BMA) junior doctors in England will start at 7am on Friday August 11 and end at 7am on Tuesday August 15.

The NHS has urged the public to continue to use 999 for life-threatening emergencies and 111 online for anything non-urgent.

It said GPs and pharmacies are also open and largely unaffected by strikes.

Meanwhile, patients should attend their appointment as usual unless they have been told that it is to be rescheduled, it added.

A Department of Health and Social Care spokesperson said: “We have repeatedly urged the BMA to put patients first by ending their hugely disruptive strikes immediately.

“We’re giving doctors a fair and reasonable pay rise, as recommended by the independent pay review body, with doctors in training receiving an average increase of around 8.8% – which is above what most in the public and private sectors are receiving, and consultants receiving a 6% pay rise.

“We are working with NHS England to put in place contingency plans to protect patient safety. The NHS will prioritise resources to protect the most urgent care while ensuring patients who have waited the longest for elective care and cancer surgery are prioritised.”

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