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Strikes by younger doctors before Christmas helped to forestall a winter crisis in the NHS because senior medics who covered for them were often quicker to discharge patients, according to health leaders.
The health service customarily buckles under seasonal pressures. But this winter its performance has been stronger in some areas than for several years, in a glimmer of hope for a government whose electoral prospects will be influenced by whether voters can see an improvement in the NHS.
Health leaders believe one reason for the reduced pressure has been the industrial action by resident doctors — previously known as junior doctors — who went on strike for five days in the run-up to Christmas, the latest in a series of walkouts over pay and jobs.
Nick Hulme, who recently retired as chief executive of East Suffolk and North Essex NHS Foundation Trust, told an NHS Confederation podcast this week that the strike, while challenging, had acted as “a bit of a fire break” as a result of senior decision makers “discharging patients a bit earlier, not ordering so many diagnostic tests, not admitting as many patients through the front door”.
He added that “walking into Colchester hospital on Christmas morning with 100 empty beds is something I hadn’t done for probably five years”.
One hospital boss who did not wish to be named noted that A&E “works so much better when there is a strike” because of more confident decision-making by the consultants.
Another health leader said that, while the strike had carried “significant risk . . . the impact of having senior decision makers at all points through the hospital means that actually hospitals went into this Christmas with a lower level of bed occupancy than we’ve seen for years”.
Two more health officials confirmed to the FT that it was widely accepted that A&Es ran more smoothly during resident doctor strikes because more senior consultants covering for them discharged patients earlier and ordered fewer tests.
Rory Deighton, director of the Acute Network at the NHS Confederation, which represents health managers, pointed out that only a handful of hospitals had so far declared “critical incidents”. He added: “In a bad winter we may well have seen two, three, four times that number.”
Far more detailed pre-winter planning, and the impact of reforms to the way the NHS in England works, such as closer collaboration between hospitals and community services, had played an important part, he suggested.
Bed occupancy rates for emergency and planned admissions at hospital trusts fell as low as 81.2 per cent on Christmas Day, according to FT research — comfortably below the 85 per cent threshold deemed safe by the Royal College of Emergency Medicine.
Meanwhile, ambulance response times have fallen markedly from their peak in 2022, especially in hard-hit regions such as the south west of England.
Although the worst fears of health leaders have largely not been realised, Deighton acknowledged there was still “immense pressure on lots of different parts of the system”. A&E waiting times show no signs of improvement, the FT’s research found.
Siva Anandaciva, director of policy at the King’s Fund, suggested the service had “got lucky” by avoiding “some of the demand-side pressures that put a health system on its knees in winter”. While flu arrived earlier than usual, the strain on hospitals levelled off from mid-December, calming fears that this could be the worst season in recent years.
However, without more deep-seated structural reforms to the way the NHS runs, his concern was that “in six or seven months’ time, we’ll be worrying about the same things: ‘are we going to have a bad flu season? Will the NHS be able to cope?’”
In a statement, Dr Helen Neary and Dr Shanu Datta — consultants committee co-chairs of the British Medical Association, which also represents resident doctors — said: “It’s interesting that before the strikes some politicians and NHS leaders were warning that the health service faced collapse if resident doctors went on strike, and yet we now have managers somehow suggesting that the opposite in fact happened.
“Consultants worked over and above to support resident doctors in their industrial action and to ensure that patients still had access to emergency and life-saving care during the strike. But to suggest at this stage that this winter is more broadly shaping up to be somehow more manageable than others is premature and not something our members will recognise as they continue to report the unacceptable levels of corridor care being normalised.”
Sir James Mackey, chief executive of NHS England, said in a statement: “NHS staff have gone above and beyond in working hard to deliver real improvements in urgent care this winter whilst at the same time achieving a historic drop in the waiting list — the second biggest on record for 15 years.
“All this has happened despite the challenge of industrial action — with most appointments still going ahead as services kept the wheels turning over on strike days.”
