Patients now often experiencing two or more cancelled operations due to industrial action, with cancer patients increasingly affected

Health leaders are warning that increasing numbers of patients who have already had their operation cancelled due to industrial action are having their rescheduled appointments cancelled again – including growing numbers of cancer patients.

Ahead of a coordinated walkout by NHS consultants and junior doctors in England this week, the NHS Confederation has been told by several of its members that the escalated strike action by the BMA is putting more patients at risk than ever.            

Health leaders told the NHS Confederation that:

• they are very worried about coordinated strike action across consultants and junior doctors, and the risk to patients is as high as it’s ever been.
• many hospitals are having to routinely cancel operations that have already been cancelled at least once - sometimes as many as three times. The clear risk is that the health of some patients will deteriorate the longer they are left to wait. 
• this round of industrial action is seeing them forced to cancel a higher number of appointments and operations than before, with a bigger impact on cancer patients than in previous rounds.
• public frustration is growing as hospitals and other providers are often left in a position where they can’t tell patients when their operation or appointment will be rescheduled to.  
• hospitals are routinely not booking in patients now, which means the true scale of the impact of strike action won’t be reflected in the official return’s data on cancellation numbers.
• health leaders can’t understand why the government doesn’t recognise the severity of the situation and are worried that Ministers see the situation as ‘business as usual’ now.
• they are worried about how the costs of industrial action – estimated to be more than £1bn already and rising – are hitting already stretched NHS budgets. If this continues, then it will either increase deficits or lead to cut backs elsewhere.

Matthew Taylor, chief executive of the NHS Confederation, said: “The worst-case scenario of NHS consultants and junior doctors walking out together has become a terrible reality. This is likely to be the biggest walkout the NHS has ever seen, will cause serious disruption, and put patients at the highest level of risk in living memory.

“Leaders are concerned that this dangerous situation is being underestimated by the government, telling us that this feels much different and more complex than previous strikes, with most reporting greater difficulties in rota planning and having to cancel huge numbers of elective operations and appointments in advance.

“This is much worse than before as we’re now seeing patients who have already had an operation cancelled due to industrial action be hit again with a cancellation to their rescheduled appointment.

“Leaders have also told us that this time round a higher number of operations and appointments for cancer patients are being cancelled, meaning that some of the very sickest patients maybe suffering the most.”

One hospital trust leader told us that: ”[the] impact on cancer is higher with these strikes - MDTs, endoscopy and clinics aren't going ahead because they don't on Christmas day. Also, a huge amount of clinical and management time spent mitigating/planning for strikes and, that hidden cost, also reduces the time we can invest in reducing the elective waiting list.”

With the number of operations cancelled because of industrial action set to top 1 million, leaders are also deeply worried that their elective recovery has been severely compromised and are increasingly frustrated by a failure to acknowledge the impact strikes are having on their efforts.

Another hospital trust leader told us: “The Elective Recovery Fund and operational planning guidance does not recognise the pressure of the IA, not only in coordinating safety (with poor tech/data making this time consuming and labour intensive work) whilst then going into the next week being challenged to "do more", meet activity targets and justify long waiters.”

As well as patients and recovery efforts, ongoing walkouts are affecting the morale of staff, including those who are striking, which is adding to pressures. One leader said that they had seen “a reduction in the number of individuals giving us an insight as to whether they are or aren't striking. This risks more short notice cancellations and pressure on admin teams.”

Another leader also told us that they have seen an increase in operations managers quitting as their time has been swallowed by industrial action, hindering their work around improvement and prevention: “I've now seen an increase in ops managers leaving the profession as this isn't fulfilling work anymore. They've been coordinating strikes for months without recognition or resolution, and it's out their hands – something no ops manager likes.”

One leader told us that demands to deliver the elective recovery may be further driving many staff to strike, saying: “not only has the escalation been delivered through strikes coinciding but that and relentless pressure is driving a new level of intention to strike.”

Matthew Taylor said: “What our members are telling us suggests that we are becoming trapped in a vicious circle whereby industrial action is making working conditions much worse, resulting in a further desire among staff to strike, or worse, leave completely.

“Health leaders are understanding of staff frustrations around terms and conditions, but desperately want to get back to the business of delivering the best care possible for patients, improving services and reducing waits. At present they are stuck in a cycle of strike preparation and clear up, while the spectre of winter gets ever close.

“With the NHS already heading into a financial crisis, it can ill afford further squeezes to its budget, but recent winter funding is likely to be fast absorbed by the costs of industrial action, so far is estimated to stand at around £1bn, unless we see resolution.

“While there is no suggestion that industrial action is the cause of the backlogs, with over a decade of underfunding largely to blame, it is certainly not helping the NHS’s continuing efforts to reduce waiting lists and is beginning to make the Prime Minister’s pledge on targets look like a fantasy.

“If we’re to escape this increasingly nightmarish scenario for patients, health leaders and the NHS, we must see the government and the BMA talk to each other to find a solution that brings an end to this.”

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