‘PATIENT DEATHS DO NOT INCREASE DURING DOCTOR STRIKES!’ says Harvard Medical School

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Over 20,000 Junior Doctors marched on October 31st against Hunt’s imposed contract
Over 20,000 Junior Doctors marched on October 31st against Hunt’s imposed contract

‘PATIENT deaths do not increase during doctor strikes,’ research has shown, as junior doctors prepare for their three days of action.

The junior doctors are walking out on strike against the Tory government’s attempts to impose a new contract which will cut their pay and force them to work long hours which will in turn be unsafe for patients.

The action will begin with an emergency care-only model, which would see junior doctors provide the same level of service that happens in their given specialty, hospital or GP practice on Christmas Day. It will then escalate to full walk-outs. The action is proposed as:

• Emergency care only — from 8am, Tuesday 1 December to 8am Wednesday 2 December

• Full withdrawal of junior doctors” labour — from 8am to 5pm, Tuesday 8 December

• Full withdrawal of junior doctors’ labour — from 8am to 5pm, Wednesday 16 December.

Researchers at Harvard Medical School and Brigham and Women’s Hospital (Boston, USA) show that, in high-income countries, ‘patients do not come to serious harm during industrial action provided that provisions are made for emergency care’.

In The British Medical Journal (BMJ) today, David Metcalfe and colleagues report that death rates ‘remained the same, or decreased, during all previous doctor strikes that have been studied in developed countries’.

They say that ‘strikes can therefore be organised in such a way that patient safety is not compromised’. ‘The right to strike is recognised as a fundamental human right by the United Nations, the Council of Europe, and the European Union,’ they explain.

However, for some doctors, industrial action is inconsistent with their over-riding duty to advocate for their patients. Tory Health Secretary Jeremy Hunt, has claimed that doctor strikes inevitably ‘expose patients to risk of serious harm’.

So, Dr Metcalfe and colleagues examined data from previous strikes for evidence to support claims that industrial action harms patients. Overall, they found that, within developed healthcare systems, doctor strikes have not been found to affect mortality provided that emergency care provision is made.

For instance, three studies examined the consequences of a strike by physicians in California in 1976, where care for all but emergency cases was withheld over five weeks, and all found that mortality fell during the strike period.

Similarly, an analysis of death certificates following action by 73% of doctors in Jerusalem in 1983 found no excess mortality during the strike, while research at an emergency department after a nine-day strike by junior doctors in Spain in 1999 reported no mortality difference between strike and non-strike periods.

And, in 2003, when most doctors in Croatia went on strike for four weeks, a subsequent study found no significant association between the industrial action and patient deaths. The only report of increased mortality associated with strike action was from South Africa, where the odds of death increased at one hospital during a 20-day strike in 2010.

However, this strike included both doctors and nurses who withdrew all services from patients, and left only one hospital open to serve a population of 5.5 million people. ‘So why don’t patient deaths increase during doctor strikes,’ they ask?

The report states: ‘Importantly, all strikes in developed countries guaranteed continued provision of emergency care, they explain. Emergency care may even improve during industrial action, they add. For example, during the 1999 strike in Spain, junior doctors in the emergency department were replaced by more senior physicians.

‘It is likely that temporary reductions in mortality are related to the cancellation of non-urgent (elective) surgery,’ they say. Other possibilities are that doctors are better rested during strike periods and that the number of staff required to avert patient deaths is comparatively low. Nevertheless, it would be naive to imagine that industrial action can be undertaken without causing any harm or inconvenience to patients, they write.

‘For instance, no study to date has explored the effect of industrial action on patients’ quality of life or confidence in the medical profession. Some doctors will always feel that industrial action is fundamentally inconsistent with their professional obligations because of its inevitable impact on patients,’ they say. However, in balancing their competing priorities, doctors in high income countries can be reassured by the consistent evidence that patients do not come to serious harm during industrial action provided that provisions are made for emergency care.’

• Only three areas of England have committed to funding seven-day GP services. Sixteen of the 19 CCGs taking part in the first wave of the Prime Minister’s seven-day GP access pilots have not committed to fund seven-day appointments beyond April 2016. Just two CCGs areas across the 20 first-wave pilots have committed fully to continue funding their scheme past next March, a Pulse investigation has revealed.

Another former pilot, in east London has agreed to continue seven-day routine GP access, but only for patients with five or more long-term conditions. And another in Bristol and south Gloucestershire has had to reapply for central Government funding. Across the other 15 areas, two CCGs have cancelled their schemes altogether.

The remainder (13) said they are still evaluating findings of the pilot schemes run over the past year or are awaiting more clarity from Number 10 regarding the future funding of seven-day access, while two have said they have no current plans for long-term funding of seven-day routine GP appointments at all.

This strikes a blow to the Government, which had always claimed that the schemes would become self-sufficient from April 2016, once savings were realised from a reduction in A&E attendances. It comes as the Treasury has said that the £750m committed to general practice would go towards seven-day access, after Prime Minister David Cameron had originally said the budget would be £400m.

The official evaluation into the PM’s Challenge Fund pilots found that there was a 15% reduction in the number of patients attending A&E with minor ailments across the pilot areas, compared with the national average of 7%. However, it also found that these savings amounted to £3.2m across the wave one schemes – way below the £50m invested in the Challenge Fund, the majority of which went on providing seven-day services.

The evaluation also recommended Sunday opening is ditched due to a lack of demand, with the potential of commissioning extended evening opening or Saturday morning clinics.