Patient safety and strikes: aspects of love

Ten years on from Robert Francis’s inquiry into events at the UK’s Mid Staffordshire NHS Foundation Trust, is the NHS any safer? A recurring theme of investigations into avoidable harm, say Graham Martin and colleagues, is a failure to heed the concerns of patients and carers (doi:10.1136/bmj.p513).1 They propose three priorities (listening, learning, leadership) to help reduce the risk of tragic events in healthcare. To these three “Ls” they might add a fourth: love.

In the wake of strike action by junior doctors in England, Jennifer Darlow, a specialist trainee, reminds us of Boris Johnson’s ode to the NHS (doi:10.1136/bmj.p588).2 It was the beating heart of the country, said the then prime minister, an NHS “powered by love.” While the flames of love still flicker, it is clear that staff are disheartened and the public is losing patience.

To frame the strike as a single issue dispute would be a mistake, explains Darlow, and the personal decision to strike is a difficult and complex one. Pay is a factor, but so are working conditions and the standards of care that staff are able to offer. These issues were often mentioned by doctors on picket lines around the country in conversation with The BMJ’s reporters (doi:10.1136/bmj.p598).3

The risk to patient safety is also a feature of government responses to threats of strike action, although it can be hard to take such concerns in good faith. Stephen Barclay, England’s health and social care secretary, has quoted patient safety while refusing to negotiate with doctors and then proposing last minute discussions with unacceptable preconditions (doi:10.1136/bmj.p599).4 Politicians might wish to distance themselves from responsibility for strike action, pinning the blame on staff, but they can’t.

Concerns about standards of care and investments in health systems, both of which affect patient safety, are frequent motivations for strikes by health professionals, who see industrial action as a last resort. Ryan Essex and colleagues draw on international experience to consider the impact of strikes on patient care (doi:10.1136/bmj-2022-072719).5 The evidence is far from clear, and better research is needed on a difficult question to study, but the authors propose that patients may well benefit when strikes lead to improvements within health systems.

With medical students being dissuaded by events from a career in medicine (doi:10.1136/bmj.p525),6 the health workforce crisis looks set to deteriorate further. The diagnosis and the solution may lie in the data. John Appleby, examining trends in NHS spending and staffing over the past 25 years, finds a consistent rate of growth in the number of hospital consultants (doi:10.1136/bmj.p564).7 Meanwhile, the number of qualified GPs grew at a slower rate, started to decline from 2015, and is now back to the level it was in the 1990s, despite more demand from patients and demographic change placing extra pressure on primary care and its gatekeeper function.

“Doctors love what they do, and they would not be standing on the picket lines otherwise,” says Chanelle Smith, a foundation year 2 doctor. Even if the government doesn’t truly share that love for the NHS it would do well to listen, learn, and—most importantly—lead.