Hospitals may be unable to provide key elements of healthcare such as emergency surgery, chemotherapy and kidney dialysis during upcoming nurses’ strikes, NHS bosses have said.
Trusts may also have to stop discharging patients, postpone emergency diagnostic tests and temporarily withdraw services from people in mental health crisis.
Bosses have been warned that a walkout by nurses in their pay dispute with the government could mean a number of vital and in some cases time-critical services for seriously ill patients may have to be cut or stopped altogether.
NHS England bosses raised the possibility in a letter sent on Monday to hospitals and other care providers ahead of critical talks with the Royal College of Nursing later this week. At this meeting they will try to agree which areas of care will be affected on Thursday 15 and Tuesday 20 December, and which will continue as normal as they are covered by ‘derogations’ – agreed exemptions from the action.
The letter lists 12 areas of care and some non-clinical activities in hospitals, such as food delivery, which could be affected if an agreement is not reached with the nurses’ union.
Eight of these involved direct patient care, three involved support services in NHS trusts and the other involved “systemic leadership and management of safe care oversight” on strike days.
It is expected that both parties can easily agree that nurses will continue to work as usual to enable the delivery of some clinically important types of care on this list, such as “time-sensitive” treatment that involves “immediate life-saving or saving limbs or organs intervention”.
However, the RCN is unlikely to agree that all eight areas of care are running normally. Union officials say there is no guarantee that any of them will definitely be granted.
The RCN is close to finalizing its own list of which services are considered ‘life-saving’ and therefore exempt, and which others its members will refuse to work in. It faces difficult decisions about whether, for example, chemotherapy sessions for cancer patients or dialysis for those with serious kidney disease are considered “life-saving” or care that can be delayed.
The RCN has been locked in an increasingly heated war of words with Steve Barclay, the health secretary, over the union, which is demanding pay equal to inflation plus 5%, or 16.1%. He dismissed the RCN’s payment claim as excessive and unreasonable.
NHS England’s letter also names ten other types of vital care, mainly involving life-or-death scenarios, titled ‘derogations not required’, which they hope will agree with RCNs to continue as usual.
These include emergency care, intensive care unit and emergency operating room services, and maternity services, including childbirth, psychiatric intensive care, time-critical organ transplants, and palliative and end-of-life care.
However, regardless of the national agreement reached by NHS England and the RCN, all 160 trusts and other NHS organizations in England where a majority of nurses voted to strike will also have to agree with the RCN’s local strike committee where an interruption will occur.
The letter was signed by Mike Prentice, NHS England’s national director of emergencies, planning and incident response, and Navina Evans, its chief workforce officer.
Meanwhile, the chief executive of NHS England insisted that patient procedures would not be canceled at the last minute because of the nurses’ strikes, but warned that some care would have to be postponed.
Giving evidence on Monday to the Commons Public Accounts Committee, Amanda Pritchard said she could not confirm how long in advance people would be informed of any upcoming treatment changes, but that efforts would be made to inform them “sooner than later”.
Committee chair Meg Hillier MP asked her: “When you have this (notice of strike action), how quickly can you start making changes and, crucially, let patients know whether their treatment will continue or not?”
Pritchard said the pay dispute presented an “extremely difficult set of circumstances.” She added: “The hopeful next step will be to agree the common set of principles on derogations with the unions, we are doing this in conjunction with the department [of health and social care]of course, but then the local trusts will have to work out the details themselves with the clinical teams, with their local unions and part of that will be making that decision for each patient so that we can let people know sooner rather than later – late.
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