Our Winter of Discontent: NHS strikes and missed targets

Betsy Goodfellow from Pharmafocus considers the current state of the NHS amid ongoing strikes and ever-growing waiting lists, as well as the impact of the infectious illnesses circulating during the winter months
The winter months often bring times of struggle for the NHS, however this year the impact seems particularly significant. This is due in part to the ongoing strike action, coupled with the usual flu season as well as the remaining impact of COVID-19.
Recently, the BBC has revealed that most key NHS targets have been missed for at least seven years, with some having never been met.1 The targets involved in this assessment covered A&E, cancer treatment and waiting times for planned care; some patients have reported being faced with delays so long that their cancer has developed to a point that it is incurable.1
Evidently, these waiting times, delays and missed targets have become a hugely significant problem.
In addition, with COVID-19 still circulating, although with a lower mortality rate than previously, the usual winter flu season is likely to have been worsened. The NHS attempted to combat this by bringing forward the booster schedule for the disease, having aimed to vaccinate those over 65, older adult care home residents and immunosuppressed people by the end of October 2023.2 This vaccination programme follows the discovery of yet another COVID-19 variant, BA.2.86, which although not currently a variant of concern, could still trigger a new wave of infections.2 As well as further COVID-19 vaccinations, vulnerable populations are offered an annual flu vaccine – these vulnerable groups include those over 65, people with certain long-term health conditions, pregnant people, people living in a care home, people who are the main carer for an older or disabled person and people who live with someone with a weakened immune system.3 These vaccination programmes are intended to both protect the individual from serious symptoms of their respective diseases and to limit the burden on the NHS, as those vaccinated are less likely to get seriously ill and therefore will hopefully not require hospital treatment while they recover.
It has been reported that in England, 31% of ambulances wait outside A&E departments for longer than 30 minutes, 31% of patients wait in A&E for longer than the target of four hours and 42% of people face waits longer than 18 weeks for routine treatment.4 It is extremely clear that there are issues within the NHS surrounding waiting times for countless areas of NHS treatment, even in emergency situations, when care is needed most urgently.
Furthermore, with the previous year seeing strike action spanning across multiple industries and sectors, from the NHS and teachers to rail workers and bus drivers, there has been a period of vast unrest nationwide. Due to this industrial action, many patients have had important appointments cancelled at the last minute, including cancer treatments and appointments for young children.5 Many patients support their healthcare workers’ decision to strike, but feel disappointed at the length of time this period of strike action has been going on. They have also reported feeling dissatisfied with the way this has been dealt with by the NHS, with some patients only hearing about their cancelled appointments just a few days before they were meant to go ahead.5
Some hospital bosses have also blamed the junior doctors’ strikes for causing a ‘fractured’ relationship with consultants, as well as increasing the risks of patients dying during strike action.6 It has also been reported that the consultants have expressed frustration at the regularity of the junior doctors’ strikes, especially as this has occurred during the period when ‘the NHS comes under its most intense pressure of the year because of the surge in winter illnesses, staff holidays and lack of social care support’.6
One hospital Trust chief executive commented: “It’s starting to fracture some of the relationships and become a moral issue. The moral issue being people’s lives are being put at risk. For example, if every ambulance in your area is outside your emergency department, that means that no other patients are being attended to. The whole system is going to be affected. We know that the most challenging time of the year is the period after Christmas and the first few days of the new year. For the junior doctors to choose to strike at this time means that this time will be significantly more challenging. I would not be surprised, but will be utterly dismayed, when someone dies. It really is not what we came into healthcare to do.”6
According to the NHS website, during the junior doctors’ strikes, ‘other doctors (including consultants and other specialist doctors) will still be working. The NHS is working hard to ensure adequate staffing through the entirety of urgent care pathways, urgent elective cases and other critical services’.7 However it also acknowledges that ‘the disruption to staffing will cause a significant reduction in elective activity and this may mean some appointments and procedures may need to be rescheduled’.7 Evidently, it is well-known that the strikes are incredibly disruptive to the healthcare system as a whole.
The strikes form part of an ongoing debate between healthcare workers and the government, predominantly concerning pay. Despite the short-term impact on patients, the strikes have the potential to enact change within the NHS and the wider British health system, which can lead to higher rates of staff retention and motivation, in turn leading to better treatments and care for patients.
Moreover, wider societal changes are also beginning to impact NHS care – for example, the Royal Mail has announced that it may reduce the days it delivers from six per week to five, with some sources even quoting only three days of post delivery.8 The NHS still heavily relies on letters delivered via the Royal Mail to communicate appointments, test results and other information to its patients ‒ some of these letters are already lost, leading to missed information and appointments, however the potential changes to the Royal Mail delivery system can only make this issue worse.
On the whole, it is very clear that the NHS could struggle this winter, with flu infections rising following the annual trend, COVID-19 continuing to spread and the usual winter illnesses infecting many. As well as this, the health service finds itself in a period of unrest, with strikes taking place fairly regularly, which continues to impact care and add to the backlog of appointments and long waiting times.