Hospitals may not be able to provide key elements of healthcare such as urgent surgery, chemotherapy and kidney dialysis during the upcoming nurse strikes, National Health Service the bosses have said.
Trusts may also need to stop discharging patients, postpone urgent diagnostic tests and temporarily withdraw services for people experiencing a mental health crisis.
Executives have been warned that strikes by nurses in their pay dispute with the government could mean that a number of important, and in some cases time-critical, services for seriously ill patients may have to be scaled back or stopped altogether.
NHS England heads have raised that possibility in a letter sent to hospitals and other care providers on Monday ahead of crucial talks with the Royal College of Nursing later this week. At that meeting, an attempt will be made to agree on which areas of attention will be addressed. Thursday 15 and Tuesday 20 Decemberand that they will continue as normal because they are covered by “derogations” – exemptions agreed to the action.
The letter establishes a list of 12 care areas and some non-clinical activities in hospitals, such as food supply, that could be affected if an agreement is not reached with the nurses union.
Eight of these involve direct patient care, three involve support services in NHS trusts and the other involves “leadership and management of the system to oversee safe care” on strike days.
It is hoped that both sides can readily agree that nurses will continue to work as normal to allow the delivery of some clinically important types of care on that list, such as “time-sensitive” treatment that involves “immediately saving lives or saving limbs or organs”. intervention”.
However, it is unlikely that the RCN agrees that the eight areas of attention are developing normally. Union officials say there is no guarantee that any of them will be provided for good.
The RCN is close to finalizing its own list of which services count as “life preservation” and are therefore exempt, and which others its members will refuse to work on. You face tough decisions about whether, for example, chemotherapy sessions for cancer patients or dialysis for people with severe kidney disease count as “life-preserving” or care that can be postponed.
The RCN is embroiled in an increasingly heated war of words with Steve Barclay, the health secretary, over the union seeking a pay increase equal to inflation plus 5%, or 16.1%. He has dismissed the RCN’s wage claim as unaffordable and unreasonable.
England’s NHS charter also sets out 10 other types of vital care, mainly related to life-and-death scenarios, headed as “derogations not required”, which they hope to agree with the RCN and which will go ahead as normal.
They include A&E care, services in intensive care units and emergency operating rooms, as well as maternity services, including childbirth, psychiatric intensive care, time-critical organ transplants, and hospice and end-of-life care.
However, whatever national agreement NHS England and the RCN reach, the 160 NHS trusts and other organizations in England where the majority of nurses have voted to strike will also have to agree to their local RCN strike committee on where the disruption will occur.
The letter was signed by Mike Prentice, NHS England’s national director of emergency, planning and incident response, and Navina Evans, its workforce director.
Meanwhile, the chief executive of England’s NHS has insisted that patients not have procedures canceled at the last minute because of strikes by nurses, but warned that some care will have to be delayed.
Presenting evidence before the Commons’ public accounts committee on Monday, Amanda Pritchard said she could not confirm how far in advance people would be updated about any changes to the upcoming treatment, but that efforts would be made to inform them “sooner rather than later.” “.
Committee chair Meg Hillier, an MP, asked him: “When you have that (strike notice), how quickly can you implement any changes and, more importantly, let patients know whether or not their treatment will go ahead? ?”
Pritchard said the pay dispute presented “an extraordinarily difficult set of circumstances.” He added: “The next hopeful step will be for us to agree with the unions on that general set of principles around derogations, we are doing that together with the department. [of health and social care]of course, but then it’s going to be for the local trusts to work out the details themselves with the clinical teams, with their local unions, and part of that is going to be about making that patient-by-patient decision so we can let people know sooner how late”.