New regulations may force striking doctors and nurses to work

20 September 2023 Martyn Bryson

The proposed MSLs are expected to include staff responsible for delivering emergency, urgent and time-sensitive hospital-based care services. The government this week launched a consultation seeking views on the scope of the MSLs and how the regulations should be applied.news_shutterstock_SteveBarclay_LANDSCAPE

Announcing the consultation, the government said it is possible for employers and trade unions to form voluntary agreements for coverage of essential service, but this leads to inconsistencies across the country. The MSLs are intended to provide a better balance between the ability for healthcare workers to strike and for the public to still have access to vital services when they’re needed in a more reliable, consistent manner. This will ensure that these vital services are still accessible during strike periods and could be introduced to hospitals next year.

Health and social care secretary Steve Barclay (pictured) outlined the reasons for introducing the proposals: ‘My top priority is to protect patients and these regulations would provide a safety net for trusts and an assurance to the public that vital health services will be there when they need them.’ He added: ‘In the face of ongoing and escalating strike action, we will continue to take steps to protect patient safety and ensure the health service has the staff it needs to operate safely and effectively.’

However, some organisations responded critically to the government’s announcement of the MSL consultation. According to Saffron Cordery, deputy chief executive of NHS providers, the regulations could deepen the divisions between NHS staff and the government: ‘The consultation announced today risks worsening industrial relations at a time when we need government and unions to get around the table and enter into talks to avert further escalation and disruption to patient care.’ She added: ‘This legislation – as well as the consultation announced today – doesn’t address any of the issues underlying current strike action, including dissatisfaction with pay and working conditions.’

Phil Banfield, chair of the BMA council, countered the government’s claims about the necessity for the MSLs to ensure minimum staffing: ‘The BMA has been clear that any strike action taken by members preserves minimum levels of staffing to ensure patient safety. We have always maintained the consultants and junior doctors together will never stage a full walk out and we have been clear that we are not planning to do so, with urgent and emergency care continuing to run. It is disingenuous for the secretary of state to say otherwise.’

Professor Banfield also claimed that the MSLs could make conditions more difficult for staff: ‘These regulations add further to what we’ve seen from this government in attempting to stifle the right for doctors to act collectively and fight for better pay and conditions in their workplace.’ He added: ‘NHS employer organisations have also warned that such restrictions could make dispute situations more difficult for them in terms of agreeing local service levels of staffing, meaning such changes would be entirely counterproductive.’

The MSL consultation comes just as junior doctors and consultants engage in a coordinated walkout across England, which is a historic escalation of the ongoing industrial action that has rocked the NHS. This is expected to cause considerable disruption on top of the almost 1 million appointments and procedures that have been rescheduled since strikes began. According to the NHS Confederation, health leaders are very concerned about how much the coordinated strike will increase the risk to patients.

The confederation said that many hospitals routinely have to cancel appointments and the new strikes are forcing them to cancel them at an even higher rate, with a bigger impact on cancer patients than previous strikes. This has led to growing public frustration, as hospitals are not able to tell patients when they will get a new appointment. And the scale of the problem may be partially hidden due to the fact that some hospitals are now not booking in patients at all, which don’t show up as cancellations in the figures.

On-going walkouts are also having a negative impact on the morale of staff, including those participating in the strikes. Some health leaders have found that operations managers are also quitting as a direct result of the strikes, as it makes their work around improvement and prevention more difficult.

According to Matthew Taylor, chief executive of the NHS Confederation: ‘This is much worse than before as we’re now seeing patients, who have already had an operation cancelled due to industrial action, be hit again with a cancellation to their rescheduled appointment. Leaders have also told us that this time round a higher number of operations and appointments for cancer patients are being cancelled, meaning that some of the very sickest patients are suffering the most.’