The impact of #N30: a day of action

Maximum disruption.  That’s the purpose of going on strike.    You will  have read the global figures on the impact of the Strike Action on November 30th but I felt it was important to write about the local impact.  Let’s begin with some basics

1.In an average District General Hospital (DGH) they will undertake about 2,000 outpatient appointments per day and 180 elective operations.

2. On an average week day, a DGH will admit about 80 patients through A&E.  On the weekend this will drop to 65.

Based on the above, the staffing levels are determined and bed moves are managed.  The Trust will run its operations tightly.  Any  significant increase in A&E attendances & admissions will be felt across the Trust.  Naturally, weekends have lower staffing levels because of the lower number of potential admissions.   On top of this, every Trust has sophisticated admission prediction tools, and they will increase / decrease elective activity in response to these predictions.   But like the weather, these predictions are sometimes wrong.

Turning to elective operations, the theatre list will be determined by the consultant who is recommending the surgery.   Each surgeon has different views on how their patients should be treated, and consultants do not “swop” or operate on another consultant’s patient except in exceptional circumstances.  The list is drawn up by specialty.  Eg a respiratory consultant will operate on all patients with lung conditions, including those with Cancer.

The same applies for outpatient appointments.  The key difference with outpatient appointments is that a patient may present with a persistent breathing issue [for example] and in the course of the appointment the potential diagnosis of cancer may present.

There were two strike exemptions on November 30th: one was emergencies, the other was cancer.  But as you can see above, it is incredibly difficult to pull out and determine who is a cancer patient on any given day without considerable effort.

Some Trusts treated November 30th November as a Bank Holiday.  Whilst it might be a sensible approach, I’m not sure how they pulled that off. Not withstanding the fact that it was [otherwise] a normal working day in terms of predicted admissions, but also the fact that usually, with planned cancellations, six week’s notice needs to be given.   Six weeks is deemed as the appropriate length of time to arrange cover / re-arrange appointments in a way that is not disruptive to the Trust.

Since the legislation states that strikers do not need to notify their employer before the day that they intend to go on strike, many Trusts had no idea of the true extent of the disruption.  They faced two choices:

1. Continue as normal, assess the situation at 8am on the day, and cancel as appropriate

2. Make cancellations at short-notice.  However, the Trust may find itself in a position where many staff arrive for work, only to find that there is no work to do.

The  impact on patients should not forgotten.  The exemptions were around cancer or emergencies.  But what abut the patient who’s been suffering for years with their leg?  Their routine operation scheduled for the 30th November is going to change their life.  And then it’s cancelled.  Or the patient who didn’t know she had cancer, until she attended an  outpatient appointment and through discussions with her doctor the diagnosis is made?

Other Trusts took the brave [but in my view the only] option to continue as normal.   What was not seen on Wednesday was the considerable work that was done behind the scenes by managers in Trusts to ensure that the hospital continued to run on November 30th.  The same managers who are in the unions that were out to strike.  And this work continues, as Trusts attempt to recover from the Day of Action.  As I said, maximum disruption.