Evaluating the Impact of NHS Strikes on Patient Flow through Emergency Departments

BackgroundSince December 2022, the NHS has experienced large-scale strikes over pay by staff. Strikes heavily impact elective care delivery. The NHS cancels approximately 12 million elective care appointments each year. One million appointments have been cancelled due to strikes between 2022 and 2024. During this time emergency care is prioritised, and in a recent opinion piece, the president of the Royal College of Emergency medicine claimed the Emergency Department ran better than usual. The aim of this paper was to investigate changes in patient flow into hospitals through the ED during the strike periods. MethodologyData from two different emergency departments (EDs) in the North West of England is analysed using Cox-regression to model time between patient arrival at the ED, and subsequent admission. Various systematic and patient-level factors are controlled for. The impact of different striking groups (nurses, junior doctors etc.) on patient time to admission is analysed. ResultsFor the Type 1 ED, hazard ratios indicate that patients are admitted through the ED more quickly on strike days where any single group of staff were striking compared to non-strike days (HRs: 1.16-1.39, all p [≤] 0.003). This increased flow was only seen for consultant strikes in the smaller ED. InterpretationThese findings for all strike types indicate that improved patient flow on strike days is likely due to the increased inpatient capacity from elective care postponement. This result may indicate that there is room for change in NHS hospital systems to improve turnaround time and reduce ED crowding. Key MessagesO_ST_ABSWhat is already known on this topicC_ST_ABSExit block is a primary issue for NHS Emergency Departments (EDs), increasing patient time spent in ED. The president of the Royal College of Emergency Medicine claimed that NHS EDs run better than usual during strikes. There is little quantitative evidence to support this claim. What this study addsThis study identifies significant increases in flow of admitted patients into the hospital during the strikes, when accounting for differences in admission patterns. How this study might affect research, practice or policyThe improvement in flow indicates that, although strike day service is unsustainable, elements of strike preparation can have a positive impact on the running of the emergency departments - demonstrating scope to improve patient flow through NHS EDs.