Objectives To examine the impacts of the four episodes of industrial action by English junior doctors in early 2016.
Design Descriptive retrospective study of admitted patient care, accident and emergency (A&E) and outpatient activity in English hospitals.
Setting All hospitals across England.
Participants All patients who attended A&E or outpatient appointments or those who were admitted to hospital during the 3-week period surrounding each of the four strikes (12 January, 10 February, 9–10 March and 26–27 April, excluding weekends).
Main outcome measures Raw numbers and percentage changes of outpatient appointments and cancellations, A&E visits, admitted patients and all inhospital mortality on strike days compared with patient activity on the same weekday in the weeks before and after the strikes.
Results There were 3.4 million admissions, 27 million outpatient appointments and 3.4 million A&E attendances over the four 3-week periods analysed. Across the four strikes, there were 31 651 fewer admissions (−9.1%), 23 895 fewer A&E attendances (−6.8%) and 173 462 fewer outpatient appointments (−6.0%) than expected. Additionally, 101 109 more outpatient appointments were cancelled by hospitals than expected (+52%). The 26–27 April strike, where emergency services were also affected, showed the largest impacts on regular service. Mortality did not measurably increase on strike days. Regional analysis showed that services in the Yorkshire and the Humber region were disproportionately more affected by the industrial action.
Conclusions Industrial action by junior doctors during early 2016 caused a significant impact on the provision of healthcare provided by English hospitals. We also observed regional variations in how these strikes affected providers.
- junior doctors
- industrial action
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Contributors Study design: PA, DF. Data collection: DF, PA, AB. Data analysis and interpretation: DF, AB, PA. Drafting the article: DF. Critical revision of the article: PA, AB. Final approval of version to be published: PA, AB, DF.
Funding NIHR Programme Grants for Applied Research: RDPSC 79560. The Dr Foster Unit is an academic unit in the Department of Primary Care and Public Health, within the School of Public Health, Imperial College London. The unit receives research funding from the National Institute of Health Research and Dr Foster Intelligence, an independent health service research organisation (a wholly owned subsidiary of Telstra). The Dr Foster Unit at Imperial is affiliated with the National Institute of Health Research (NIHR) Imperial Patient Safety Translational Research Centre. The NIHR Imperial Patient Safety Translational Centre is a partnership between the Imperial College Healthcare NHS Trust and Imperial College London. The Department of Primary Care and Public Health at Imperial College London is grateful for support from the NW London NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) and the Imperial NIHR Biomedical Research Centre.
Disclaimer “The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.”
Competing interests PA is principal investigator for the Dr Foster Unit, an academic unit in the Department of Primary Care and Public Health, within the School of Public Health, Imperial College London. The unit receives research funding from Dr Foster Intelligence, an independent health service research organisation (a wholly owned subsidiary of Telstra).
Ethics approval The principal investigator has approval from the Secretary of State and the Health Research Authority under Regulation 5 of the Health Service (Control of Patient Information) Regulations 2002 to hold confidential data and analyse them for research purposes (CAG ref 15/CAG/0005). We have approval to use them for research and measuring quality of delivery of healthcare from the London - South East Ethics Committee (REC ref 15/LO/0824).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All SAS code used in the study is available upon request from the corresponding author.
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