Strikes speed up admissions from A&E

Accident and emergency patients at the Royal Preston Hospital wait less time for a bed on a ward when medics are on strike, new research has found.

A study by Lancaster University discovered that admissions from the emergency department (ED) came, on average, five hours quicker during stoppage periods than on non-strike days. The biggest improvements were seen when it was resident doctors – previously known as junior doctors – and consultants who had walked out.

Sixty-one days of NHS industrial action were assessed between January 2022 and April 2024 – 40 involving resident doctors, 11 concerning nursing staff, 10 related to consultants and seven by ambulance workers. Resident doctor and consultant strikes coincided on four occasions in that timeframe, which saw an unprecedented number of walkouts in long-running disputes across the health service over pay and conditions.

The median waiting time for admission to the Royal Preston from its A&E fell from 18 hours 4 minutes during ordinary periods of operation to 13 hours exactly when strikes were on.

The study examined the waits only of those ED patients who were subsequently taken into hospital after their visit, not those who were discharged from – or passed away in – the department.

The proportion of attendees who were admitted – from what was identified in the research only as “ED1” at Lancashire Teaching Hospitals NHS Foundation Trust, but which the Local Democracy Reporting Service (LDRS) has established is the Royal Preston – remained the same regardless of strike action, at 41 percent.

Analysis of the findings concluded that the wait reductions were largely the result of “improved inpatient capacity” within the wider hospital as a result of the postponement of pre-planned or ‘elective’ procedures. That pre-emptive move was made across the NHS at the height of the strikes, with around one million routine appointments having been put on hold because of staff walkouts between February 2022 and January 2024.

While the researchers stressed that neither the strikes for themselves nor any delay to scheduled operations was desirable, they suggested that “patient flow through NHS EDs can be improved by expanding capacity and efficiently discharging medically fit patients”.

Speaking to the LDRS about the study she led, Professor Jo Knight from Lancaster Medical School, acknowledged that the conclusion drawn may seem obvious, but added:  “Until you actually evidence it, sometimes it’s difficult to get people to sit up and listen and make the changes.

“Also, if it’s obvious, why haven’t we done it yet – and what more is needed to make us do it? This research could be [amongst] the statistics used to influence those decisions.”

Professor Knight said any suggestion that A&E could function better for some patients during strike action seemed “counter-intuitive”, but was something that those on the frontline had long recognised.

The study highlights that the ED at the Royal Preston saw almost the same number of mean average daily attendances during strike and non-strike periods – 54.0 and 52.8, respectively – while the median wait to be seen by a clinician was identical in both scenarios, at two hours and 27 minutes.

Those stats seem further to point to the reduction in admission waits being a function of the increased ease with which patients have been moved on from A&E to whichever part of the hospital they are ultimately sent.

Asked by the LDRS whether the expense of a wholesale expansion of inpatient hospital space made it an unrealistic aspiration, Professor Knight said it may prove more cost effective in the long run than ignoring the evidence for it.   She also said that it was not at odds with the focus in the NHS 10-year plan on ill health prevention and delivering more care in communities, away from hospital – and could even complement it.

“We know that people waiting in emergency departments for too long is detrimental to their health – [and that means] they’re going to cost the NHS more money.  So, yes, having more beds is more expensive, but maybe it’s cheaper than keeping people in A&E, getting sicker and therefore needing more care for longer.

“[But also] there are other ways of increasing inpatient capacity [than] just building another ward.

“For example, work on avoidable admissions shows that if you have a good community [health] offering, people are less likely to turn up in ED – and that’s an important thing. So I’m not saying that we shouldn’t be [doing that as well],” Professor Knight explained.

Lancashire Teaching Hospitals was approached for comment on the Lancaster University research.