Junior doctors' strikes, ambulance waiting times and the rise in medical negligence claims

Written by Rebecca Brisley | Medical Negligence Team |17 October 2023

The medical field is constantly under pressure to maintain impeccable standards. With an increase in patient loads and varied complexities, the healthcare sector faces immense challenges.

One of the recent pressures faced by healthcare providers is the strikes by junior doctors. Junior doctors, like many of us, are struggling to afford basics like food and heating. Not only that but they are struggling with deteriorating working conditions, and it is hoped that the industrial action will lead to a pay deal which will impact positively on motivation, rates of attrition, productivity and patient care.

These strikes have however, raised serious concerns over patient safety and have subsequently led to a rise in medical negligence claims.

Junior doctors and their strikes

Junior doctors are the backbone of the medical industry, often being the first port of call for patients. However, there have been instances where these doctors have felt the need to voice their concerns through strikes. These strikes, primarily driven by issues such as working conditions, pay, and contract terms, have a direct and indirect impact on patient care.

Impact on patient care

When junior doctors strike, the immediate effect is a reduction in manpower. This means fewer doctors are available to attend to patients, leading to longer wait times and potential lapses in care. 

The flip side to striking junior doctors is a daunting reality where patient care is impacted, treatments are delayed, and the workload on existing medical staff amplifies. There is inevitably a link between strikes and a surge in medical negligence claims.

Ambulances waiting outside Emergency Departments

Another grave concern that has a direct correlation to medical negligence claims is the backlog of ambulances waiting outside emergency departments. This issue is not isolated but intertwined with the above-discussed challenges. When emergency departments are overwhelmed, it's often a ripple effect from other factors like junior doctor strikes.

The 10th October saw what may well be the first of many critical incidents declared by Derriford Hospital in Plymouth this winter period. There were 22 ambulances waiting outside the Emergency Department, and the Department itself had been overwhelmed with the attendance of almost 400 patients in one day.  Whilst patients were being urged to seek medical assistance from local GP surgeries and pharmacies, it is becoming increasingly clear that the strain on the ambulance service is being worsened by difficulties in patients accessing their GP’s due to a lack of appointments, limited access to the eConsult service and a nationwide shortage of GP’s.  With nowhere else to turn desperate patients are turning to the ambulance service.

The Prevention of Future Deaths (PFD)Report

A critical document highlighting these concerns is the Prevention of Future Deaths Report by Andrew Cox, the Coroner. This report sheds light on the tragic deaths of patients who had to wait unduly long for an ambulance.

In his report he confirmed that, “All of the cases listed…have recurring themes, being long delays in ambulance attendance and/or long delays in admission into the only acute hospital in the coroner area, Royal Cornwall Hospital. It is appropriate to record both that these are only a selection of the inquests of this nature already heard and that there are a number of inquests of a similar nature still to be heard.”

Some of the key findings of the report were that there were unnecessary delays in ambulances reaching critical patients, directly resulting in fatalities; that there were systemic issues that needed urgent rectification to prevent future deaths and that there was a need for better communication, increased staffing and more efficient management systems.

It was clear from the report that delays in ambulance response times were not as a result of a shortage of ambulances, but instead because the ambulances were in the wrong place at the wrong time; specifically, they were parked up outside Emergency Departments.  It had been noted that there were occasions when there had been queues of over 20 ambulances outside the Emergency Department of the Royal Cornwall Hospital, with patients in the back for extended periods awaiting admission.

Case studies

The Prevention of Future Deaths report prepared by Andrew Cox wasn’t the first of this nature, and possibly won’t be the last. His report alone highlighted 4 cases where ambulance delays and hospital overcrowding had been an overwhelming factor in the cause of preventable deaths in his County.

Mr Reedman sadly passed away as a result of stroke at the age of 54 years. He was an otherwise fit and healthy man. Following a stroke, standard first line treatment is thrombolysis which can only be administered within 4.5 hours of stroke onset. 

In Mr Reedman’s case thrombolysis was administered 4.5 hours after the onset of symptoms, which is at the extreme edge of the window for that form of treatment. The PFD Report noted that, “this delay in treatment was a direct consequence of ambulance delay”, which was caused by the fact that there was no available ambulance to respond because they had been detained in the Emergency Department car park due to an inability to offload patients.

Another PFD Report was filed with the Department of Health and Social Care earlier this year, by Coroner Jacqueline Lake following the death of Lyn Brind who died of Congestive Cardiac Failure after being conveyed to hospital in an ambulance with an elevated NEWS2 score (the National Early Warning Score 2 is a system used by healthcare professionals to assess illness severity and risk of deterioration). She finally made it into the Emergency Department more than 4 hours after her arrival to the hospital, despite suffering from a deterioration in her condition. She sadly passed away 22 minutes after her admission. 

The rise in medical negligence claims

A direct consequence of these difficulties within the NHS is an increase in medical negligence claims. With reduced manpower, existing doctors and medical staff might be stretched thin, leading to mistakes, delayed treatment and miscommunication. 

Strikes and industrial actions inevitably lead to a reduction in the workforce, stretching the remaining medical staff thin and potentially leading to oversights, delayed diagnoses, and treatment errors. The surge in medical negligence claims during and post-strike periods can be attributed to these factors, as patients may experience suboptimal care, mismanagement, or encounter avoidable medical mishaps.

Of course, addressing the root causes of industrial action, safeguarding the rights and wellbeing of junior doctors, and ensuring the unwavering provision of quality patient care are pivotal in navigating this complex landscape.

The other issue which arises as a direct consequence of a reduction in manpower is a delay in treatment as a result of the inevitable cancellations which occur.  The Covid-19 pandemic stretched the NHS to breaking point and most NHS Trusts are continuing their attempts to overcome their huge waiting lists. This, coupled with the Junior Doctor strikes has led to an ever increasing strain on the service.

Furthermore, when ambulances are made to wait there are a multitude of consequences including delayed response times to critically ill patients, patient deterioration and an overcrowded Emergency Department which places its own strain on medical staff.

During the winter period from 2022-2023, there were at times up to 13 NHS Trusts across the country declaring critical incidents, and the delays in care were said to be causing the deaths of as many as 500 patients every week.  Whilst the needless death of any patient is unconscionable, we mustn’t forget that delays in treatment will also leave many with life changing injury. 

In conclusion

While strikes by junior doctors and the backlog of ambulances are pressing issues, it's essential to see them in the broader spectrum of medical care.

These challenges highlight the underlying structural and systemic issues in healthcare that need to be addressed. Quite how the NHS will seek to rectify these issues remains to be seen. Downing Street confirmed last winter that they were doing “everything possible” to increase the number of beds available. Whether that is borne out over the winter of 2023/24 is yet to be proven.

Ensuring that medical staff are heard, their concerns addressed, and systemic inefficiencies ironed out will not only reduce medical negligence claims but also ensure a higher standard of patient care.

If you are concerned with the treatment that you or a loved one has had in hospital, please contact Rebecca Brisley, Associate Solicitor, in the Medical Negligence team. You can reach her on 01752 827027 or at rbrisley@nash.co.uk