The impact of health care strikes on patient mortality: A systematic review and meta-analysis of observational studies

Social media opposition to the 2022/2023 UK nurse strikes

Previous research has established that the success of strikes, and social movements more broadly, depends on their ability to garner support from the public. However, there is scant published research investigating the response of the public to strike action by healthcare workers. In this study, we address this gap through a study of public responses to UK nursing strikes in 2022-2023, using a data set drawn from Twitter of more than 2300 publicly available tweets. We focus on negative tweets, investigating which societal discourses social media users draw on to oppose strike action by nurses. Using a combination of corpus-based approaches and discourse analysis, we identified five categories of opposition: (i) discourse discrediting nurses; (ii) discourse discrediting strikes by nurses; (iii) discourse on the National Health System; (iv) discourse about the fairness of strikers' demands and (v) discourse about potential harmful impact. Our findings show how social media users operationalise wider societal discourses about the nursing profession (e.g., associations with care, gender, vocation and sacrifice) as well as recent crises such as the Covid-19 pandemic to justify their opposition. The results also provide valuable insights into misconceptions about nursing, strike action and patient harm, which can inform strategies for public communication.

From plaster casts to picket lines: Public support for industrial action in the National Health Service in England

This paper explores public sentiment towards strike action among healthcare workers, as a result of their perceived inadequate pay. By analysing survey data collected in England between 2022 and 2023, the study focuses on NHS nurses and junior doctors, due to their critical role in delivering essential public services. Results indicate higher public support for strikes by nurses and junior doctors compared to other professions such as postal workers, teachers, rail workers, airport workers, civil servants and university lecturers. However, variation in support for strikes by healthcare workers is observed across societal segments. Significant disparities in support are linked to individual political affiliations, left-right ideological positions and trust in the NHS. In short, nonconservative voters, individuals leaning towards left-wing politics and those with greater trust in the NHS demonstrate higher likelihoods of supporting strikes by health workers. These findings carry implications for future strike decisions and highlight specific target groups for enhanced communication efforts to garner increased public support.

Impact of junior doctor strikes on patient flow in the emergency department: a cross-sectional analysis

BACKGROUND AND IMPORTANCE

Healthcare worker strikes are a global phenomenon. Mortality and morbidity seem to be unaffected by doctor strikes, but there is little evidence on the impact on emergency department (ED) flow and patient characteristics. In March and April 2023, two consecutive UK junior doctor strikes occurred.

OBJECTIVES

This study investigated the impact of junior doctor strikes on ED patient flow. Additionally, variation in patient presentations was compared between non-strike and strike days.

DESIGN, SETTING AND PARTICIPANTS

This cross-sectional study was conducted at King's College Hospital ED, a university hospital in London. All ED attendances during the 72- and 96-hour strike actions were compared with the corresponding non-strike days of the previous week.

OUTCOME MEASURES AND ANALYSIS

National key performance indicators (KPIs) were analysed and compared between non-strike and strike days. Patients' demographics, acuity and diagnoses were compared. Outcome measures included number of 4-hour breaches, number of patients admitted or discharged and ED mortality. Staff seniority was categorised into levels for analysis.

MAIN RESULTS

There was increased ED patient flow during strike days with a significantly shorter total time in department in March [240 min (IQR 155-469) vs. 286 min (IQR 198.5-523.5), P  < 0.001] and in April [222.5 min (IQR 147-351) vs. 251.5 min (IQR 174-443), P  < 0.001]. Time to first clinician, treatment, and decision to admit were all shorter during both strike actions. Number of attendances, acuity, diagnoses, admission, discharge, and mortality rates were similar during strike and non-strike days. Staffing numbers were lower or equivalent on strike days but level of seniority was higher ( P  < 0.001).

CONCLUSION

The improved KPIs and increased patient flow during strike days, while multifactorial, seem largely attributed to the higher number of senior staff. Patient presentations and outcomes were unaffected by junior doctor strike action.

Revisiting the comparison between healthcare strikes and just war

In the UK, healthcare workers are again considering whether to strike, and the moral status of strike action is being publicly debated. Mpho Selemogo argued that we can think productively about the ethical status of healthcare strikes by using the ethical framework often applied to armed conflict (2014). On this view, strikes need to be just, proportionate, likely to succeed, a last resort, pursued by a legitimate organisation and publicly communicated. In this article, I argue for a different approach to the just war comparison. Selemogo adopts a traditional, collectivist conception of just war reasoning but this is not the only view. So-called 'individualist' approaches to the morality of war can also be applied to strike action. Taking an individualist perspective complicates the traditional picture of a dispute arising between three well-defined groups of healthcare workers, employers and the innocent subjects of collateral damage: patients and the public. We arrive instead at a more complicated moral picture: some people might be more morally liable to be harmed than others during a strike, or can justly bear increased risks, and some are more obliged to strike than others. I describe this shift of framework before critically examining some of the traditional jus ad bellum conditions as applied to strikes.

The impact of strike action on healthcare delivery: A scoping review

BACKGROUND

Strike action carried out by healthcare workers raises a range of ethical issues. Most fundamentally, as a strike is designed to disrupt, it has the potential to impact patient outcomes and healthcare delivery. This paper synthesises and analyses the empirical literature that details the impact of strike action on healthcare delivery.

METHODS

A systematic scoping review was utilised to examine the extent, range and nature of research activity. Embase, Medline, CINAHL, Bioethicsline, EconLit and Web of Science were searched, yielding 5644 results. Papers were included if they examined the impact that strike action had on healthcare delivery (i.e., admissions, presentations, waiting time). After screening, 43 papers met inclusion criteria.

RESULTS

Nineteen studies explored presentations to emergency or admissions to hospital. Both dropped dramatically when comparing non-strike to strike periods. Ten studies examined length of stay in hospital and waiting times. No clear relationship was found with strike action, with some studies showing that wait times decreased. Nine studies examined the impact of strike action in facilities that were not on strike, but were impacted by nearby strike action along with the impact that strike action had on treatment seeking. Hospitals dealing with these upstream impacts often saw increase in presentations at hospitals, but results relates to treatment seeking during strike action were mixed.

CONCLUSION

Strike action can have a substantial impact on the delivery of healthcare, but this impact is not felt uniformly across services. While many services are disrupted, a number are not, with several studies reporting increased efficiency.