Doctors' strikes can have surprising benefits - but are they sustainable?

"We sighed with relief - strikes act like a firebreak."

That was how one hospital boss recalled hearing news of a walkout by resident doctors in England last December.

Now that the latest doctors' strike has ended, some NHS trust leaders who have spoken to BBC News are reflecting again that the system has run more efficiently - with some saying it has been smoother than on non-strike days.

Looking back to previous walkouts they suggest that far from the predicted chaos, there were shorter patient waits, faster decisions and calmer corridors.

But there is an acknowledgement that this has depended on patched-up solutions, which can prove costly.

About 25,000 doctors who could have been working were absent each day because of the strike in December, according to NHS England.

The five‑day walkout of British Medical Association (BMA) members, timed to run up to the start of the Christmas season, was branded "irresponsible and dangerous" by ministers.

But inside at least one hospital, the mood, helped by evidence that flu was easing, was strikingly different.

The trust chief executive, who noted that the strikes act like a firebreak, told the BBC: "With consultants on the front door, decisions are made fast and admissions fall. Lower bed occupancy before Christmas was a gift."

Consultants and other senior doctors deployed in A&E are able to assess quickly whether patients need urgent treatment or whether it is safe to redirect them to other community health services.

More direct decision‑making

At King's College Hospital, a study of the first junior doctor strikes in 2023 found patients were seen, treated and discharged faster on strike days, despite fewer staff on duty. Crucially, researchers reported no rise in deaths or re-admissions.

Performance figures elsewhere show a similar pattern. At the Royal Berkshire Hospital, for example, the four‑hour A&E target was met in 82% of cases during December's walkout, compared with 73% the previous week. While other factors may have played a part, the improvement aligned directly with the strike.

Dr Layla McCay, director of policy at the NHS Alliance, representing trusts, said: "We have heard, anecdotally, that the enhanced presence of consultant colleagues in A&E, with their additional experience, can mean quicker, less risk-averse decision-making, which is good for patients.

"But this is a temporary, unsustainable solution with knock-on effects."

On routine non-strike days, emergency departments are staffed mainly by early‑career doctors in training for specialist roles, who often order more tests and seek multiple layers of senior opinion. Each extra step slows the patient journey.

When consultants take over front-line roles during strikes, decision‑making tends to be more direct, according to Dr Damian Roland of the University of Leicester.

"The more doctors involved in a patient pathway, the longer everything takes," he said.

But training resident doctors is essential to provide the consultant workforce of the future.

The BMA's Dr Jack Fletcher said that when the consultants of today retire "we have no one to replace them as [trainee doctors] have left due to a combination of inadequate pay and conditions, and a lack of jobs".

Every December, hospitals try to discharge as many patients as possible before the festive slowdown. The pre‑Christmas strike accelerated that process.

"Lower occupancy improves flow, and with that the patient experience," Roland said.

Flow is hospital jargon for the timely movement of patients from the emergency department to other parts of the hospital for treatment.

Patients noticed the difference. One woman described her strike‑day visit as "a blessing". A mother said her son, often admitted with asthma, received the quickest treatment he'd ever had because "an experienced consultant just got him sorted".

NHS England reported that the service had safely discharged thousands of patients home to their families ahead of Christmas, despite the strike action.

Some hospitals are now trying out new plans on non-strike days. At one trust, cardiology consultants are placed at the front door every Friday. This follows lessons learned from deployments on days with industrial action.

"Cardiologists rarely admit someone with chest pain," said Nick Hulme, former chief executive at East Suffolk and North Essex NHS Foundation Trust.

"Junior doctors are more cautious.

"After seeing the impact of the strikes, we realised this was a smart way to reduce admissions ahead of the weekend."

Complex financial picture

The strike‑day model may look efficient, but hospitals only achieve it by stripping out some normal work.

Planned operations and appointments are postponed, although NHS England says 95% of routine treatment does continue on strike days.

Senior doctors redeployed to the front door also have to cancel other commitments. And consultant cover itself is expensive.

Premium rates can exceed £3,000 for a single night shift, and a BBC Freedom of Information request found that, in 2023, consultant cover cost three times more than trusts saved in withheld junior doctor pay.

The financial picture is complex.

According to the Nuffield Trust, paying premium rates to cover industrial action and the extra administrative work to rearrange appointments costs around £30m per strike day, though the final figure varies depending on turnout and the time of year.

The government estimate is higher at £50m. Hospitals lose income when operations are postponed but they are paid when the procedures are carried out later.

"The financial costs of industrial action in the NHS are fairly opaque," said Sally Gainsbury of the Nuffield Trust. She notes that no detailed breakdown of the numbers has been provided by the government or NHS England.

As for sustainability, consultants are finite - and tiring of strike action. Some feel exposed returning to front-line roles they haven't done for years. Others report feeling fatigue and frustration because of the extra workload.

"An NHS getting by over a strike period is completely different to managing without resident doctors all of the time," the BMA's Dr Fletcher said.

"There are benefits to a strike day, but they are ultimately limited before you hit the ceiling of other pressures from outside the trust," said one senior hospital manager. Services in the community are stretched every day - strike day or not.

"You can't run a hospital in 'emergency mode' all the time," said Prof Carol Propper of Imperial College. "It simply isn't a stable way to run hospitals."

That leaves fundamental questions: Fifteen walkouts have failed to result in an acceptable deal, so if the strikes are having limited impact, why keep calling them?

And was the government right to ramp up rhetoric claiming strikes were inflicting disruption and harm on patients?