Publication reference: PRN01079

To:

Trust and integrated care board (ICB)

• Chief executives
• Chief operating officers
• Medical directors
• Nursing directors
• Human resources (HR) directors
• Emergency preparedness, resilience and response (EPRR) leads

cc.

Regional

• Directors
• Medical directors
• Chief nurse
• Chief operating officers
• Director of workforce training and education
• EPRR teams

Dear colleagues,

Industrial action washup and next steps

Thank you for the contribution you and your teams have made to keep patients as safe as possible during the latest two periods of prolonged industrial action by junior doctors.

We know a significant amount of work and resource has been invested to prepare for and manage this industrial action, particularly since it coincided with the usual winter pressures seen by the NHS in early January, and two Bank Holiday periods. This could not have been achieved without the support of all colleagues working over and above to support the safety of service during this period.

It is thanks to the hard work and commitment of teams that we were able to plan for and manage this incident. However, we know working in this way has an impact, both personally for colleagues’ health and wellbeing, and organisationally in terms of lost opportunities and momentum in our delivery and improvement efforts.

As you work together across systems and with NHS England regions to restore operations, the remainder of this note is designed to provide clarity on the approach we are asking you to take to meet winter pressures, and over the remainder of this financial year.

Priorities for the recovery phase

Over the coming fortnight, we are expecting the NHS will need to manage a challenging combination of pressures, including;

• seasonal Covid and flu presentations, including those who require hospitalisation;
• a spike in other presentations related to cold weather;
• the need to urgently reschedule patients requiring time-sensitive treatment who were impacted by the latest industrial action, and those patients with the longest wait times;
• accumulated need for rest and recuperation time for those doctors and other healthcare professionals who have worked additional hours/shifts over the last few weeks, and;
• staff sickness.

We are therefore asking you to continue to prioritise the safety of patients requiring urgent and emergency care during this time, including urgent planned surgery and other treatment for time-sensitive conditions, particularly fast progressing cancers.

The priorities from here to March remain for:

• All systems to deliver at least 76% 4-hour performance and category 2 ambulance response times as committed to in quarter four in the November planning round, supported by continued delivery of actions identified as part of the UEC Recovery Plan.
• All systems and providers to deliver their cancer 62 day backlog reduction targets as well as achievement of the 75% FDS standard by March 2024.
• All systems to continue to reduce elective long-waits in line with the ambitions in the Elective Recovery Plan and activity levels agreed in the most recent planning exercise.

Capturing learning from industrial action

The NHS – locally, regionally and nationally – has continued to learn and refine our approaches and processes through the prolonged industrial action we have collectively managed since December 2022.

Drawing on feedback from local clinical leaders on the patient safety mitigation process, we wrote to the BMA on 4 January notifying them of additional steps we would take to ensure both the NHS and the BMA better understand the impact on services and patients of the current system.

Specifically, this includes asking Trusts who have had mitigations rejected by the BMA, or where they have not received a decision in a timely fashion, to inform us of the impact this had on services, and wherever necessary ensure that any patient safety incidents are notified to us as soon as possible.

We understand this impact, particularly with regard to patient-level harm, may not become apparent for days or weeks to come, but please do continue this reporting through systems and regional teams to ensure that we have as much information as possible to support national-level conversations with the BMA in advance of any future strikes.

Thank you again for your leadership through this very complex combination of challenges.

Yours sincerely,

Dr Emily Lawson DBE, Chief Operating Officer (interim), NHS England

Mike Prentice, National Director for Emergency Planning and Incident Response, NHS England