Preparedness for potential industrial action in the NHS – Update 22nd November 2022

Classification: Official
Publication reference: PR00012


  • Integrated care board (ICB):
    • chief executives
    • chief operating officers
    • chairs
    • chief people officers/human resource (HR) directors
  • Trust:
    • chief executives
    • chief operating officers
    • chief people officers/HR directors
    • directors of nursing


  • Regional:
    • directors
    • directors of nursing
    • heads of emergency preparedness, resilience and response (EPRR)

Dear colleague,

Preparedness for potential industrial action in the NHS

We wrote to you on 2 November 2022 to advise you of the steps that the NHS was preparing for managing potential industrial action.

Thank you for all the work you and your teams are doing to prepare for potential industrial action in the NHS.

Earlier this month the Royal College of Nursing announced the results of their ballot for industrial action. A number of other NHS trade unions will be announcing the results of their industrial action ballots soon.

A key element of the preparations shared with you was a self-assessment checklist which was developed to support your preparations and we advised that this would be used for future assurance. A small number have changes have been made to the checklist, and the latest version is attached. We are now asking all providers to complete the checklist and ICBs to consolidate and review returns. Regional teams will be seeking assurance from ICBs about the plans, mitigations and activity needed to ensure patient safety.

We recognise that there might not be a current mandate for industrial action in your specific organisation. However, irrespective of this we are asking all organisations to complete the checklist to assess preparedness for potential industrial action across the system.

We are also asking ICBs to work with all providers to consider the system wide implications of industrial action and how each organisation, whether or not their staff are participating in industrial action, can contribute to the system response.

NHS organisations should have regular and open discussions with trade unions through partnership arrangements. We encourage all organisations to discuss their preparations for potential industrial action in partnership with their local trade union representatives.

We know maintaining patient safety during periods of industrial action is essential for all partners. We have identified a number of clinical priority areas in the readiness self-assessment checklist for you to consider in your preparations. This list is not intended to be exhaustive. At this stage we are asking you to discuss how patient safety can be maintained during any period of industrial action with all partners who have a role in achieving this.

We will write to you shortly with more details on the preparations for potential industrial action, including guidance on communications, support for system leaders and reporting arrangements.

The arrangements for assurance for NHS Ambulance Trusts will also be confirmed shortly and a lead ICB will be asked to provide the oversight for each Ambulance Trust. We will work with regional heads of EPRR to identify the ICBs.

Trusts and ICBs with the exception of ambulance trusts, are asked to complete the self-assessment.

ICBs are asked to submit collated returns to their regional operations centre by midday Monday 28 November 2022. Further details on how to complete and submit the return are provided in the updated self-assessment checklist attached.

If you have any questions, please contact your regional team.

Yours sincerely

Mike Prentice, National Director for Emergency, Planning and Incident Response, NHS England.
Navina Evans, Chief Workforce Officer, NHS England.