Winter is always a busy and challenging time for the NHS. Last winter was the toughest on record.
Trust leaders and staff need time to plan and prepare for the extra demand and pressure, including from flu cases, which winter brings. And Covid-19 hasn't gone away.
Yet instead they are having to spend too much time dealing with another pressure point – strikes.
This week trust leaders face their toughest test yet as thousands of consultants and junior doctors go on strike on the same day for the first time ever. And next month a second coordinated strike will coincide with further action by radiographers whose recent two-day strike caused 13,000 postponed appointments. Nine in 10 patients see a radiographer for acute diagnosis or treatment, including in A&E, cancer care and maternity services.
We are in uncharted territory this week and it's all hands on deck. Volunteers will be stepping up their efforts in some hospitals to support patients and staff will continue to do all they can to minimise the impact but we know there will be some more seriously ill patients affected by this coordinated action who previously were spared disruption.
The NHS – right across acute, ambulance, mental health and community services – has been under intense pressure for many months as wave after wave of strikes has heaped more pressure on services already under immense strain.
The effects of this week's walkouts will be felt for a long time to come. Although the impact of industrial action varies from trust to trust and region to region, the overall scale of the challenge is huge. Every strike piles more pressure on trusts' capacity and tight budgets.
It's an uphill struggle.
Industrial action across the NHS for the last 10 months has delayed nearly one million patient procedures and appointments amid record-high waiting lists. That alarming number doesn't tell the whole story because every strike affects many more patients who just don't get booked in on strike days. There is concern too about long-lasting effects on the health of patients who have had treatment delayed. The disruption and potential harm of delayed treatment is a growing risk for the NHS to manage.
Strikes make it harder for trusts to keep making headway on cutting backlogs, a government priority. But waiting lists were getting longer before the pandemic, a symptom of a decade of underinvestment and severe staff shortages.
Strikes are estimated to have cost the NHS around £1bn already including lost income from postponed procedures and the mounting bill for hiring expensive staff cover. The work consultants do can't be covered by other staff.
Trust leaders understand why so many staff feel pushed to strike but the longer that industrial action goes on the bigger the impact on patients and the NHS long-term.
Morale among NHS staff who have come through the pandemic and one of the toughest winters ever seen in the health service has been sapped over time not just by the knock-on effects of pay disputes but by heavy workloads and the cost of living crisis.
Recent detailed soundings from more than 100 trust chairs and chief executives by NHS Providers revealed deep concerns about the lasting legacy of these protracted disputes.
The domino effect of disputes is in danger of wearing away the fundamental relationship between trust leaders and their staff, who they value and work with for patients every day. These teams want to be able to concentrate their time and energy on seeing more patients more quickly instead of having to present them with disappointment and delay.
As always, in this week of unprecedented strikes action by senior and junior doctors trusts will do everything they can to minimise strike disruption and to keep services running, including cancer services and urgent and emergency care.
The prospect of 'business as usual' strikes haunting the NHS for months to come is frightening. Unless the government and unions sit down and talk there's no light at the end of this very long tunnel.
This blog was first published by The BMJ.
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