A&E at risk from nurses’ strikes as it fails to make list of protected areas

Accident and emergency is under threat from forthcoming nurses’ strikes after the Royal College of Nursing (RCN) failed to include emergency care in its list of exemptions.

The RCN has published a list of four areas that will be protected during strikes: chemotherapy, dialysis, critical care units such as intensive care and high dependency, and neonatal and paediatric intensive care.

Other services will be reduced to Christmas Day or night-duty levels, the union said.

It had previously promised to protect emergency care, such as A&E, during any industrial action. However, it has now passed the responsibility on to trust leaders and local union representatives to negotiate staffing levels in A&E during strike action.

It comes as A&E services across England are under significant pressure, with one in three ambulances delayed outside emergency departments by at least 30 minutes.

The Royal College of Emergency Medicine has also warned around 4,000 patients a day are spending more than 12 hours in A&E as the emergency case system “collapses”.

Pat Cullen, the union’s general secretary, said on Friday: “Patients are already at great risk and we will not add to it.”

In letters sent to NHS employers on Friday, the RCN set out its commitment to a “life-preserving” care model and the four areas of exemption.

When asked whether other areas, such as A&E, would be included on the list the RCN said employers would have to request additional exemptions if they are unable to maintain safe staffing levels.

“It is always the employer’s responsibility to maintain personal safety in their services,” a spokesman said.

“If an employer is not able to maintain services without striking nursing staff, employers may request additional derogations beyond critical care units, ITU/HDU, dialysis and chemotherapy services, neonatal and paediatric ICU.”

Ms Cullen said: “Every nurse feels a heavy weight of responsibility to make this strike safe. Patients are already at great risk and we will not add to it.

“This list of exemptions shows how seriously we take our commitment and it should put patients’ minds at ease.

“Nursing staff do not want to take this action but ministers have chosen strikes over negotiations. They can stop this at any point.”

Hospital bosses must now work with local union representatives to apply for such exemptions before the first strike day in just under two weeks – Dec 15.

Any local agreements must also be signed off by the union at a national level, adding an additional layer of bureaucracy.

On Friday, trust leaders expressed concern that A&E had been excluded from the list of protected services.

Other vital services, such as highly secure mental health facilities, urgent surgery and maternity, have also been omitted.

Saffron Cordery, interim chief executive of NHS Providers, which represents trust leaders, said leaders at affected trusts would “redouble efforts to reach local agreements with the union about where strikes will hit, given the apparent exclusion of A&E and maternity services from the national list of services exempt from industrial action”.

“The decision to nationally exempt ‘life-preserving care’ such as critical care units, intensive care, dialysis and chemotherapy services, neonatal and paediatric ICU is of course welcome,” she said.

“But with less than two weeks to go until the first strike, trust leaders at NHS organisations now face the daunting prospect of entering into a period of intense negotiations with their local strike committee to seek urgent, additional exemptions for other critical patient services.

“What was already expected to be a particularly challenging situation for the NHS has now become even more so.”

Members of the RCN in England, Wales and Northern Ireland are set to take industrial action on Dec 15 and 20 after voting in favour in a ballot.

Nurses will take action at half of the locations in England, and every NHS employer except one in Wales and throughout Northern Ireland. The strike will include up to 100,000 nurses.

Matthew Taylor, chief executive of the NHS Confederation, said coordinated strike action across the NHS before Christmas increased the risk of cancelled appointments and scaled-down services.

He called on the Government and unions to begin negotiations “without delay” so that strikes could be called off.