Sunak wrong to claim October’s waiting list improvement followed a pause in strikes

We’ve obviously been hindered by industrial action… Towards the end of last year, we had a period without any strikes in the NHS, and what did we see? We saw the waiting list fall. Tens of thousands. By 65,000 over the period of October, waiting lists started to fall when you had a period without industrial action.

The government has now reached resolution with every other part of the NHS [besides junior doctors]. Nurses, midwives, paramedics, consultant doctors, specialty doctors most recently. So every other part of the NHS workforce—and I’m grateful to them for everything they’re doing—has reached a resolution with the government on a reasonable fair pay settlement.

During a BBC interview with Laura Kuenssberg on Sunday, the Prime Minister and the presenter were discussing NHS waiting lists and the impact of strike action. Mr Sunak made one incorrect claim and another questionable one about strikes in the NHS in England (the part of the health service that the UK government controls).

Although the number of cases awaiting planned treatment with NHS England did fall in the latest month’s data, for the end of October 2023, this did not follow a period “without industrial action”, as Mr Sunak said. There had been strikes by junior doctors, consultants and radiographers covering 2-5 October. This has been noted by others on social media. There were no strikes in November, but November’s waiting list data has not been published at the time of writing. 

It was also potentially misleading to say that every part of the NHS workforce other than junior doctors “has reached a resolution with the government on a reasonable fair pay settlement”.

The British Medical Association (BMA) and the Royal College of Nursing (RCN) have both said this is not true with respect to consultants, specialty and specialist doctors or nurses, who have not formally agreed a pay deal with the government. Indeed consultants and specialty/specialist doctors have voted to continue strikes if they do not accept the offer. 

Ms Kuenssberg also said that “7.71 million people” were awaiting treatment, which is not quite right. In fact, an estimated 6.44 million people are awaiting treatment—for 7.71 million different cases. The first figure is lower than the second, because some people are waiting for more than one thing. 

Ms Kuenssberg and many others have made this mistake before. We wrote to the BBC again to make them aware of this error and have also written to Downing Street about the Prime Minister’s comments.

Ministers should describe the performance of public services truthfully, so that the public is not misled about the reasons for any problems or successes.

How have strikes affected waiting lists?

There are many different kinds of NHS waiting list, as we have explained before. But Mr Sunak was clearly talking about the number of non-emergency cases awaiting treatment in NHS England’s Referral-to-treatment (RTT) waiting list, which fell by an estimated 65,518 cases from September to October last year.

This was the first monthly fall since November 2022, and therefore the only one since Mr Sunak made the pledge to cut waiting lists and times in January 2023, which he and Ms Kuenssberg were discussing.

However, it is not true that the fall recorded at the end of October 2023 followed “a period without any strikes in the NHS”, because there was a three-day period of strikes by consultants, junior doctors and radiographers at the beginning of the month. 

In this respect, October was not very unusual. June and March, for instance, also contained three-day strikes by junior doctors (but not by consultants or radiographers), and the number of cases on the waiting list rose in both months.

Consultants did announce a pause shortly after the October strikes, and there were no NHS strikes in England in November. It is therefore possible that the data for November, when it is published on 11 January, will show a fall in the waiting list. However, this data was not available when Mr Sunak was speaking. 

While strikes do affect NHS performance, at least in the short term, many other factors besides strikes might affect the length of the waiting list. 

In an analysis published in September, the independent health think tank the Nuffield Trust said “it is unlikely that the lost activity would have been enough to enable waiting lists to come down, and it is certainly not the case that the strikes alone are to blame for continued long waits.”

Are the other strikes resolved?

Junior doctors are the only part of the NHS workforce currently pursuing national strikes, as far as we can tell.

However, that doesn’t necessarily mean that all the other industrial disputes have reached a “resolution” or a “settlement”, as Mr Sunak claimed.  

Consultants and specialty/specialist doctors in particular have not yet confirmed that their strikes are over.

The HCSA union and the BMA are currently balloting consultants and specialty/specialist doctors over whether to accept an offer from the government and have said they will pause strikes until the result is known. These ballots close on 14 January and 23 January respectively. Both have mandates to continue strikes if the offer is rejected.

In short, although the government and the unions have negotiated a deal for the unions to put to their members, this does not mean that the unions or their members consider the strikes resolved.

Strikes by nurses ended last June after a ballot of RCN members did not achieve a mandate for more strike action. This means its members cannot strike again and the RCN has said they will not be balloted again about pay in 2022/23 or 2023/24.

In effect this seems to mean that the nursing strikes are over, although whether this amounts to resolution or a settlement is probably a matter of opinion.

Image courtesy of Chris McAndrew