Senior health leaders have raised concerns about the care of cancer patients during the impending nurses’ strikes – including warnings that some chemotherapy appointments are being rescheduled.
In a letter seen by Sky News political editor Beth Rigby, the head of cancer care for NHS England, Dame Cally Palmer, called on Royal College of Nursing (RCN) union boss Pat Cullen to protect “life-saving” and “urgent” cancer surgery from walkouts, which begin on Thursday.
In another letter obtained by the Times, chief nursing officer for England, Dame Ruth May, says chemotherapy appointments are being rescheduled, and asked for assurances about the care of dying patients during the strikes in England, Wales and Northern Ireland on 15 and 20 December.
Dame Cally said she was “extremely concerned about the absence of national derogation for urgent cancer surgery”.
A derogation is an exemption, either of an individual or a whole service, from taking part in strike action.
She went on: “I understand how enormously difficult these issues are for all concerned, but our common aim is to ensure we do not cause harm to people undergoing vital cancer treatment to achieve cure or extension of life.
“It’s important there is a clear and consistent decision on urgent cancer in line with the national derogation for chemotherapy and critical care.”
The RCN insists there will be a derogation for emergency cancer services, as well as for mental health and learning disability and autism services, and said the public was behind its action.
“The public backs our campaign and knows that patients need a strong nursing workforce, but at the moment there are record losses jeopardising safe care,” the union said.
Dame Cally said the strikes were likely to lead to cancelled operations for cancer patients in P1 and P2 categories.
In her letter, she explained P1 surgery “is life-saving, and time critical, and must be maintained”, while P2 is “urgent cancer surgery which has an optimal time window”.
She said rescheduling procedures “is likely to lead to delayed operations and poorer outcomes” and many of these patients will move into the P1 category, requiring life-saving procedures as a result of re-scheduling.
The RCN, however, insisted cancer patients would get emergency and clinically urgent surgery, and in its response to the letter assured that was “not in doubt”.
A spokesperson for the union added: “This is a politically-motivated smear from a government that is failing cancer patients.”
In their correspondence, the chief nursing officer for England, and her counterparts in Scotland, Wales and Northern Ireland, wrote to Ms Cullen raising a series of concerns about patient safety.
“Many chief nurses/directors of nursing are, of course, RCN members themselves and some have expressed feelings of having been let down by the RCN,” they wrote.
The chief nursing officers said chemotherapy is being rescheduled from the strike days at some hospitals despite the union agreeing it would be exempt nationally.
They wrote that “there are examples of some trusts being asked to submit derogation forms for chemotherapy and organisations now preparing to reschedule chemotherapy from 15th and 20th December”.
The chief nurses also asked for assurances that community nursing services providing “end of life care and good pain and symptom relief” continue in order to “alleviate unnecessary distress” for palliative patients and their families.
The RCN said on Tuesday it had agreed further exemptions to the strike action, including emergency cancer services and “front-door” urgent care assessment and admission units for paediatric-only A&E departments.
“This letter is already out of date, as we have met senior clinicians today and agreed key points. The safety of patients is everybody’s top concern,” the union’s spokesperson said.
The heated letters exchange came at a time when a new report shows the NHS is treating fewer patients than it was pre-pandemic despite more funding and staff – suggesting a long-term COVID impact on the health service’s performance.
The Institute for Fiscal Studies has said the NHS carried out 14% fewer emergency admissions, 14% fewer outpatient appointments and 11% fewer elective and maternity admissions in the latest month of data than it did in the same period in 2019, according to the IFS.
Why did talks break down?
Talks between the unions and the government to try to avert strike action broke down on Monday, after Health Secretary Steve Barclay was accused of refusing to negotiate on pay.
The union is demanding a pay rise of 5% above the RPI rate of inflation, which was 14.2% in October, but Ms Cullen has hinted that she could compromise if the government negotiates on pay.
Ministers have repeatedly insisted they can’t afford to give inflation-busting pay rises and say they have accepted the independent pay review body’s recommendation of a £1,400 rise.
Meanwhile, members of the Rail, Maritime and Transport union (RMT) began the first of two 48-hour strikes at Network Rail – and 14 train companies – on Tuesday which will last until Friday.
The strikes come at a time of planned industrial action in a whole number of UK spheres, including healthcare – with paramedics also planning to walkout – postal workers, Border Force agents, firefighters, driving instructors, bus operators, airport baggage handlers and even coffin makers.