The Royal College of Nursing has confirmed which services will be exempt nationally from taking part in the strike action slated for later this month.
It said adult intensive care units and high dependency units, neonatal and paediatric intensive care units, and dialysis and chemotherapy services, will all be exempt – or ‘derogated’ – from the action.
“This list of exemptions shows how seriously we take our commitment and it should put patients’ minds at ease”
By exempting, or derogating, these particular critical care services, the college said that the strike action due to be undertaken by RCN members would follow the “life preserving care model”.
However, under the current RCN decision announced today, the derogation of emergency departments and maternity services looks as if it will be decided by local agreement at trust level.
Under the union’s rules, services, including accident and emergency, that have not been named today for derogation nationally by the RCN can be made exempt via agreement locally.
For example, the college has told trusts that if they were not able to maintain services without striking nursing staff, employers may request additional derogations beyond critical care units.
Such requests will be considered by the RCN’s Industrial Dispute Strike Committee on a case-by-case basis, Nursing Times understands.
Most applications for derogations will be made by employers but there is the ability for members to apply for individual derogations, according to guidance previously published by the college.
In its guidance for members on the upcoming action, the college has previously stated that patient safety was “always paramount” and that it would be following a “life preserving care model”.
“Unlike workers in many other sectors during a strike, some nursing staff continue their work. This is carefully negotiated with employers beforehand to make sure patients are safe,” it noted.
It highlighted that a way of maintaining safe staffing levels was through derogations – defined as an exemption provided to a member or service from taking part in strike action.
“The prospect of industrial action remains of significant concern to health leaders”
During the RCN’s 2019 strike in Northern Ireland, there were three models for derogations that were decided based on the service and need.
These were complete derogation – with an entire service being exempt – a Sunday or Christmas Day service, and a night duty model – where night duty numbers were agreed to cover day duties.
However, it also noted that RCN member could choose to participate in the strike action and not attend work, even if they worked in a unit or service that was derogated.
But it stressed that derogations were in place to ensure life was preserved and said that “we would ask members to carefully consider their position”.
The RCN announced on Tuesday that half of the NHS employers in England where a legal mandate for strikes was secured will initially see strike action from nurses, with the option to escalate in future.
It confirmed that up 100,000 nursing staff would take part in strikes in England, Wales and Northern Ireland on 15 and 20 December.
Meanwhile, the college said it had sent formal letters to NHS employers today, setting out what it meant by a commitment to a “life-preserving care model” during industrial action.
In addition, it confirmed that other services, which do not meet these criteria, may be reduced to what it is describing as a “Christmas Day” or “night duty” level during the strike days.
The RCN’s strikes are currently due to take place on Thursday 15 December and Tuesday 20 December.
However, the college claimed that government negotiations on nurse pay were still “able to pause the action”.
RCN general secretary and chief executive, Pat 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,” she said. “This list of exemptions shows how seriously we take our commitment and it should put patients’ minds at ease.”
She added: “Nursing staff do not want to take this action but ministers have chosen strikes over negotiations. They can stop this at any point.”
In response, Matthew Taylor, chief executive of the NHS Confederation, said: “There is an urgent need to clarify the position for individual trusts regarding emergency departments, highly secure mental health facilities and urgent surgery.
“The prospect of industrial action remains of significant concern to health leaders,” warned Mr Taylor.
“This is particularly true as other unions have since announced their intentions to coordinate strike activity across the NHS before Christmas, which increases the risk of cancelled appointments, scaled down services and increased waiting times when the NHS is already running hot.
“The strength of feeling from workers who have felt no choice but to opt for strike action is very clear,” he added.
But health leaders needed “negotiations between the government and the unions to commence without delay so that a resolution can be found and the strikes can be called off”, he stated.
Interim chief executive of NHS Providers, Saffron Cordery, said trust leaders would “redouble efforts” to reach local agreements with the union, given the “apparent exclusion” of A&E and maternity services from the national list of services exempt.
“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,” said Ms Cordery.
She added: “Today’s developments once again underline the urgency of the government and unions getting around the table and doing everything they can to avert these strikes.”
Meanwhile, Unison health worker members at two hospital trusts in Liverpool look set to go on strike over pay and staffing, following a ballot with its members.
The union announced on Wednesday that it had only received a mandate to strike at Liverpool Heart and Chest Hospital NHS Foundation Trust, and Liverpool University Hospitals NHS Foundation Trust.
Despite more than 80,000 health workers across England voting to go on strike in the Unison ballot, many employers did not meet the threshold. The same was true in Wales, where none met the threshold.
Under the Trade Union Act 2016, industrial action ballots in England, Scotland and Wales require a 50% turnout to allow workers to legally go on strike.