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During strike action employers negotiate with trade unions to seek agreement to provide a certain level of cover for priority health services to protect life and health. These agreements, known as 'derogations', mean that certain staff members or groups of staff are exempted from strike action in order to provide the cover needed to care for patients at risk of harm. Derogations are entirely dependent on goodwill from unions and staff. During some strikes, derogations have been agreed in good time, but in others, unions have not agreed them until very late or have not agreed them in advance of the strike commencing, which has particularly affected hospital services.

We are proposing to introduce minimum service levels as a further measure to ensure continuity of access to essential services during strike action. The proposal is that hospitals will treat people as they would on a non-strike day who require urgent or emergency treatment in hospital during the period of industrial action and people who are receiving hospital care and are not yet well enough or able to be discharged. 

We propose that hospitals will treat people as they would on a non-strike day who require urgent or emergency treatment in hospital during the period of industrial action, and people who are receiving hospital care and are not yet well enough or able to be discharged. As such, the minimum service level that is required to ensure this treatment is delivered to patients in hospitals during strike action should be informed by expert clinical judgement, meaning the following sets of patients could expect to be treated as they would on a non-strike day:

• inpatients already receiving hospital care
• existing patients requiring urgent elective treatment that would normally be delivered during the period of industrial action (for example: people on priority 1 or priority 2 elective surgery lists (surgery that is required within 72 hours for priority 1, or 4 weeks for priority 2), people requiring dialysis, transplant patients where a potential donor match is identified, elective caesarean or induction of labour)
• existing patients who could or will need emergency, critical or urgent assessment, diagnostics or treatment in hospital, (for example cancer or cardiac diagnostics and treatment, but not for example routine knee or hip replacement)
• new patients presenting to hospital that require unplanned assessment, diagnostics and/or treatment in hospital, (for example people presenting to emergency department, people in active labour) 

NHS hospitals in Great Britain are operated by NHS trusts or health boards, who may sub-contract some of their work to other organisations. This may include cleaning or other support services being contracted to a private company; third-sector providers, such as social enterprises or charities, delivering some services; or other NHS organisations delivering services that support hospital treatments, including blood and transplant services which facilitate treatment requiring blood platelets or donated organs. 

This means NHS trusts or health boards may not employ all the staff who are involved in the delivery of essential care provided by hospitals. In writing the MSL regulations the Secretary of State may specify the type of organisations the MSL applies to. This could limit the types of employers who are able to issue a work notice to ensure the continuity of essential hospital services during strike action. 

We are proposing to introduce a minimum service level that would apply only to hospital care. This measure would not include health services available in the community such as pharmacies, GP surgeries and community health teams.  

Because you said you were employed as a member of staff during a period of strike action, this question asks you about how industrial action in the NHS impacted on people in your care whilst at work. 

The following questions asks for your organisation’s views on the impact of hospital strikes since December 2022 on patient health. 

The ‘review your answers’ feature lists all the questions that you have answered or had the opportunity to answer.

Clicking on the 'Change' button against an answer will allow you to amend that answer.

After making any amendments you can then click through the survey using the ‘Next’ button, previously answered questions retain their answers.

We have a few questions we would like to ask to help us improve future consultations.