Doctors in Cheshire and Merseyside have entered into a formal dispute with the Secretary of State for Health and Social Care over money-saving targets, which are putting patients’ safety at risk and harming staff wellbeing.

Earlier this year, doctors had warned that financial restrictions imposed by NHS England on Integrated Care Boards (ICBs) – the NHS organisations which plan and manage healthcare services in a region – and NHS trusts are destabilising services. As a result of these funding restrictions, the ICB in Cheshire and Mersey has introduced recruitment freezes, plans to reduce staffing levels despite significant workload demands, limits/bans on agency workers, and imposed a unilateral reduction of overtime rates. Cuts to payments for routine and essential extra work undertaken by resident doctors and Specialty, Associate Specialist and Specialist (SAS) doctors, imposed by the ICB, have been as much as a 27% reduction in pay. This has inevitably caused a lower uptake of those extra shifts and unsafe staffing levels, putting patient safety at risk.

The BMA wrote to the previous Secretary of State asking him to address their concerns, but the response did not provide reassurance that patient safety, staff wellbeing, and service continuity would be protected under the current funding and enforcement arrangements.

In a BMA survey in the region, which was released in March, 88% of respondents said they believe that funding cuts are seriously harming the delivery of safe patient services. 92% of respondents to the survey support formally entering a trade dispute should the matter not be resolved, and 80% of respondents support industrial action should it be deemed necessary.

Doctors have now warned that the staff shortages in hospitals in the region are a ‘catastrophe waiting to happen’.

A doctor working in the Cheshire and Merseyside region who qualified two years ago said:

“There just aren’t enough doctors working in our hospital and it feels very dangerous. On a typical night we are so short-staffed that we are dealing with emergencies on our own on opposite sides of the hospital when we are meant to do so as a team. When there aren’t enough of us on shift it's hard to get to all the very unwell patients and manage their emergencies safely. Patients are slipping through the cracks and becoming very unwell as a result, which could be avoided with more staffing. To prevent critical incidents, we need to fill rota gaps, but the only way to do that is to pay doctors properly. If we don’t, it’s like a catastrophe waiting to happen.”

Doctors are calling on the reversal of funding restrictions and for local leaders who know the local system best to be given back control to make the decisions required to deliver system improvements. They are also calling for the removal of recruitment freezes, enforced targets for reductions in staff headcount, and removal of caps on overtime payments.

Dr Den Langhor, BMA Mersey regional consultants committee chair and a consultant working in Mersey, said:

“We enter this dispute after many months of unsuccessful engagement with local Trusts, the ICB, NHS England, and the Department of Health and Social Care. Cheshire and Merseyside has had more deficit support funding withheld than any other region in England, reinforcing our concern that national policy decisions are disproportionately impacting our region. As a result, patients are being put at risk and doctors cannot give them the care that they rightly expect and deserve.

“Consultants in the region are being forced to plug rota gaps, overseeing busy wards with not enough staff, which has a knock-on effect on hospital capacity, leaving services destabilised and patient care compromised. We demand that these funding cuts are immediately reversed for the sake of both staff and patients.”

Dr Kartik Goyal, co-chair of the BMA’s Mersey regional resident doctors committee, said:

“Resident doctors in the Cheshire and Mersey can’t be clearer: enough is enough. We are pushing ourselves to the brink of burnout, going above and beyond our normal hours trying to keep our patients safe. The ICB has rewarded us with cuts to overtime rates that have left shifts unfulfilled and dangerous gaps in rotas. We must return to safe staffing levels and that means a reversal of these cuts that not only risk patient safety, but also the wellbeing of all resident doctors in the region.”

Notes to editors

Doctors' demands are as follows: 

Immediately reinstate deficit support funding for Cheshire and Merseyside and ensure that trusts and other providers have the required level of funding to provide safe and effective patient care. To do this; 

1. Give local leaders who know the local system best back control to make the decisions required to deliver system improvements. 

2. Abolish the blanket cost reduction policies that have been implemented and instead allow decisions to be taken on clinical rather than financial grounds. This would include a removal of recruitment freezes, enforced targets for reductions in staff headcount, and removal of caps on overtime payments; 

3. Support changes to the way services are organised and delivered, including investment in buildings and equipment, so that they can work more efficiently, avoid duplication of work, and work more closely and effectively across different specialities.  

4. Ensure that in future the ICB and NHS England work with staff to deliver service improvements. 

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.