What impact do strikes have on the NHS?

Labour disputes are not new – either to the UK or the NHS. But my goodness, they used to be rare.

Fifty years ago, both consultants and resident doctors (formerly known as ‘junior doctors’) withdrew non-emergency services during the 1975 doctors’ strikes. It would be forty years until the next national walkout of resident doctors in 2016.

But since 2022, strikes by different NHS staff groups have become an increasingly familiar feature of our lives. And with that familiarity there’s a risk that we become inured to their impact. Here, then, is an updated reminder of the different ways in which strikes can affect the NHS and the people it serves (see Figure 1).

The impact on staff

The impact of strikes on the personal finances of NHS staff is hard to assess, partly because striking workers may not completely lose out on pay if they can access union-organised collective funds. But the mounting number of lost working days is still clearly a concern coming after a sustained cost-of-living crisis that at times led to NHS employers offering staff access to food banks.

Many health care staff view their work as a vocation and are already routinely working several unpaid hours a week. So, especially after the trauma of delivering services during the Covid-19 pandemic, strikes can pose the risk of moral distress and injury. Where staff feel a tension between their actions and their moral beliefs, it can lead to longer-term psychological harm.

Staff not on strike are also heavily affected by industrial action. This includes the moral distress to administrative staff who need to tell patients their treatments are being delayed, and clinical staff who have their annual leave cancelled so they can cover essential services. As one London chief medical officer said during a previous wave of industrial action: ‘Strikes also have a huge physical and emotional impact on our staff. The weeks before strikes are absorbed by reorganising services, negotiating staffing cover, making cancellations and rebooking patients ... And the weeks after are spent catching up on pent-up demand, while trying to allow appropriate rest and recovery for staff.’

Because NHS staff are not a homogeneous group and strike action can be divisive, strike action may also risk fracturing relationships between different types and grades of professionals. In The King’s Fund’s work with NHS clinical leaders over the past three years, we have seen multiple cases of clinicians grappling with the decision of whether to strike and how to support or challenge the decisions of their colleagues. I’ve heard the gamut from ‘If I were in their shoes, I’d be out on strike too’ to ‘I’m sorry but they just need to suck it up’. More than anything, I’ve been struck by how often I now hear the words ‘they’ rather than ‘us’ in these conversations.

The financial impact on the NHS

So how much do strikes cost the NHS? To illustrate the scale of the issue, we know that the government provided an extra £1.7 billion in dedicated funding to NHS England in 2023/24 to cover the cost of previous waves of strikes. But the cost implications of NHS strikes are broader than that number.

First, there are the relatively direct costs in the here and now, such as additional spending on temporary staff to cover the shifts of striking workers. But additional costs can be stored up, such as the cover provided by NHS staff who cancel their annual leave to keep services running and who will either have to be paid in lieu or carry their extra leave into future years.

Second are the costs of lost activity during the strikes. This can become a financial headache for the NHS in the future if it has to catch up (rather than write off) the cancelled and postponed activity by using expensive additional weekend or evening sessions and clinics – and this costly route is likely to be needed if the government is to achieve its headline ‘health milestone’ of tackling hospital waiting lists.

Third is the opportunity cost of dealing with strikes. This includes everything from the time it takes national bodies to produce copious FAQs on the impact of strikes to the headspace required from senior leaders in the government, unions and NHS that could have been directed towards other matters.

These opportunity costs are partly driven by the need for generic preparation for strikes – the government estimated that it would cost NHS employers £1 million alone to familiarise themselves with the legislation and guidance around minimum service levels in hospital (including two days of chief executive and board-level time in each NHS provider) – and partly, the opportunity cost of planning is high because not every NHS strike is exactly the same. Some strikes can have a nationwide impact, while others a more localised impact (eg, if thresholds for strike action are not met within individual NHS organisations). A strike by resident doctors will heavily affect many NHS organisations but may not have the same impact on NHS organisations that rely less heavily on this staff group.

The nature of action can also be radically different – for example, action can range from full walkouts and withdrawal of services to deprioritisation of non-emergency services and offers to perform only emergency services; or, as was the case during collective action by GPs in 2024, picking from a menu of 10 actions, such as limiting the number of daily patient contacts for each clinician or diverting patients to local urgent care settings.

Overall, it is hard to assess the financial impact of the strikes on NHS organisations or the ultimate cost to the government. To give just one example of the complexity – NHS organisations might incur extra costs if they need to employ temporary staff to provide extra cover during strike days, but those extra payments to staff will ultimately lead to higher tax revenues for the government. Whichever way you cut it, though, responding to industrial action is an unfunded cost pressure for an NHS that was already struggling financially.

The impact on patient care

NHS England data shows that since the end of 2022 at least 1.7 million health care appointments have been rescheduled because of industrial action across acute (outpatients and inpatient), mental health and community appointments. This includes the latest data for July 2025 strike action, which shows 54,095 appointments were rescheduled; however, this figure only comprises acute appointments, as official data is not yet available for mental health and community appointments. But even this understates the impact of strikes on access to care – partly because not all NHS organisations routinely report this data on the impact of strikes, and partly because some NHS organisations book in fewer appointments than usual on strike days (and hence have fewer appointments to cancel).

During the most recent strikes by resident doctors in July 2025, senior NHS leaders took a stronger line in asking that routine activity, such as planned procedures or outpatient clinics, should still be booked and go ahead. But a recent survey of NHS providers showed that 89% of surveyed trust leaders thought strike action would still have a negative impact on waiting lists.

So, patients are having to wait longer for care – but what direct impact do strikes have on patient safety and health outcomes? Here we enter trickier territory.

Analyses of hospital data during previous strikes – particularly the junior doctors’ strike in 2016 – suggest that mortality rates for patients admitted to hospital are not significantly different on strike days. In part, this may reflect the protection put around critical services, such as non-striking staff covering critical care or A&E, and striking staff agreeing derogations (or exemptions from strikes) to deliver care to patients.

Although recent reporting of coroners reports has linked disruption from previous resident doctors strikes to the deaths of five patients, it is difficult to come to firm conclusions. If you read the coroners’ reports (which are in the public domain), you can clearly see the impact of strikes being invoked, but it is hard to say definitively whether it was the instance of the strikes or the quality of planning in response to the strikes that led to harm.

Ultimately, measuring the impact of strikes on the health of the nation is complex. The NHS has good outcome data on patients who were admitted to hospital during strikes but not on the outcomes for people who stayed away or were not able to access services. A research report from Healthwatch suggested cancelling or delaying care (for reasons that include – but go beyond – strikes) had a self-reported impact on both the physical and mental health of patients (see Figure 2).

The impact on public perceptions

An even more complex issue is how the strikes might be affecting the public’s views of the NHS and trust in public services. For example, in Healthwatch’s research, 15% of people surveyed said the NHS told them their care was postponed because of strikes, but a further 24% believed ‘strike action was the reason for the cancellation – even though NHS services had not told them this’.

Previous studies have found that the public often hold governments or health service leaders, rather than striking health care professionals, responsible for strikes. And, historically, the public in the UK have broadly been more likely to support, rather than oppose, strikes from most health care workers (especially when compared with other striking workers, such as teachers, railway workers and civil servants). But a recent set of polling from Ipsos shows that there has been a steep fall in public support for strikes from resident doctors over the past year (see Figure 3).

Conclusion

It is helpful to have a structured way of thinking about how strikes are affecting patients and the public as well as NHS staff and services. But there is a risk that we try to over-rationalise something that is ultimately an emotional issue – one that inflames passions, stokes anxieties and polarises us into camps.

Realistically, it will not be possible for the government to achieve the aims of its new 10 Year Health Plan and meet the Prime Minister’s commitment to tackle long waiting times for patients if the next three years are dominated by a rolling wave of strikes. The government and union representatives are not short of reasons to come back to the negotiating table. The sheer breadth and depth of how NHS strikes affect us all are just two more reminders of what is at stake.