Will fewer people die if doctors strike?
The British Medical Association's decision to pursue industrial action for the first time in over 40 years provoked a great deal of interest in this morning's papers.
The Independent included in its coverage of the story a Q&A on how the strikes would affect the public. One of its questions was:
"Q. Will the action put patients at risk?
A. The last time doctors took industrial action, in 1975, death rates fell. But it will be small comfort to those who find their operations cancelled or appointments postponed."
In 1975 NHS consultants went on strike between January and April and junior doctors followed suit later in the year in November. According to the Independent death rates fell during these periods.
Unfortunately, the Office of National Statistics does not produce monthly mortality figures that go back that far and therefore we cannot compare the impact of the strike on a month-by-month basis in 1975.
However a few studies have been conducted that suggest that the correlation between doctors downing scalpels and a drop in the death rate might not be as far-fetched as it at first appears.
For example, in 2008 a report published in the journal 'Social Science and Medicine' looked into the issue. This report reviewed the literature on doctors' strikes focussing on five strikes around the world between 1976 and 2003, all lasting between nine days and seventeen weeks. The report found that:
"All reported that mortality either stayed the same or decreased during, and in some cases, after the strike. None found that mortality increased during the weeks of the strikes compared to other time periods."
While the report does not cover the 1975 strike in the UK specifically, it does support the idea that during a doctors' strike mortality rates fall.
Similarly, in 2000 the British Medical Journal analysed a story first published by the Jerusalem Post about a three month doctors' strike in Israel which showed a concurrent decline in the mortality rate. As Epidemiologist Ben Goldacre has noted however, this does rely on some shaky foundations, with the data on deaths being taken from funeral parlours.
What is behind this phenomenon?
The main explanation for this correlation is that during a doctors' strike elective surgeries - that is non-emergency procedures - are postponed or cancelled. All forms of surgery carries a risk, and the cancellation of these operations could mean that the deaths that might have resulted from certain procedures might have occurred in later months instead.
However this doesn't mean that a doctors' strike is somehow safer for patients.
Former King's Fund Chief Executive (and Full Fact Trustee) Baroness Neuberger has pointed out on Radio 4's More or Less that if a strike were to carry on for a long time - six months or more - death rates would be expected to return to rise as a consequence of the failure to carry out those elective surgeries.
It is also important to note that doctors do not completely withhold their services when on 'strike' in the same way that many other groups do. During all the strikes mentioned here and the forthcoming strike doctors still maintain emergency services. In 1975 for example, junior doctors stuck to a 40 hour week and only dealt with emergencies.