Background Since December 2022, the NHS has experienced large-scale strikes over pay by staff. Strikes heavily impact elective care delivery. The NHS cancels approximately 12 million elective care appointments each year. One million appointments have been cancelled due to strikes between 2022 and 2024. During this time emergency care is prioritised, and in a recent opinion piece, the president of the Royal College of Emergency medicine claimed the Emergency Department ran 'better than usual'. The aim of this paper was to investigate changes in patient flow into hospitals through the ED during the strike periods. Methodology Data from two different emergency departments (EDs) in the North West of England is analysed using Cox-regression to model time between patient arrival at the ED, and subsequent admission. Various systematic and patient-level factors are controlled for. The impact of different striking groups (nurses, junior doctors etc.) on patient time to admission is analysed. Results For the Type 1 ED, hazard ratios indicate that patients are admitted through the ED more quickly on strike days where any single group of staff were striking compared to non-strike days (HRs: 1.16-1.39, all p < 0.003). This increased flow was only seen for consultant strikes in the smaller ED. Interpretation These findings for all strike types indicate that improved patient flow on strike days is likely due to the increased inpatient capacity from elective care postponement. This result may indicate that there is room for change in NHS hospital systems to improve turnaround time and reduce ED crowding.

The authors have declared no competing interest.

AG is funded by EPSRC Doctoral Training Partnership, grant number EP/R513076/1.

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The project was approved by Lancaster University Faculty of Health and Medicine Research Ethics committee, reference FHM-2023-3868.

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Data supporting this study is not publicly available due to ethical considerations around accessing linked patient-level healthcare data. Please contact the main author for more information (a.garner2@lancaster.ac.uk).