Why we should focus on NHS surge capacity not new restrictions

When we became alert to the new Omicron variant, I argued that our immediate focus should not be on attempting to impose new restrictions. This was not because I didn’t think that the new variant definitely wouldn’t be a significant problem for us.  At that time, we had little data to go on at all. Now we have more data but there is still a level of uncertainty.  As I argued here, cases could peak soon and drop quickly with little impact on admission rates. In that case we’ll see hospitalisations increase but the NHS shouldn’t be overwhelmed. However, we still could see them continuing to rise, the severity of illness get worse and admissions and deaths sky rocketing.

Not only that, but whilst I’ve heard people say that the NHS should be able to cope with four or 5 thousand extra admissions per day, it isn’t just that they are having to treat COVID patients. They have all the other challenges of winter illness to deal with it. And whilst they survived the previous peaks, just about, they did so by cancelling other appointments with significant and negative impact. 

The reason why I was and remain wary of additional restrictions was that I thought such measures would have a serious impact beyond suppressing COVID with consequences for the economy and social, emotional life and health. My argument wasn’t that we should do nothing but rather that we should focus on seeking to increase NHS capacity for a temporary period to cope with the additional demand.  Those with good memories may remember that this has been my argument from early in the pandemic and that in the summer I argued that we needed a long term strategy to ensure the NHS could cope with future surges in demand. This might include the power to requisition sites in order to open up Nightingale hospitals as well as to call up a National Heath Reserve in times of crisis.

My approach arises from three reasons. The first is from my studies, research and experience whilst working in industry.  Our attempts to flatten the curve are reminiscent of manufacturing attempts to manage demand when it is in fact much better to try and become more responsive to the demand. This is what the Japanese learnt post war. Western manufacturers told the customers when they could have the product, the Japanese said, “we’ll have it ready for you when you want it” (Just In Time). Our health services have ever run to Just In Time. We schedule appointments and operations far into the future and we spend a lot of time handling what John Seddon called Failure Demand. In other words, our doctors’ surgeries and hospitals are full of people not because they are being treated by the original problem but because we are having to respond to the follow up issue. Postponing routine appointments and “non-urgent operations” during previous lockdowns will have added significantly to that.

The second reason is the situation we find ourselves in now. Politicians are having to make decisions about the next month or two ahead when they still don’t have real certainty about what we’ll be dealing with in a few weeks, never mind a few months. Rightly, in my opinion, they’ve resisted huge pressure to announce draconian measures now, just in case they are needed (I fully expected them to give way to such pressure but I got that prediction wrong).   However, this creates further uncertainty for the rest of us as we wait to hear what things might look like the.  Focusing on increasing NHS capacity might just help to relieve that uncertainty. We would know that restrictions are less likely because the problem would be solved by other means if required.

My third reason is a look at the bigger picture. Post Brexit and through the pandemic we’ve seen not just pressure on the NHS but also supply chain issues due to shortages of factory workers and lorry drivers. This has arisen partly because there has been a level of hostility between the UK and the EU. We are not at war, technically those countries remain our friends and allies in many respects but we didn’t part on the best of terms and it has long been known that there were people in the EU who saw it as a positive if Britain learnt its lesson the hard way. The result of this is that others with much more hostile intentions will have seen how vulnerable the UK is as an island nation to small changes such as the closure of borders or the loss of a fuel supply line. Add in to the mic our vulnerability to a viral or  bacterial epidemic and enemies of the future have a blue print for how to attack.  By shutting down our borders, cutting fuel lines and at its worst using a bit of biological warfare, rogue states, terrorists or an aggressive/expansionist super power could inflict a lot of damage. 

So, I think it makes sense to be prepared for such emergencies. It means for example that the surge capacity I referred to is a national security matter.  If we want our military to be able to protect us then maybe it matters as much that they know how to inject a vaccine or monitor a mechanical ventilator as it does that they know how to hold a rifle or drive a tank. This also means that we have a significant source of highly trained resource to support such a surge capacity.  As well as looking to retired doctors and nurses to come back at short notice we should be able to look to the armed forces to step in just as we might expect them to help drive lorries, fuel tankers, fire engines and ambulances.

Of course, one hopes that we never have to make such a call but that type of responsiveness would be good to be prepared for and would enable us to respond to a smaller crisis.

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