One of the annual winter traditions in the UK is doom headlines about the NHS collapsing. This winter has been particularly grim with high levels of COVID, flu and other illnesses. Add into the mix key worker strikes including by nurses and ambulance drivers and it sounds like a lot of hospital A&E departments are struggling to cope.
Now, I’m not in a position to comment on whether things are worse or the same as previous years. Even if we are in no different a position, we shouldn’t really have a couple of months when the whole care system is in peril and people fear the worse for loved ones who get sick. I’m also not qualified to determine whether or not additional finance is the solution, though I understand that the UK does spend less on healthcare as a % of GDP.
However, I do have an area of interest which may be relevant. Prior to working in the church, my role was in operations management and involved capacity management. This involved managing supply and demand. The problem that the NHS has is very similar to what we experienced in repair and overhaul contexts. Whilst some maintenance and overhaul work was routine, scheduled and to a clear timetable, a lot of the repairs were unpredictable in terms of the when they would come in, how many at a time and the level/complexity of work required. There were also particular times when we had to respond to a specific surge in demand, for example when supporting the RAF through conflicts such as the Gulf War.
So, here’s the first thing to say about NHS capacity and demand. The NHS does not need the same amount of capacity all the year round. The detailed needs are a little unpredictable, however, we can observe patterns and identify when demand will be higher, primarily through the winter months. I’ve been arguing throughout the pandemic that we need to find a way of creating surge capacity for crisis moments. This is why I’ve argued previously that we should create a health service reserve of retired and former nurses and doctors to provide additional support during COVID and influenza waves.
Secondly, one of the things that we learnt, which is relevant to the NHS is that a lot of demand that puts pressure on capacity is what we call “failure demand.” Failure demand is where someone or something comes back to you for another look because you failed to deal with it effectively the first time round.
I believe that a substantial element of the demand pressure on emergency services at the moment is what we would classify as failure demand. There are a few ways in which we see this. It includes when an ambulance has to be called out again because the person wasn’t treated effectively the first time. It also includes where people have seen their health deteriorate so that they are more vulnerable to acute health issues now because more routine and/or chronic conditions haven’t been treated effectively over a period of time. This is of course what you would expect to see when routine surgery and therapy has had to be postponed due to the pandemic.
Similarly, I think there are questions about what gets spotted and when. It is best to identify problems early before they become serious. In fact over the years, a big help in spotting risks early has been routine dental appointments. At your six monthly check up, not only did your NHS dentist make sure you didn’t need any fillings but they also kept an eye out for potential early warning signs of worrying tumours, growths and neurological complaints. Of course, they could not diagnose or treat such things but they could spot the warning signs and refer you on. Sadly, a lot of people are currently not able to see an NHS dentist meaning that there’s a risk that these things go unspotted until much later by which time it may even be too late.
So, it’s also about systems thinking. It’s about seeing how the whole thing needs to fit and work together. This also includes the issue of social care too -though that’s worth a discussion in its own right.
So, my proposals to help the NHS are that whilst we may need further investment into our hospitals, before we do so, we need to make sure that the foundations are right. This means making sure that the primary healthcare givers are properly supported with the right resources to enable them to spot problems early. This may well reduce pressure on our A&E services further down the line.