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| What will it take for the government to confront pressures on the NHS? | What will it take for the government to confront pressures on the NHS? |
| (10 days later) | |
| There is no safety valve for a health service running at full throttle with frazzled staff. The potential for significant harm to patients is increasing | |
| Fri 5 Jan 2018 11.43 GMT | |
| Last modified on Fri 5 Jan 2018 11.44 GMT | |
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| What pressure will the NHS be under in the first week of 2020, and what will be the consequences? | What pressure will the NHS be under in the first week of 2020, and what will be the consequences? |
| This winter, the NHS finally ran out of road. Among the deluge of data revealing the depth of the current problems, three shocking figures stand out. So far, 23 out of 152 acute hospital trusts have declared black alerts – this means a wet week in January is a “serious incident” preventing them offering comprehensive care. | This winter, the NHS finally ran out of road. Among the deluge of data revealing the depth of the current problems, three shocking figures stand out. So far, 23 out of 152 acute hospital trusts have declared black alerts – this means a wet week in January is a “serious incident” preventing them offering comprehensive care. |
| BBC analysis shows that, this winter, more than one in eight ambulances taking patients to hospital on an emergency call have had to wait more than 30 minutes to hand over to A&E staff. People who have had strokes are among them. | BBC analysis shows that, this winter, more than one in eight ambulances taking patients to hospital on an emergency call have had to wait more than 30 minutes to hand over to A&E staff. People who have had strokes are among them. |
| In the last week of 2017, bed occupancy averaged 91.7%, with virtually every trust in the country exceeding the widely accepted safe threshold of 85%. | In the last week of 2017, bed occupancy averaged 91.7%, with virtually every trust in the country exceeding the widely accepted safe threshold of 85%. |
| The pressures are no less in general practice. So there is no safety valve, no reserve capacity, no underused resource. Old-style winter planning – such as opening extra wards – is largely redundant because hospitals need their entire capacity all year round. So in winter they have nothing left to give. | The pressures are no less in general practice. So there is no safety valve, no reserve capacity, no underused resource. Old-style winter planning – such as opening extra wards – is largely redundant because hospitals need their entire capacity all year round. So in winter they have nothing left to give. |
| Action by NHS England, such as cancelling operations, is helping to ease the problem but will not solve it. Theresa May told the chief executive of NHS England, Simon Stevens, that she was holding him personally responsible for health service performance this winter. Replacing him with someone more politically quiescent would make no difference to the scale of the problem. | Action by NHS England, such as cancelling operations, is helping to ease the problem but will not solve it. Theresa May told the chief executive of NHS England, Simon Stevens, that she was holding him personally responsible for health service performance this winter. Replacing him with someone more politically quiescent would make no difference to the scale of the problem. |
| Choreographed apologies to patients and thanks to staff might be just enough to get ministers through this winter, but they won’t wash in the coming years. | Choreographed apologies to patients and thanks to staff might be just enough to get ministers through this winter, but they won’t wash in the coming years. |
| With demand growing relentlessly, the prospects for 2020 are dire. Unless there is an abrupt change of direction on local government funding, the impact of social care cuts is likely to be significantly worse. While adult social care grabs the headlines, concerns are growing about the depletion of child protection services, so even if more council cash is forthcoming it is not clear the NHS would feel all the benefit. | With demand growing relentlessly, the prospects for 2020 are dire. Unless there is an abrupt change of direction on local government funding, the impact of social care cuts is likely to be significantly worse. While adult social care grabs the headlines, concerns are growing about the depletion of child protection services, so even if more council cash is forthcoming it is not clear the NHS would feel all the benefit. |
| King’s Fund analysis of public health spending reveals services that might help control demand – such as advice, health checks and smoking cessation programmes – are all being cut. | King’s Fund analysis of public health spending reveals services that might help control demand – such as advice, health checks and smoking cessation programmes – are all being cut. |
| Excess winter deaths in the UK remain high by European standards, totalling 34,300 last year. The factors behind this are complicated and there is no simple connection with government policy, but a study led by Sir Michael Marmot has highlighted the link between old, poorly heated and insulated homes and higher mortality. This might provide one of the few practical and quick ways to prevent circulatory and respiratory diseases. Pushing harder on flu vaccinations is another. | Excess winter deaths in the UK remain high by European standards, totalling 34,300 last year. The factors behind this are complicated and there is no simple connection with government policy, but a study led by Sir Michael Marmot has highlighted the link between old, poorly heated and insulated homes and higher mortality. This might provide one of the few practical and quick ways to prevent circulatory and respiratory diseases. Pushing harder on flu vaccinations is another. |
| By 2020, many more hospitals should be matching the performance of the best in running their services as integrated systems with active management of patient flows. But with virtually every trust pushing into unsafe bed occupancy levels, this will not be enough. | By 2020, many more hospitals should be matching the performance of the best in running their services as integrated systems with active management of patient flows. But with virtually every trust pushing into unsafe bed occupancy levels, this will not be enough. |
| So in two years’ time, the blitz spirit that has sustained NHS staff through this winter is unlikely to be enough to stave off significant harm to a large number of patients. Growing risk is everywhere. Apart from the obvious impact of delays and cancellations, a system constantly running at full throttle with frazzled staff maximises the potential for serious errors. It will also push staff to quit the NHS just as there is a drive to improve retention. | So in two years’ time, the blitz spirit that has sustained NHS staff through this winter is unlikely to be enough to stave off significant harm to a large number of patients. Growing risk is everywhere. Apart from the obvious impact of delays and cancellations, a system constantly running at full throttle with frazzled staff maximises the potential for serious errors. It will also push staff to quit the NHS just as there is a drive to improve retention. |
| One way or another, the government will be forced to confront this. Choreographed apologies to patients and thanks to staff might be just enough to get ministers through this winter, but they won’t wash in the coming years. An avoidable death will cut through to the public’s consciousness. | One way or another, the government will be forced to confront this. Choreographed apologies to patients and thanks to staff might be just enough to get ministers through this winter, but they won’t wash in the coming years. An avoidable death will cut through to the public’s consciousness. |
| Richard Vize is a public policy commentator and analyst | Richard Vize is a public policy commentator and analyst |
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