Constant crisis? Reflecting on another long winter for the NHS.
One shouldn’t speak to soon, but it feels like the worst of this winter’s weather might be behind us. With temperatures starting to rise and with a few sunny days under our belts for 2019, the bitterly cold mornings of this January seem long ago – or at least not too recent. Although winter isn’t officially over for a few weeks yet, we are beginning to gather perspective and data enough to begin to look at how the NHS has fared through a predictably challenging few months.
And winter has been tough for the health service, with the language of ‘winter pressures’ and even a ‘winter crisis’ seeming never too far away. The news headlines provide one crude way of gauging the prevailing, and here are just a few examples that illustrate media anxiety over the health services’ ability to weather the winter months:
- Top doctors warn of ‘worst winter’ in hospitals as A&E crisis grows
- A&E figures ‘show NHS in winter crisis’
- NHS winter crisis underway as figures show hospital trusts running out of beds
- Leaks show full extent of NHS winter crisis
- NHS winter crisis officially worst on record and patients still suffering, final figures show
- Hospitals in race to combat ‘toughest ever’ winter crisis for NHS
If these kinds of headlines feel like an annual fixture, well, they should. Each of the above headlines represents a different winter, starting in 2013/14 and running to 2018/19. A winter crisis no longer feels exceptional: it seems normal.
The factchecking charity Full Fact published an analysis in 2017, updated in January 2018, testing the impression that ‘winter crises’ have become a sort of routine. Counting the number of newspaper articles using both the word “NHS” and phrase “winter crisis”, they showed that reporting of an ‘NHS winter crisis’ was rare between 2002 and 2012, but has become common since 2013.
It’s not quite correct to say that the health service has reached a state of ‘constant crisis’ so much as that seasonal crises have become normalised. Either way, it’s hard to see how this sort of position could continue to be maintained for too long. Systems and the people who work within them can only have so much resilience to crises, and the strain of dealing with extreme challenge only builds with time.
A&E waiting times figures arguably provide some measure of the service’s ability to renormalise after winter. Over the last few years these figures have shown sharp spikes in the proportion of patients waiting more than four hours during the months of December to March; the troubling point is that the scale of the peaks has risen and the average for the April to November period has also pushed upwards. This January, almost one in six people attending A&E (15.6%) spent more than four hours in the department – the highest since records began. In major (type 1) emergency departments, 23.9% of patients waited more than four hours.
NHS staff, too, feel the pressure. Although rates of winter flu and vomiting bugs have fallen this year compared to last, overall demand has increased dramatically. Staffing numbers have failed to keep pace, as highlighted in an important new report by the Health Foundation, and the NHS faces challenges in recruiting and retaining a suitably skilled workforce across all of its sectors. Pressure on staff, including long hours and poor work life balance, have been identified as particular concerns. This is an issue that we will return to in another blog in the coming weeks.
For the system as a whole, and for policy makers, the challenge ahead is of breaking the cycle of crisis that the NHS has found itself in. There are no simple answers or golden bullets, but a number of factors appear important. The workforce needs support and services need funding to deliver against rising demand in all sectors. Equally, more must be done to move care out of hospitals and manage the impact of long term conditions through a coordinated approach to ongoing care and support. The Principles of Person Centred Care identifies a number of features that describe care that is structured around the patient; embracing these should help to deliver a more holistic approach that anticipates and manages need.
- Chris Graham, March 2019