Insight by Jan Filochowski, a key contributor to Møller Institute Healthcare Programmes.
Health service facilities and staff are being stretched to a breaking point that will take costly short-term measures to fix.
Barely a day passes without a new NHS tale of inadequate performance, excessive patient waits, services not delivered, trusts effectively bankrupt, or even preventable deaths attributed to unbearable pressure on services and staff.
The reports come from doctors, august professional bodies, trusts, patient watchdogs, patients themselves and expert commentators. But somehow this isn’t yet registering as general public uproar that the NHS is now failing. Why on earth not?
I think the explanation lies in the fact that NHS healthcare, unlike, say, the Grenfell Tower disaster, doesn’t give us a calamitous across-the-board failure. It is so varied and comprehensive that while many services may be on their knees or worse, particularly at times of maximum pressure, others will be delivering adequate or even great services at the same time. There is a mixed picture. And for those who don’t want to see or face up to the hard facts, the possibility of highlighting other ones, and carrying on as before, presents itself.
However, this can only go on for so long. If what is causing the increasingly poor performance is unrecognised and unaddressed, it will, as it has done over the past couple of years, get progressively worse, as the dismal performance figures released by NHS England for this winter show. But it won’t do it in a predictable, sliding-down-a-gentle-slope fashion – or not for ever.
As performance deteriorates, correcting the failures of yesterday becomes the first requirement of today, leaving even less time and fewer resources to deal with today’s problems, which continue to be more than the NHS can handle. So the rate of decline accelerates. And breaking points appear. As facilities and staff are stretched further and further, continuing to provide a service but an ever more inadequate one, they eventually reach a point where there is no more slack and the NHS simply runs out of capacity. Often there is no space in nursing and care homes to discharge patients to. Which can mean no hospital beds are available, as those patients are still in them. So you can’t admit that critically ill patient. There are no spare staff in A&E, so patients who need to be seen immediately have to wait hours. There are no more ambulances, so patients who need to get to hospital in minutes take an hour, and might die.
The figures are now showing failure multiplying while demand increases only marginally
When this happens, as it is now, pretty much across the board, things don’t get worse by 3% because demand has increased by 3%, they get worse by 50% or 100% because there is no slack left to deal with what is only a 3% increase. And the figures are now showing just this: failure multiplying while demand increases only marginally.
If this is where we are now, and there is much evidence it is, the performance of the NHS will now quickly get much worse. And this will, sometime soon, become clear to all. At that point something will have to be done – and will be done.
What will that be? It won’t be a promise to give the NHS an unspecified level of long-term funding some time. It will have to be immediate service increases and improvements with extra resources, to stem the flood of failure here and now: more money, yes, but more facilities, and more staff, all immediately, and, with costs guaranteed by government, feasible using quick-fix and stop-gap means. It will be quite costly, though the extra amount you can usefully spend in the short term isn’t huge.
But the alternative at that point will be a collapse of the NHS. And the sobering lesson is that had the warning signs been heeded and action taken before things came to this pass, the cost of putting things right would have been far less. The breaking point would have been avoided. Once the collapse has been prevented, we can all look at how we get things sorted permanently. Get ready for the penny to drop.
Jan Filochowski is a key contributor to Møller Institute Healthcare Programmes and was the CEO of various NHS trusts for 20 years. He retired as chief executive of Great Ormond Street Hospital in 2013. This article was published in the Guardian, 6 April 2018.