New surveillance systems might help

Sudden increases in hospital admissions have been a feature of the NHS for many years, but explicit plans for their management were not introduced until 1996, after a particularly severe crisis that January.1 Since then research has been proposed,2 and the emergency services action team has made practical recommendations on such issues as diverting hospital admissions or speeding discharge arrangements.3 This work has concentrated on what to do when winter pressures arise, and this year most hospitals will be better prepared. However, the NHS also needs to be able to anticipate the rise in demand so it can implement plans and notify the public. This issue has received less attention, yet early indicators exist that could be used to warn of impending problems.

Effective forecasting of peaks requires an understanding of their causes and indicators that rise at least a few days before the increase in demand. In two of the past three years peak demand in the NHS coincided with the new year …