Analysis

The current crisis in the NHS: are we missing the point? An essay by Jan Filochowski

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2122 (Published 24 April 2015) Cite this as: BMJ 2015;350:h2122
  1. Jan Filochowski, visiting professor
  1. 1School of Information Systems, Computing and Mathematics, Brunel University, Uxbridge UB8 3PH, UK
  1. jan{at}filochowski.net

Jan Filochowski argues that the NHS can no longer respond to financial challenges by simply reducing capacity and has to adopt a new approach that acknowledges and meets demand

A year ago the highly respected Commonwealth Fund made its latest assessment of first world health systems and rated the NHS top.1 Politicians of all hues hailed the assessment. The praise peaked in the Scottish referendum campaign, with the “yes” camp saying vote for independence to preserve the NHS and pro-UK politicians saying the NHS was safest within the United Kingdom. And polls consistently show the NHS located at the apex of the nation’s affections.

Since then, there has been an increasing chorus that the NHS needs more funding to continue to thrive, with the £8bn specified in NHS England’s Five Year Forward View in November widely accepted as authoritative but the assumed savings of £22bn much less so.2 The Forward View did not refer to any impending crisis. However, by December the NHS was embroiled in its biggest one for a decade, with long and unacceptable waits breaking out everywhere. Despite two successive mild winters without a major flu outbreak, the NHS has hardly coped this year. Why has this happened, what does it tell us about the sustainability of the NHS, and how can we begin to rectify it?

System in crisis

Waits of over four hours in emergency departments (the accepted measure of coping) were 50% higher in 2014-15 than in 2013-14.3 Delays in discharging patients needing post-hospital care are 29% higher than a year ago, 49% higher than two years ago.4 The extra beds needed to accommodate these patients have been found by taking surgical, intensive care, and maternity beds. This has displaced other patients, creating new waits. Cancelled operations increased by 32% in a year. …

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