NHS's fundamental problems must be solved

EDITOR—The NHS Confederation and the BMA have argued that the recent problems in dealing with emergency demand conceal more fundamental problems: the NHS has too little capacity run at too high a rate of use.1

Running hospitals at the current rates of occupancy is not efficient. Bagust et al show that hospital occupancy of more than 85% will guarantee periodic bed crises and the cancellation of hospital admissions.2 NHS occupancy information excludes patients who stay less than one day and therefore underestimates the true picture. In critical care a growing body of evidence suggests that there is insufficient spare capacity in the system.

Many NHS staff have a ridiculous workload. They are required to cope with the chaotic results of high levels of admissions and occupancy and, in particular, the problem of patients on outlying wards. There is no time for staff to muster new resources, and nurses have had the parts of their work that allowed recuperation devolved to other staff. There is growing evidence that these problems affect outcomes and lead to staff …