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Feature NHS Pressure

Winter crisis? What crisis?

BMJ 2017; 359 doi: (Published 13 November 2017) Cite this as: BMJ 2017;359:j5203
  1. Nigel Hawkes, freelance journalist, London, UK
  1. nigel.hawkes1{at}

Are the doom laden headlines that warn of imminent NHS collapse justified, asks Nigel Hawkes—and are we making progress on plans to prevent it?

Winter provides a test of NHS resilience, each year foreshadowed by evermore claims that this time there really will be a major breakdown. No winter since 2012-13 has passed without warnings of crisis, each year’s predictions more apocalyptic than the last.

Yet the NHS has managed to survive so far. The Care Quality Commission, England’s health and social care regulator, last month reported that the quality of care is mostly good and improving overall.1 Public satisfaction has declined from its 2010 peak, when 70% of respondents declared themselves very or quite satisfied, but in 2016 it still stood at 63%—“high by historic[al] standards,” says the King’s Fund.2 Is the public blind? Is the NHS indeed on the verge of collapse, unseen by those it serves?

Last month, the annual warnings from health chiefs began in earnest. NHS Confederation chief executive, Niall Dickson, said there was “an even greater sense of foreboding this year than last,” echoed by NHS England chair, Malcolm Grant, who said: “We face winter better prepared than we have ever been but more scared than we have ever been.” Andrew Foster, chief executive of Wrightington, Wigan and Leigh NHS Trust, tweeted: “A perfect storm of funding and workforce shortages vs an abundance of patients.”

Although these warnings of a winter crisis are widespread, the doomsayers never specify how we would recognise one if it happened. The NHS is not going out of business like Monarch Airlines. Crisis is the wrong word since it implies an event that, once overcome, is history. The process is really more akin to slow strangulation, with winter tightening the ligature.

“More will die”

The result is not the …

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