Is the NHS overwhelmed?
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o51 (Published 11 January 2022) Cite this as: BMJ 2022;376:o51
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Dear Editor,
I have enjoyed reading Hugh Alderwick’s article exploring the current state of the NHS (1). The only thing to add to this most excellent of editorials is to say, drawing on a parallel from the mountaineering world, that the majority of accidents and tragedies occur on the way down after an arduous climb.
The pandemic was a steep and long climb and one that has been emotionally and physically challenging. During the descent one is tired and it is getting colder and darker. Indeed in healthcare the sympathy has evaporated and has on occasions been replaced by frank hostility. Dark are the times when fear, anxiety and exhaustion amongst those with patient facing roles are palpable. When the pandemic wanes the sense of victory and relief is likely to be overshadowed by the pressures of increased demand over backlog and ongoing mismatch between resources available (or perhaps not available) and the societal expectations.
You can’t have cake and eat it. Something’s is going to crack. And like in the mountains when the avalanche or crevasse fall often destroys dreams, the dream of what is the National Health Service may shatter in a way that could be irreversible.
(1) Alderwick H. Is the NHS overwhelmed? BMJ 2022; 376:o51.
Competing interests: No competing interests
Dear Editor
In discussing the current pressures on the NHS, Alderwick points out that there cannot be a single definition of an ‘overwhelmed’ health system.(1) Rather, the performance of the health system has to assessed in the context of contemporary values and expectations.
However, can this contextual assessment be reduced simply to the NHS’s ability to provide people with the ‘care they need’? The idea of a person’s ‘need’ is usually taken as obvious. But, is it really so simple? A need has to be distinguished from a want. And, in the words of Lady Hale (former President of the Supreme Court), ‘we cannot always have what we want’.(2)
One definition of a ‘need’ is ‘what is essential for the ordinary business of living’.(3) Apart from healthcare, many other services (e.g. roads, security, education, etc.) are also essential for daily life. Given that public resources are inescapably finite, we have to be realistic about what we can expect from the NHS. A change in approach might help. Perhaps, we should start thinking about what NHS services are not essential, so that we can then focus on real needs. This might lead us to a better understanding of an overwhelmed NHS.
1. Alderwick H. Is the NHS overwhelmed? BMJ. 2022;376:o51.
2. Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67, [2014] AC 591 [45].
3. R v Gloucestershire County Council, Ex p Barry [1997] AC 584 (HL) 598G (Lord Lloyd) .
Competing interests: No competing interests
Dear Editor
The NHS is not providing the level of care expected by UK citizens. There are now fewer professionals than there are required to adequately manage present demand, and even less when considering the levels of absenteeism due to the current pandemic.
The NHS needs to look for solutions to maximise efficiency considering the limitations present. Remote consultations have had a considerable impact in allowing services, letting clinicians to consult from home when simply isolating, and reducing the number of patients in waiting areas by having some of the consultations over phone or video when an examination is not required. Patients benefit and welcome the choice of not commuting, dedicating too much time to a hospital or GP appointment. Many would prefer to have a much quicker remote engagement.
One issue to be considered when using telephony is the fact that the majority of these calls are from hidden numbers, and we live in a world where people receive far too many nuisance calls. Patients argue that they have not been contacted when probably they have dismissed hidden number calls, presuming they were not relevant.
Digital solutions are advancing, helping in this transition, but telephony needs also to progress. What if the calls were not anonymous? If, for example, all NHS hospitals were to be identified as 113 and primary care as 114, patients could identify easily the importance of the call, not a nuisance but a health issue. They would be more likely to answer the call, and they should be able to contact the service back as they would have an idea of who was supposed to be calling them.
Clinicians need to identify themselves better with the patients when working remotely. Change is paramount to facilitate it.
Competing interests: No competing interests
Cavalier policies are not enough. We're not getting New Model Roundhead efficiency
Dear Editor
Hospitals are overwhelmed.
It is rather as if the NHS Titanic has collided with the Covid iceberg, and is now sinking.
Without trace.
There has been a third wave this winter, but it happily seems reduced compared to the second wave a year ago. Even so, the Covid daily death toll unfortunately went above a thousand on February 1, 2022.
When Covid first struck, back in early 2020, doctors didn't know what had hit them. First they tried (useless) antibiotics against a viral infection. At one point, only the basic generic steroid dexamethasone appeared a defence. Today, we have only partial vaccines, and not enough antivirals.
Coivd is just as difficult as HIV, and it took so long - too long - for HIV treatments to emerge.
If it hadn't been a mild winter, if the omicron variant hadn't been less severe, what would have happened then?
Christopher Murray, in the Lancet (1), is hopelessly overoptimistic about Covid.
Covid is much more aggressive even than flu. Covid is a terribly smart pathogen, an auto-immune disease able to outmanoeuver antibodies, B-cells, T-cells. Covid is like HIV rather than flu, in terms of threat.
Being cavalier about the Covid colossus is suicidal.
We're not getting a New Model NHS, to cope with a vicious menace that may be far bigger than we realize at the moment.
What about:
The pandemic isn't going to end. It's just started...
References:
Covid-19 will continue but the end of the pandemic is near. C. J. L. Murray, The Lancet. Vol.399. January 29, 2022. pgs. 417-19.
Competing interests: No competing interests