The expectation is that the NHS will be well prepared for the increase in demand over the winter period. After all it happens every year! True, but there’s winter pressure and there’s massive winter pressure. Potentially we the people are creating some of the problem.
When we begin to analyse urgent care statistics for the period over Christmas and New Year and look not just at the A&E department but also the NHS 111 and Ambulance Services we can start to appreciate the real impact of our behaviour on the system that supports us and maybe see beyond the headlines.
In the visualisation below we can see the daily trend in the number calls made to NHS 111. While we see a regular weekend increase when GP Practices are closed, the Christmas and New year weekend and bank-holiday period has shown not just a more sustained increase but also a step change in demand of around 40%.
Should we blame the flu? Well yes, and its fair for us to if we have all been and had our jab and ensured all those around us have done. Then there’s making sure we store and reheat our leftover turkey properly and so on…
In the chart below we can see how this additional call volume pressure impacts NHS 111 and in particular, the number of calls NHS 111 is unable to answer while striving to maintain a high quality, safe service.
Many of these abandoned calls move demand downstream and the caller may instead have gone on to attend an Urgent Care Centre or A&E departments or call 999 and end up in an ambulance.
Its difficult to tell but it would be foolish to suggest these additional missed NHS 111 calls placed no further burden on the urgent care system. So an overwhelmed NHS 111 service is likely to create a disproportionate level of pressure on other parts of the urgent care system.
So what about Christmas cheer? The chart below shows the pattern of ambulance arrivals at A&E departments over the Christmas and New Year period.
Its noticeable that leading up to Christmas we still see relatively little variability in the number of ambulances arriving at A&E departments. At New Year though there’s a 13% rise for that one night.
You can just picture the chaos. These are not patients with twisted ankles who apologise for causing a fuss. They’re the more difficult to deal with inebriated, often volatile type who require a more time-consuming response and place a disproportionate level of pressure on the ambulance crews and waiting A&E teams. The knock on effect for 111,ambulance and acute trusts who have to attempt to deal with this tremendous spike must be immense, if all your staff are working on one day they need time off afterwards and so we would expect the effects to go on for days. We note that within a week of last week’s reported apocalypse, the number of ambulances delayed 30-60 minutes has halved and the number of patients waiting 4 hours for a hospital bed was 13% below its Winter 2016/17 peak in December. Ah some balance.
While media focus has been on trolley waits, ambulance delays and worst ever A&E 4-hour performance we’d argue that considering the massive increase demand the system coped extremely well despite the avoidable public behaviour driven pressures.
There’s no denying that the NHS requires additional resources to cope with the challenges of the ageing population, and that even if we all took responsibility for looking after ourselves over the Winter period, historic underfunding still means we haven’t the skilled trained staff in the NHS to cope with the inevitable spikes in winter pressures.
But we feel strongly that constant focus on the A&E department as the fulcrum of the winter pressures problem misses the point somewhat.
Only by showing how winter pressures affect all parts of the urgent care system, and by understanding how pressures on one part of the system impact other parts, can we hope to have a meaningful conversation about how well the NHS is working.
This enhanced understanding will support local system leaders to develop the right solutions to our winter excesses.