NHS strains under flu epidemic

PM sorry for NHS chaos as thousands queue in ambulances

By Chris Smyth
The Times, January 4, 2018

Theresa May has apologised to patients hit by winter chaos in the NHS as figures showed that thousands of patients who arrived at hospital by ambulance struggled to get into A&E because hospitals were so full.

Long waits for ambulances to hand over patients doubled in a week as flu increased over Christmas.

NHS leaders say that so many patients arriving in A&E need admitting that they are running out of beds. Hospitals were well above the 85 per cent bed occupancy level considered safe, with a national average of 91.7 per cent last week.

Professor Derek Alderson, president of the Royal College of Surgeons, said: “That many hospitals have full wards, even after cancelling operations, shows that we simply don’t have sufficient numbers of beds in English hospitals.”

Sir Vince Cable, the Liberal Democrat leader, said: “Every day seems to bring yet more bad news about the state of the health service. The blame lies firmly at the government’s door. Ministers refused to provide the funding top NHS officials said was necessary and now patients are paying the price.”

Professor John Appleby of the Nuffield Trust think tank agreed that the NHS simply did not have enough money or staff to cope. “The sobering reality is that winter for the NHS has hardly started,” he said. “The service is likely to face another three months of exceptional need for care, and it is starting from a precarious position. There is an underlying mismatch between the capacity to deliver care and the level of care patients require.”

The NHS 111 urgent care helpline had its busiest week on record as almost half a million patients called for advice over the Christmas period, resulting in 58,000 ambulances being sent out.


Socialized medicine update: Britain cancels 50,000 surgeries as NHS hospitals face winter crisis

By Philip Klein
Washington Examiner, January 4, 2018

American liberals such as Sen. Bernie Sanders like to tout socialized healthcare systems such as Britain's for spending less and covering everybody, but here's a reality check you shouldn't expect to hear in any of his fiery speeches: the British government-run National Health Service has abruptly canceled 50,000 nonemergency surgeries due to overcrowding at hospitals this winter.

Do we think Americans are going to stand for a system in which government officials cancel surgeries en masse based on bureaucratic judgments about what is urgent and go on TV to offer inadequate apologies?



By Don McCanne, M.D.

It is expected to be a bad year for influenza, and the United Kingdom is already experiencing an overload of its health care delivery system. Because of the overload, 50,000 nonemergency surgeries are being postponed. What lessons are there for the United States?

The capacity of the system is crucial, and that requires balance. If there is excess capacity then personnel and facilities are underused and that wastes money. Furthermore, excess capacity results in overutilization of services that may be of little value. When capacity is at the right balance, services of little or no value tend to be crowded out, while essential services are readily accommodated.

When capacity is inadequate, excessive queues for elective services tend to form, and acutely ill patients may be subjected to crowded conditions such as being admitted to hospital corridors, or, worse, being held in ambulances for hours. Though hospitals should not deliberately create excess capacity, they do need to have plans for surge capacity such as with epidemics or major catastrophes. Triage becomes even more important during times that the system is stressed.

At such times, postponing elective procedures in order to handle the surge in urgent problems may reflect appropriate planning. But if the system is running near capacity at times of less urgent demand, then the capacity may be deficient. The same can be said if excessive queues persist throughout the year, including times when no reasons for surges exist.

It appears that the conservative and neoliberal governments of recent decades may have underfunded the NHS resulting in deficient capacity. Certainly the opponents of single payer reform in the United States are going to attack the NHS for cancelling surgeries (see Philip Klein's comment, above). Underfunding is a vulnerability of publicly financed systems during inevitable intervals of conservative control. But the counter to this is the popularity of public programs that drives political support for them.

Lessons? Support public planning of a balanced capacity in the system. Support public stewards who will fund the system adequately. Counter the naysayers by spreading the truth about a well designed single payer system that would work well for all of us in the United States.

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