According to Einstein, the definition of insanity is to do the same thing over and over again while expecting different results. Welcome to winter in the NHS.
It’s not exactly a secret. Winter is bad for the NHS. It’s the time of year when resources are the most stretched and when various groups in society, but particularly the most vulnerable, are susceptible to ill health. This year promises to be worse than most, with services including A&E likely to put under pressure as never before. But, the same was said last year. And the year before that. So why, in Einstein’s words, are the same things happening over and over again?
That is not to say the problem is being exaggerated. It certainly is not. There are clearly enormous strains on A&E units up and down the country, there is an issue of admittance to hospital for conditions that could be addressed in primary care, and there are problems with bed-blocking and re-admittance, particularly amongst the elderly. But this year all the signs were there. The Government was forced to inject money into A&E during the summer, so there was no escaping the fact that further problems would be faced once winter set in.
The Department of Health now faces two problems. The first is what to do about what are longstanding problems, as putting more money into A&E year after year is treating the symptoms rather than the underlying condition. It’s not a quick fix. The answer will lie in primary care and ensuring that the services are in place to make sure patients are only treated in hospital when necessary. It is also inevitable that the upward trend in the amount of NHS work being undertaken by the private sector will continue in order to provide additional capacity and alleviate some pressure on NHS trusts.
The second problem is one of public confidence. This is a problem of the Department of Health’s own making. Headlines about how the DH is scrambling to recruit staff and reopen wards to cope with winter demand will do little to reassure the public as it is an obvious reaction to negative headlines about the problems facing the health service. Indeed it’s probably too late for the DH to do much in the way of public reassurance this year. There will be weeks and months of headlines about patient waiting times and cancelled operations. Little, short of the expected crisis failing to materialise, will prevent that.
Lessons need to be learned for winter 2014/15 and the DH could do worse than to start talking about the preparations being made for winter far earlier in the year – potentially during the summer or even sooner. This would allow the Department to seize the initiative and show it’s in the driving seat rather than in recent years where it appears to be responding to the fears of the Opposition, the press and the public.
If the DH is still on the back foot this time next year and expects different results, they will be proving Einstein’s definition.