They're angels of course, best to use their time efficiently

Frances Ryan is betraying, again, her usual lack of knowledge of how this real world out here works. For she’s demanding that non-urgent operations should still be taking place at the moment of peak demand for the National Health Service. Nope, that’s not the way this universe out here works, not at all:

Halfway through the opening episode of BBC’s Hospital this week, we see an orthopaedic surgeon stand in the middle of an empty operating theatre. It’s 8.30am and the surgeon – dressed in scrubs and ready to work – is forced to stop for the day: without enough intensive care beds, there’s nowhere for his patients to recover after surgery.

Filmed at two Nottingham hospitals this winter, this scene takes place a few days after the government announced all non-urgent operations would be cancelled across the country because of mass bed shortages.

Watching Hospital is a scary, surreal experience: a sort of shot-by-shot chronicle of what feels like something historians may later use as evidence of the decline of one of the world’s greatest social institutions.

This isn’t evidence of a decline in the NHS – which isn’t one of the world’s great social institutions either. Instead, it’s evidence of someone, somewhere, being sensible about the NHS.

Think on it a moment. We do not go shopping on Christmas Eve for that t-shirt we’ll wear on our holibubs in February, do we? No, for we know that every shop in the country will be packed with husbands doing that all important Christmas shopping they’ve just had 364 days to prepare for but haven’t. The shopping system is built to, just about and creaking at the edges to be sure, cope with peak demand. And that means shifting some non-time dependent demand to moments outside that period of that peak demand. Like shopping for the holiday t-shirt when men in fear of their wives are not thronging the red frilly underwear counter.

This is true of any system which faces a reasonably predictable change in time necessary demand over said time. It’s most certainly true of a health care system. Those with ‘flu in January need to be treated for their ‘flu in January. We cannot wait until March to get to them for they’ll be dead or better by then anyway. Those with curvature of the spine can and should be shifted from January to March. Yes, sure, it’s something that should be dealt with but it’s not necessary to do it today.

You know, this triage thing? Exactly what every A&E in the country employs at least one land whale to organise?

So, when running a health care system we do so to have just, and only just, enough capacity to treat those who really must have treatment now at those periods of peak demand for health care. Those whose treatment is not time dependent should, actively must in fact, be time shifted to when there is that spare, not over-used capacity. Because that’s the best use of the overall resources we’re going to devote to health care.

The alternative would be staff and wards grossly underused in those low demand times. Which is a pure waste of those societally scarce resources, isn’t it?

I happened to be in A&E at Nottingham Queen’s Medical Centre with breathing problems while the series was being filmed. As I waited to be seen, A4 posters stuck to the doors told me of my right to choose to be filmed or not, while an elderly woman behind a screen in need of a catheter repeatedly called out for a member of staff to tell her where she was. I was relatively lucky: I had several tests fitted into six hours, and the medical team were kind and efficient. A few days later, as I recovered at home, a respiratory nurse told me: “If you need to call 999, do, even if you see on the news we’ve got no beds.”

It’s shameful this would ever need to be said – that in someone’s most vulnerable moment, they would have to calculate whether the NHS could help them. But then, this all feels quite shameful, doesn’t it? There’s a moment in Hospital in which a 12-year-old boy, Keilan, with a spinal curve so severe it’s reducing his lung capacity – is shown quietly asking if his major surgery to correct it will be postponed. It has already been cancelled twice. He has waited almost a year for the surgery – and he’s so anxious that his dad tells the doctor Keilan can’t sleep. “As time goes on, his curve has gone from 35 to 80 degrees in less than two years,” his dad explains.

That Frances Ryan got treated, because she needed to be treated right now, that Keilan didn’t get treated because he didn’t need to be treated right now isn’t evidence of Tory Scum not funding the NHS, or the plutocrats wanting to kill off the poor nor even of something wrong in the NHS. It’s the way the damn thing is supposed to work. Build the capacity to treat, and only to treat, time dependent patients at that moment of peak demand. Non-time dependent treatment should be shifted through the seasons to take advantage of the spare capacity revealed at those non-peak moments.

Anyone not grasping this basic point just isn’t thinking.

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    • Yes, there is a point more basic than the basic point. The optimal total capacity is a question that must be answered (not just how best to adapt to undercapacity), and the best way to answer it that we know of is the free market, in which anyone can build more capacity, in anticipation of making a profit. Oh, that’s right, we are in a fantasy universe where everyone thinks it’s horrible “that in someone’s most vulnerable moment, they would have to calculate” – where it’s better that health care not have a price, but that need be a claim against ability. Surprise, there are no beds.

  1. Actually there is enough capacity in the system already, the fallacy is to assume that the only choice in town is the state-run GUM store when in fact there are plenty of private providers ready and willing to take in extra patients in exchange for hard cash. The NHS aught to out-sourcing care to the private sector the next time they run out of beds or get overwhelmed by the winter sniffles.
    The risk of course is that someone might find out that the private healthcare sector can do the routine stuff cheaper, faster and with better outcomes than the NHS.

    • NHS does outsource to private outfits. Sometimes those outfits have wards right there in the NHS hospital and do routine stuff. With NHS consultants maximising their throughput. Farbeit from me to suggest that this might lead to a consultant giving you a date a year away for the NHS ward but next week in the private one.

      • Yes you are quite correct, and everyone has heard a story or two of NHS consultants advising that the NHS surgery waiting list is 6 months before mentioning that they happen to also do a bit of private work and can fit you in next week if you want to get your credit card out.
        I would be interested to know if the NHS ever hands patients over to private providers and picks up the tab? I vaguely seem to recall one of the many NHS crisis in the distant past where they shipped a number of patients off to the continent for routine surgery.

  2. The main problem with the NHS is that no-one in the whole bloody organisation can be disciplined, especially if you are an ethnic so that about 1% of admin and 5 % of nurses actually give a toss.

    And whoever came up with the idea of paying agency nurses !0x employed nurses should be shot.