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Breaking the cycle of winter crises

The problem with the NHS is, sooner or later, everything is filtered through hospitals

A couple of years ago, I interviewed a ward manager about the various travails associated with his role. We covered lots of areas, but one thing he said really stuck.

‘If I had to sum up what is wrong with the NHS in one sentence it would be: sooner or later, everything is filtered through hospitals.’

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Cuts in public health programmes turns bad habits into morbidities; shortages of GPs mean long queues for triage in A&E; threadbare social care services turn the elderly and vulnerable into bedblockers. These are all stories we are too familiar with, and yet the cycles keep repeating, even as this winter the tailbacks of ambulances build up around the hospitals.

Clearly not all the problems are structural. A long term failure of workforce planning, and cuts to real terms income have left the NHS understaffed, overworked and demoralised. To be fair to the policy makers the COVID backlog is also a factor, but it feels that some form of restructure is going to be necessary – lest these crises steadily worsen.

Any political discussion of NHS reform is almost invariably a one-person birthday party: nobody gets any presents they didn’t bring. For the right, it is question of increasing market efficiencies and invoking the dark spectre of moral hazard wherever medical treatment is a right, not a product. For the left it is generally a question of more funding, and regularly accussing the other side of privatisation. Consensus seems impossible. And any restucture inevitably leads to short term disruption and losses to productivity.

But logic is moving us inexorably towards a health service that catches problems earlier and less expensively in primary care or the community. Somehow the ceaseless cascade of patients into acute care must end.