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  • Alexander Thompson

Now is the winter of our discontent

Happy New Year to all of you. A time of celebration, of reflection, of goal-setting and ambition driving. Yet sadly a time of year when the NHS we love typically faces such great operational pressure that the maintanence of delivery of high quality care becomes a daily battle.

Unlike the popular Game of Thrones quote "winter is coming", we can say with certainty that winter is well and truly here.


News outlets are animated with the tales of a health and social care crisis. In my most recent blog post I discussed the concept that disaster are in fact not natural. The same can be said of crises. The NHS is not in this position through cosmic bad-luck, but through decades of politics and policies - proactive choices.


Influenza A is rife. Hospital admissions with or due to flu are significant. COVID has made a resurgence and although not occupying anywhere near the level of critical care beds it once did, continues to work in partnership with influenza to significantly complicate the delivery of NHS services through requirement of infection prevention and control measures across healthcare estate.


Hospitals are bursting at the seams with patients, cohorting 'escalation beds' in places sometimes not seen previously. The numbers of patients medically fit for discharge (i.e. they have no medical need to be in an acute hospital bed) continues to stay high and high occupancy rates have a direct impact on the ability to flow patients out of the emergency department and into an appropriate bed space. Social care workforce data shows that vacancies have risen to the highest rate since records began in 2012/13, increasing by 52% in 2021/22 to 165,000 vacant posts.


Ambulance Services continue to struggle to deliver against core response targets with published November statistics showing national mean and 90th centile response times well beyond what is required for safe pre-hospital healthcare:

(Graphs reproduced from AQI Statistical Note, published 8 December 2022)


In much of the country ambulances continue to spend far too long outside hospitals waiting to handover patients. If you are interested in some recent data on this, the Association of Ambulance Chief Execs have a handy summary slide-deck.


Industrial action is no suprise. None of the above performance is occuring through a lack of dedication from NHS staff to solving these problems, be they clinical or managerial. The pressure from Government on the NHS to do better is significant, the ministerial thirst for information unquenchable, the significant policy shift and pan health-and-social-care financial committment required to fix it however...?


Across society industrial action shows no signs of abating, least of all in the healthcare sector. Without Government action this will undoubtedly continue across the winter months.


In a slightly different lens of healthcare, keepers of birds or poultry are battling 'Flockdown' - mandtory housing orders from the Department for Environment, Food & Rural Affairs and Animal and Plant Health Agency as a response to the frighteningly large spread of avian influenza across England. Let me tell you, my chickens are not happy about.

Meanwile the British Army seems to be focused on advertising itself as a disaster response organisation. A fascinating dive into the securisation of statutory services.

If you follow the original link and it does not work, you can find the video here. The British Army deleted the original video following a mass outcry on Twitter, but have recently reposted it. Don't worry, though, they corrected 'army satellites' to just 'satellites', as that is clearly the main problem with the narrative here. We wouldn't want anyone thinking the army managed satellites....

 
What does this all mean for Emergency Preparedness, Resilience and Response?

A few months ago I was asked to talk very briefly on the challenges that NHS EPRR faced over the next year. Here's what I talked about. Let me know via Twitter or in the comments if you agree or think otherwise.


Ongoing response efforts and a crisis of concurrency

Complex problems

We continue to face multi-discipliniary issues that cannot be resolved within one NHS organisation or one team/directorate. This requires strong collaborative working across ICBs and within NHS organisations. ICBs and ICSs were born into the most uneasy of times and whilst one may think problems force people togther, it still requires time and space to be effective in collaboration.


Moveable baselines

COVID-19 has modulated the foundations for our delivery of services, including our delivery of services during emergencies/crises. We need to understand this better. We need to revisit programmes of work and factor this in to our preparedness activity.


Genuine risk

The risk of other incidents is ever-present and is often realised. Concurrency is a significant threat. Do we really plan for concurrency as we need to?


Exhausted people

NHS people are tired from the response efforts of the last three years. This is seen from the frontline to the back-office and very much includes EPRR staff.

As a community of interest, EPRR colleagues must be brought together under the leadership of our ICBs to recover, learn and grow. We must wrap our arms around our EPRR people, support them and not forget them.


Stalled programmes

EPRR programmes of work have often had to stand-still due to the challenges of the past three years. Risks remain and require structured portfolios and programmes of work to address them and bring back meaningful assurance of preparedness across the NHS. Doing so while responding is hard, but it is vitally important.


This is of course not an exhaustive list, and many more priorities could be listed. Further, none of this will happen without the time and space to do such things - both of which are critically in short supply at the present time.

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