NHS in the news

06 Jul 2015

Why does the NHS still operate when over clinical capacity?


Guest posting by Dr Tom Duncan, anaesthetist

Last winter's failure of computer systems at NATS resulting in multiple cancelled flights, highlighted the capacity issues we have with our airspace. Thousands of people were inconvenienced and there were serious and public questions asked about the way in which we run our airspace.

Let's compare this to the NHS.

How many operations were cancelled yesterday for non-clinical reasons? The best answer I can find is data from 2 years ago,  suggesting that in the three months to March 2013, there were nearly 20000 cancelled elective operations. Delays on emergency operations are not counted in this statistic. That’s 222 people a day cancelled for reasons that relate to the operation of the Trust.

Heathrow operates at about 99% capacity on a good day. To achieve this hundreds of millions of pounds have been spent on control centres, integration of European and strict protocols surrounding the handover of patients from one control centre to another.

And whilst the public may be quite rightly peeved off, I have yet to meet anyone who is keen to head into the skies if there is a risk of a mid air collision.

Now lets compare that to secondary care in the NHS. Our partners in social care, with who we share bidirectional flow of traffic are not integrated in a strategic, operational, or commercial way. We run at about 90-95% capacity, and with the greatest respect to bed managers, they have had far less investment in their roles that NATS control centres.

We have no real time information systems, and our process of handing over patients usually involves scraps of paper on a proprietary system that is unique to each ward or department.

If you are lucky this piece of paper may be a fresh printout, but more likely it is a photocopy of a photocopy.  How on earth can we run what is mathematically over our operational capacity (roughly 85% if you believe in queuing theory) with that kind of information infrastructure?

Our integration is appalling within services in hospitals and between different sectors within health and social care. It is not uncommon for the patient to be brought to theatres by a nurse who has no knowledge of the patient. Yet we are depriving a ward of that nurse for 30 minutes to what useful end?

DSC05970 by Andy G, on Flickr
Creative Commons Creative Commons Attribution-Share Alike 2.0 Generic License   by    Andy G  

We go through rituals and practices that add no value to the patient or care team during handover because it’s what we ‘have to do’. Perfectly stable patients being escorted round hospitals by nurses, who are in short supply as it is, strikes me as a huge waste of resources.

What about the pathways for our increasingly co-morbid elderly population who make need some optimisation prior to major surgey? Healthcare is complicated I am told. Well I just tried to book flights to New York and the multitude of stopovers and combinations was bewildering. My flights back from Australia were changed from via Singapore to via Dubai. A total of 15 minutes difference in my arrival time at Heathrow. From Darwin.

Healthcare is complicated but we have so much to learn about how to ‘divert’ patients via a cardiology appointment on their way to major surgery and yet keep their arrival time in theatres the same. We are stuck in the early 20th century when it comes to information systems, patient tracking and logisitics, and we cannot hide behind arguments of how complicated things are when others have learned how to overcome them so well. I do not know how many bed days are wasted, but I would wager that bed blocking is the tip of the iceberg when it comes to flow across the whole system.

People are not allowed to fly when the sky is overcapacity. Why are they still allowed to come into hospital?

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