El NHSiño – the undiagnosed storm facing the NHS


The BBC has reported the NHS is facing its biggest crisis to date. Within the first three hours there were over 1,000 comments. Increasing delays in ambulance targets, increases in missed A&E targets, increase in people waiting more than 18 weeks for treatment…

The NHS is facing a challenging time, but will probably get through the winter. Unfortunately the same may not be true of many others that need its help over the period.

What is often missed is the complexity of how the health system works and interacts with other parts of society – specifically the family. People feel unwell and go to A&E and sometimes get admitted. This may sound simple, but there are a large number of steps and stages of care potentially through many different systems (e.g. GPs, hospitals). Navigation is often complex and onerous for families offering support – a definitive diagnostic alone can often involve a painfully long diagnostic odyssey.

… But rarely does anyone mention Christmas.

It’s a well-known phenomenon that Christmas day in a hospital is peaceful. Many beds are empty and fewer people tend to turn up at A&E. This reflects the fact that a lot of people in hospital are not acutely ill – they are old, vulnerable, and often struggling to manage on their own at home. At Christmas they are cared for by families. This is good – not least as they spend less time in bed (1) and maintain a degree of independence.

As the winter deepens, it is time to ask what is happening to the all-important family support – including the type that seems very happy getting family members out of bed in the morning, but is reluctant to get family members out of a hospital bed (except on Christmas day).

So, while the NHS has many symptoms that are consistent with the need for policy makers to take action, it is unlikely that the current response is or will have the desired effect. In a recent interview, David Bennett (ex-Monitor Chief Executive) highlighted challenge of the dependency driven culture that government micromanagement is creating – comparable perhaps to the dependency culture that exists between some patients and their hospital bed.

Families can help break this dependency, but anyone who has cared for an elderly relative will understand the onerous demands that can follow from the commitment. It is time to ask what can be done to support families and carers to look after elderly relatives.

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(1) The Dallas Bed Rest and Training Study (1966) saw athletic 20-year olds confined to beds for three weeks. Hearts shrunk by 11% and VO max (a measure of fitness used by athletes) dropped by 28%.


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