In sickness and in health

The latest evidence that pressures on the NHS are piling up comes in the form of a steep rise in bed-blocking, with a remarkable 21,698 days of delay in patients being discharged from the region’s hospitals in the three months to November.

Meanwhile, waiting times in accident-and-emergency departments are increasing, ambulances are facing greater delays in handing over patients to casualty and patients are waiting longer to be admitted to beds.

The problems are being seriously exacerbated by the need for the NHS to make £20bn in efficiency savings before 2015. This, of course, is intended to make the spending increases go further in the long term, but at the moment their sole effect is to make it appear as if the health service is suffering from the cuts afflicting the rest of the public sector as problems increase for patients and practitioners alike.

However, while few foresaw the financial crisis or its extent, the other sources of pressure on the NHS have been all too identifiable for a very long time: a growing population, with more people living longer and developing multiple illnesses as a result, and the steady advance of technology, which is making so much of this possible, also driving up costs.

In this sense, the NHS is a victim of its own success, a success that should have been anticipated and planned for by successive governments who chose to ignore the problem.

Now is the time, however, not for recriminations but for identifying every way of ensuring that the financial strictures of the next three years impinge as little as possible on patient care. And before anyone says that the situation is hopeless without an end to cost savings, consider the example of the Calderdale and Huddersfield trust which, over the past year, has managed to reduce bed-blocking dramatically, from 575 days to nine, by the simple initiative of giving staff instant, up-to-date information on all beds and all patients’ discharge dates.

If other trusts can take note of, and learn from, the few that are managing to get things right – rather than lamenting their own problems in isolation – then there may yet be hope that the NHS can ride out this crisis without patients’ experiences growing inexorably worse.