Daniel Sokol: Is the NHS really under “unprecedented” pressure?

On 9 July 2021, the Academy of Medical Royal Colleges—the coordinating body for the UK and Ireland’s medical Royal Colleges and Faculties—issued a statement. It called for a “responsible approach when [covid] restrictions are formally lifted” on 19 July and argued that the NHS is “currently under unprecedented pressure.”

Since the pandemic began, the NHS has apparently been under “unprecedented pressure” so often that the phrase, once so potent, has lost its force. Is the NHS today really under more pressure than it was in January 2021, when some days had well over 1,000 deaths and close to 5,000 new hospitalisations from covid, when elective operations were cancelled, and staff from distant departments mobilised to help in critical care wards?

This raises another question: what does it mean for the NHS to be “under pressure?”  What factors determine whether the NHS is under greater pressure today than it was in January?

The NHS is made up of thousands of parts and some will be under greater pressure now than they were at the height of the pandemic. After all, at one point, most elective procedures were cancelled and surgeons dealt only with emergencies. At one point, attendance at emergency departments slumped to such a degree that one chief executive in the Midlands told the Health Services Journal “For the majority of our staff it has never been as quiet, there are many with not a lot to do.” GP consultations also dropped dramatically in some periods. Yet, even then, the NHS was considered close to collapse. Why?  Because critical care was overwhelmed. In January, NHS England told the BBC that critical care services were under “unprecedented pressure.”

Now that the NHS has resumed its functions, there is a large backlog of cases. Waiting times in emergency departments and for elective procedures are longer than they were before the pandemic. Many healthcare staff are sick, exhausted, and stressed. Some are in isolation or on holiday leave. The loosening of restrictions later this month is likely to aggravate matters. There is no doubt that the NHS remains under tremendous pressure and will continue to be so for the foreseeable future.

Yet, it seems unhelpful to describe the situation in the NHS as one of “unprecedented pressure.” It gives the false impression that the situation in the NHS is worse now than it was at the peak of the pandemic, when much of the NHS was shut or barely functioning. If healthcare bodies abuse the phrase, the public will react in the same way as the villagers who heard the boy cry “wolf!” one too many times. As all barristers know, hyperbole does not persuade. It casts doubt on the reliability of the speaker.  It would have been better to use the language of Chris Hopson, chief executive of NHS Providers, who explained a few days ago that “the NHS is still likely, as a whole, to be under very significant pressure.Layla McCay, director of policy at NHS Confederation, spoke of “greater pressure than usual for this time of year.”

The Academy’s call for people to “continue to act with care” suggests it has reservations about the government’s decision to relax measures on the 19th July. This is echoed by several other NHS leaders. Pat Cullen, acting general secretary of the Royal College of Nursing, warned that the government will “rue the day it sent the wrong signal for political expediency.”  Such criticism is perhaps not surprising given the focus of medics on health and disease. If your priority is to reduce further disease, then it makes sense for restrictions to continue. 

However, the impact on infection rates, waiting lists, and the population’s health is only one factor in the decision to ease restrictions. Advisers, including lawyers like me, often over-value the significance of their advice. With their narrow-minded focus, the scientists shout “follow the science!”, the ethicists “follow the ethics!”, the medics “avoid sickness and death!”, the economists “consider the costs!”, and so on for each expert. Each group believes they hold the key to the solution.  

In fact, the decision for the government is far more complex than any single consideration and the decision-makers must listen to the views of the medics, lawyers, economists, ethicists, behavioural psychologist and other experts, balance the various factors, and make an all-things-considered decision. Without having sight of all the advice at the government’s disposal, it is difficult to say with any confidence whether it has made the right decision. Time will tell. What is certain is that any decision would have attracted bitter criticism from some groups.

Daniel Sokol is a barrister, medical ethicist, and has sat on advisory committees for the Ministry of Defence, the Ministry of Justice and the Metropolitan Police. He is the author of ‘Tough Choices: Stories from the Front Line of Medical Ethics (Book Guild, 2018). 

Twitter: @DanielSokol9