{"id":50652,"date":"2021-07-13T22:06:17","date_gmt":"2021-07-13T21:06:17","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50652"},"modified":"2021-07-13T22:06:17","modified_gmt":"2021-07-13T21:06:17","slug":"daniel-sokol-is-the-nhs-really-under-unprecedented-pressure","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/13\/daniel-sokol-is-the-nhs-really-under-unprecedented-pressure\/","title":{"rendered":"Daniel Sokol: Is the NHS really under &#8220;unprecedented&#8221; pressure?"},"content":{"rendered":"<p><span style=\"font-weight: 400\">On 9 <\/span><span style=\"font-weight: 400\">July 2021, the Academy of Medical Royal Colleges\u2014the coordinating body for the UK and Ireland\u2019s medical Royal Colleges and Faculties\u2014issued a statement. It called for a &#8220;<\/span><i><span style=\"font-weight: 400\">responsible approach when <\/span><\/i><span style=\"font-weight: 400\">[covid]<\/span><i><span style=\"font-weight: 400\"> restrictions are formally lifted&#8221;<\/span><\/i><span style=\"font-weight: 400\">\u00a0on 19<\/span><span style=\"font-weight: 400\"> July and argued that the NHS is &#8220;<\/span><i><span style=\"font-weight: 400\">currently under unprecedented pressure.&#8221;<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400\">Since the pandemic began, the NHS has apparently been under &#8220;unprecedented pressure&#8221; 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?<\/span><\/p>\n<p><span style=\"font-weight: 400\">This raises another question: what does it mean for the NHS to be &#8220;under pressure?&#8221;\u00a0 What factors determine whether the NHS is under greater pressure today than it was in January?<\/span><\/p>\n<p><span style=\"font-weight: 400\">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 &#8220;<\/span><i><span style=\"font-weight: 400\">For the majority of our staff it has never been as quiet, there are many with not a lot to do<\/span><\/i><span style=\"font-weight: 400\">.&#8221; GP consultations also dropped dramatically in some periods. Yet, even then, the NHS was considered close to collapse. Why?\u00a0 Because critical care was overwhelmed. In January, NHS England told the BBC that critical care services were under \u201cunprecedented pressure.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">Now that the NHS has resumed its functions, there is a<\/span><span style=\"font-weight: 400\"> large<\/span><span style=\"font-weight: 400\"> backlog of cases. Waiting times in emergency departments and for elective procedures are longer than they were before the pandemic. <\/span><span style=\"font-weight: 400\">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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Yet, it seems unhelpful to describe the situation in the NHS as one of &#8220;unprecedented pressure.&#8221; 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 &#8220;wolf!&#8221; one too many times. As all barristers know, hyperbole does not persuade. It casts doubt on the reliability of the speaker.\u00a0 It would have been better to use the language of Chris Hopson, chief executive of NHS Providers, who explained a few days ago that \u201c<\/span><i><span style=\"font-weight: 400\">the NHS is still likely, as a whole, to be under very significant pressure.<\/span><\/i><span style=\"font-weight: 400\">\u201d <\/span><span style=\"font-weight: 400\">Layla McCay, director of policy at NHS Confederation, spoke of &#8220;<\/span><i><span style=\"font-weight: 400\">greater pressure than usual for this time of year.&#8221;<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400\">The Academy\u2019s call for people to \u201ccontinue to act with care\u201d suggests it has reservations about the government\u2019s decision to relax measures on the 19<\/span><span style=\"font-weight: 400\">th<\/span><span style=\"font-weight: 400\"> July<\/span><span style=\"font-weight: 400\">. This is <a href=\"https:\/\/www.bmj.com\/content\/374\/bmj.n1762\">echoed by several other NHS leaders<\/a>. Pat Cullen, acting general secretary of the Royal College of Nursing, warned that the government will &#8220;<\/span><i><span style=\"font-weight: 400\">rue the day it sent the wrong signal for political expediency<\/span><\/i><span style=\"font-weight: 400\">.&#8221;\u00a0 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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">However, the impact on infection rates, waiting lists, and the population\u2019s 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 \u201cfollow the science!\u201d, the ethicists \u201cfollow the ethics!\u201d, the medics \u201cavoid sickness and death!\u201d, the economists \u201cconsider the costs!\u201d, and so on for each expert. Each group believes they hold the key to the solution.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">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\u2019s 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.<\/span><\/p>\n<p><i><span style=\"font-weight: 400\"><strong>Daniel Sokol<\/strong> is a barrister, medical ethicist, and has sat on advisory committees for the Ministry of Defence, the Ministry of Justice and the Metropolitan Police.<\/span><\/i> <i><span style=\"font-weight: 400\">He is the author of \u2018Tough Choices: Stories from the Front Line of Medical Ethics <\/span><\/i><span style=\"font-weight: 400\">(Book<\/span><span style=\"font-weight: 400\"> Guild, 2018).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\"><strong>Twitter<\/strong>: <a href=\"https:\/\/twitter.com\/danielsokol9?lang=en\">@DanielSokol9<\/a><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>On 9 July 2021, the Academy of Medical Royal Colleges\u2014the coordinating body for the UK and Ireland\u2019s medical Royal Colleges and Faculties\u2014issued a statement. It called for a &#8220;responsible approach [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/13\/daniel-sokol-is-the-nhs-really-under-unprecedented-pressure\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":50653,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[18886,236],"tags":[],"class_list":["post-50652","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-daniel-sokol","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Daniel Sokol: Is the NHS really under &quot;unprecedented&quot; pressure? - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/07\/13\/daniel-sokol-is-the-nhs-really-under-unprecedented-pressure\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Daniel Sokol: Is the NHS really under &quot;unprecedented&quot; pressure? - The BMJ\" \/>\n<meta property=\"og:description\" content=\"On 9 July 2021, the Academy of Medical Royal Colleges\u2014the coordinating body for the UK and Ireland\u2019s medical Royal Colleges and Faculties\u2014issued a statement. 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