It's time to question the notion of seasonal crises affecting the NHS, argues NHS Confederation policy manager Matthew Macnair Smith.
People across the UK have basked – or baked – in above-average temperatures this summer. It really does feel like seasons have returned, after several summers transitioned seamlessly into autumns with but a few days of sun to differentiate them.
Predictably, the media is awash with stories about the multitudinous ‘crises’ caused by the heat. One headline reported that the NHS is in the midst of a 'summer crisis', as the heatwave sees record numbers at A&E.
This is particularly worrying given that it was only a few months earlier that the NHS was going through what is now routinely described as the ‘winter crisis’, with daily reports of missed targets, people waiting on trolleys in corridors and cancelled operations.
So, are we seeing a summer crisis?
Well, we should be careful before we start labelling things. July did see above average attendances for this time of year, with nearly 5 per cent more people turning up in A&E. But we shouldn’t forget that it has long been the trend for summer months (June, July and, to a lesser extent, August) rather than winter months to record the highest number of A&E attendances.
In fact, last year’s comparably lacklustre summer saw 43,000 attendances per day in June and July, while there were 41,000 attendances a day over the winter period.
June and July this year had a higher number of attendances than either December 2017 or January 2018.
The evidence that would really allow us to label this summer as something akin to a crisis would be worsening A&E performance against the four-hour waiting time target, particularly as despite the summer regularly having higher attendances, performance against the target still tends to be higher.
Many agree that this is probably due to the nature of A&E attendances, with more people turning up in summer months to have cuts and sprains treated quickly compared to winter, when a far greater number of elderly people attend and require emergency admissions and longer-term care.
So far this summer's performance against the four-hour A&E target is improving, reaching 90.7 per cent in June and 89.3 per cent in July, so even though we are seeing a lot more people attending, the NHS is still managing to see slightly more of them within four hours than it did in the winter.
This leads me to think that perhaps we should question the notion of seasonal crises altogether, as month after month, demands increase, with only minor peaks and troughs. Regardless of any seasonal variation, NHS performance is not significantly improving.
Our report System under strain highlighted this view and suggested that annual reports of a winter crisis in hospital A&E departments disguise more systemic problems caused by increasing demand for NHS and social care services and underfunding.
Importantly, this isn’t just being seen in A&E, but in fact increasing demand for services is affecting all parts of the NHS and is occurring throughout the year. This is most clearly demonstrated in some of the other statistics released today, not least the number of people waiting 52 weeks or more for treatment, which has doubled to 3,517 compared to June last year.
This means that this June over one-and-a-half thousand more people are now having to wait a year or more for treatment, compared with last June, in a system that is overstretched.
Instead of passing the pressures off as a seasonal crisis, we need to encourage politicians and policymakers to look more closely at what the longer-term statistics show. And to consider what the inability of the NHS to meet many of its performance targets – regardless of season – really mean.
Because until they do, we will never have a system-wide and long-term solution for health and care.
Matthew Macnair-Smith is a membership and policy manager at the NHS Confederation. Follow us on Twitter @nhsconfed