Report

System under strain: why demand pressures are more than a winter phenomenon

Why increasing demand in one part of the system can affect the performance of other NHS services elsewhere over winter and beyond.

30 April 2019

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In recent years, it has become routine for the media to highlight a crisis in the NHS each winter. Examples cited include postponed operations, patients diverted between hospitals, and ambulance crews providing care to patients outside emergency departments that are full to capacity.

The tendency has been to focus on what happens in one part of the NHS system at one point in the year. However, with demand for care outstripping funding growth, the pressures facing the NHS and social care are year-round.

Moreover, these pressures extend beyond the struggling hospital accident and emergency departments that we see in news bulletins, and into every area of the NHS, as well as the social care system that supports it.

This report shows that increases in demand are not restricted to particular parts of the service and specific times of the year. It describes ways in which increasing demand in one part of the system can affect the performance of other NHS services elsewhere. It outlines how some NHS and social care providers have adapted their services to enable patients and service users to access care more efficiently.

Finally, it argues in support of a shift away from viewing performance solely as an organisational issue. It calls for regulators to support NHS and social care providers and commissioners in thinking more holistically about how the benefits of local provider and commissioner relationships can be maximised to meet soaring demand.