Monday, 8 January 2018

Apologise for what?

Last week, it seemed as though we had government ministers – at both Welsh and UK level – lining up to apologise following the cancellation of routine procedures and appointments in the light of the winter peak of hospital admissions.  I’m unsure, though, what they were really apologising for, let alone how sincere the apologies were.
I’ve talked to NHS managers in the past about ‘bed closures’, i.e. the apparently relentless reductions over time in the total number of hospital beds available in the NHS.  And I entirely take the point that if more care can be provided in the community, and if newer less invasive procedures reduce the length of hospital stays, it should be possible to reduce the number of hospital beds without reducing the overall responsiveness of the service.  I also take the point that, in planning the total number of available beds, it is more ‘efficient’, and a better overall use of resources, to have a smaller number of beds occupied 99% of the time, than a larger number of which a significant percentage will be unoccupied for much of the year.
To put that final point another way – do we plan the number of beds around the average usage, or do we plan around the peak demand (or, of course, at some point in between)?  The direction of policy over many years now has been to plan for a lower number of beds with a higher percentage of occupancy, and that is a policy which has been pursued by both Conservative and Labour governments at UK level, and by Labour governments (including coalitions with Lib Dems and Plaid) at a Welsh level.  All of our political parties are complicit in the implementation of this policy, a point to be borne in mind when listening to opposition criticism.
I’m not going to go into the argument here about whether that policy is the right one or not; there are good arguments both for and against.  It is sufficient here to note that it is, in effect, a policy enjoying a wide political consensus.  It is a policy, though, which has consequences.  We know that there will be a peak in demand over the winter period – it happens every year.  What we don’t know (and cannot know) is the size or duration of that peak; the best anyone can do is to make informed guesses.  The point is that the policy being followed makes it inevitable that the only way to cater for a peak in demand for emergency beds is to reduce the demand for non-urgent admissions, and that’s exactly what we’re seeing happening.  In a rare moment of absolute honesty in an interview yesterday, the Prime Minister actually said of the cancellations “That was part of the plan”.  Cancellation of non-urgent cases when faced with a peak in ermergencies isn’t a failure of the system, it’s a feature.  It’s exactly the way that they have designed the process to work – and it’s the only way it can work.
So, to come back to my original question – what are the ministers apologising for?  The fact that the system is operating as planned?  The fact that neither they nor anyone else knew, or could have known, in advance exactly what the level of peak demand would be?  Making the wrong guesses?  More importantly, if they are not planning to change the overall policy (seeking to set bed numbers as low as possible on the grounds of 'efficiency'), how sincere can the apologies be?
I’m not a fan of the political culture which has developed around demanding apologies for this, that and everything, and hounding individual ministers and politicians until they say the word ‘sorry’; I’m more interested in seeing the relevant policies changed.  It sometimes seems as though that sort of debate and analysis is just too difficult for politicians these days; demands for apologies make a better sound bite.


Anonymous said...

There is always talk of patients not turning up for appointments at surgeries/hospitals and that they should be charged/penalised for this. So, what happens when operations are cancelled - a general apology/excuse is given!

Spirit of BME said...

Hear!,Hear! - good post