The NHS and a perfect storm of winter pressures:

  • The NHS pressures this summer was worse than the worst-case projections, meaning services experienced little respite.
  • Lack of recovery time due to summer pressures, combined with factors such as pension taxation legislation (forcing senior doctors to work fewer shifts to avoided large tax bills), and energy being spent on Brexit planning means the NHS is facing a ‘perfect storm’ this winter.
  • Just like the summer, this winter could be far worse than the worst-case projections, especially if cold weather and significant flu outbreaks occur this year.
  • The Government needs to act now to prevent an unprecedented NHS crisis.

What is likely to happen this winter?

Figure 1.0 – Shows the percentage of people seen, admitted or discharged within a four hour period last winter in secondary care, and based on projections by the British Medical Association it shows the best and worse case scenarios this winter.

The scenarios shows different versions of what the 19/20 winter could look like, the best scenario would be similar to last winter in many areas (which was the worst on record) whereas the worst-case scenario presents a far bleaker picture of how the NHS could fair in the coming months.

We have already seen articles, reports and news so far in the months of November and December showing how the worst-case scenario is looking the most likely and reports are already showing that this winter could be the worst on record in terms of Staff and Bed shortages.

Why was the summer so bad?

  • Emergency admissions

During the summer months, the NHS averaged 17.536 emergency admissions per day. This was an increase of 3.6% from 2018 (which using the same timeframe, saw a 5.8% increase from 2017).  Emergency admissions place a huge strain on resources, as by their very nature, trusts can’t plan for them. Even a small increase can cause blockages throughout hospitals.

  • Increase attendances.

Using the same timeframe as above (the three months of the summer), attendances increased by 5.7% at A&Es, up from 4.4% in 2018. From 2011 to 2017, the average annual increase was only that of 1.6%. This can cause a lot of pressure because more attendances are likely to mean more admissions, therefore more strain on staff, resources and waiting times.

  • Winter hangover

The NHS has proved tough and resilient in recent years, but as winters become increasingly problematic, it follows that summers will too. Trusts have experienced four straight winters with at least 150,00 trolley waits and four-hour wait performance of below 88%. Therefore, it should be no surprise that the health services struggle’s all year round due the the winter hangover.

Other factors include:

    • Brexit
    • Senior Doctor tax legislation

A perfect storm this winter for the NHS?

In addition to the pressurised summer, there are a number of other potential variables this winter that the NHS was unable to adjust for, these include:

1. Weather: despite last winter being significantly milder than the previous one, trusts were still overwhelmed by demand. Per the Nuffield Trust, each 1oC drop in average daily temperature below 5oC results in a 4% increase in death rates in England, so if there is any kind of substantial and sustained fall in temperature this winter, it is likely to dramatically increase pressures on the NHS.

2. No deal Brexit: the BMA has already highlighted the potential issues around NHS pressures arising from a no deal Brexit. A number of separate but related issues are also likely to arise however (for example the potential loss of EEA nationals from the workforce), while it’s likely that planning for both winter and Brexit will present a challenge to trusts.

3. Senior doctors reducing shifts: as discussed above, doctors are being forced to reduce their hours in order to avoid punitive tax bills. If there is no imminent resolution to this issue, there could be substantial staffing issues at a very difficult time for the NHS.

For more information read another of our blogs about the future of the NHS in 2020.

How this affects you

Overall this winter, it is safe to say that trends are not looking promising for the NHS. However, in terms of careers it means that there are a lot more possibilities and opportunities than ever before.  Staff members are needed across all hospitals and trusts are willing to pay Doctors higher salaries than before, meaning that advancing your career as a Doctor or a Nurse could be as simple as taking the right action, now.

If you are looking for a job in medicine or are simply looking for a career change then we at Fast Medical can place you in the right job. For more information on what jobs we have available contact us at or via our contact page.


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