But, above all, we need on-line capacity

March 31, 2020 8:32 AM

A big move. But think about what this means. All this effort, all those cancellations, all those people staying away from emergency departments and the health service is only just below the 85 per cent line – what was once considered its normal operating capacity.

In The NHS at capacity Chris Cook looks at how the last few decades have left the NHS overstretched even in normal times because it had to choose efficiency over spare capacity for a crisis.
posted by MartinWisse (3 comments total)

It's a point that we make to clients all the time: think very carefully about what efficiency means and what you may be trading off.

Another great example is rail utilisation. What country in Europe has the most efficient rail network? Well, by some measures it's the UK. We pack trains onto the network very tightly. A consequence of that is delays cannot easily be recovered from. The Swiss on the other hand run a very "inefficient" network which means that they have unused headroom in front of their trains which they can use to make up for late departures.

It's a very interesting topic where the answers are generally not easy ones. Obviously it is very easy to say right now: I wish we had as many ICU beds as Germany. It is less easy to say, over the course of a fifty year period what is a correct number of beds? We know that the NHS is one of if not the most efficient systems in Europe in terms of quality adjusted life years gained per unit spend but that does have a price at times like this.

Not mentioned in the excellent linked article is the broader system inefficiency imposed by the micro-scale efficient NHS bed model. Trust managers within the NHS are not required nor incentivised (or even equipped, really) to measure the costs of cancelled elective operations. About 10% - 14% of all surgeries are cancelled on the day in the NHS (as of 2018) and only about a third of those are for clinical reasons. Since some specialties are relatively immune to this (obs and emergency surgeries for example) it is the case that in specialties where many cases are elective such as orthopaedics, cancellations are very frequent. In many cases, these patients show up to hospital with family only for the operation to be cancelled.

Apart from the emotional toll this takes, it imposes an inconvenience cost on all those people which is currently completely invisible. It might seem a minor thing, but a few working age people being non-productive on a day for a non-existent surgery does cost the economy something. That is assuming that no NHS resources were used for the abortive surgery, which is of course wrong.

Most egregiously, it does happen that a shortage of recovery beds (ICU especially) leads to idling of surgeons and operating suites. This at least does show up in trust numbers so managers are incentivised to prevent if from happening.

It sort of reminds me of the argument made by Peter Kolchinsky that we under-value genuinely novel new drugs because they open up chemical and biological spaces for manipulation. In other words, remdesivir did very little for Ebola but having a range of nucleotide analogs that have human safety profiles gives us anti-viral options against completely novel things.

Basic science, even from the vulgar purely mercenary perspective of future use value, has the largest ratio of open-ended use value to closed-ended immediate value. It's not the only thing that has open-ended value though. As we are now seeing, system slack in things like hospital beds and food distribution capacity is waste until the moment when suddenly it is not.
posted by atrazine at 9:35 AM on March 31, 2020 [14 favorites]

In a world that hates the idea of an idle worker and has almost no concept of idle work, we now find ourselves overflowing with idle workers and essential services with a fraction of the necessary capacity.

I don't have a solution that doesn't involve a time machine.
posted by krisjohn at 10:19 AM on March 31, 2020 [4 favorites]

Mod note: One deleted; this is about the NHS, so let's please take care not to divert the topic to the US/CDC response.
posted by LobsterMitten (staff) at 11:06 AM on March 31, 2020 [3 favorites]