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14 January 2021updated 23 Jul 2021 12:18pm

The NHS is already overwhelmed

Far from being on the brink, the health service has already fallen over it. 

By Ailbhe Rea

The National Health Service faces a “very substantial risk” of running out of intensive care unit beds, the Prime Minister told MPs yesterday, as the United Kingdom recorded 1,564 deaths from coronavirus in a single day, the highest daily figure since the pandemic began.

Sadiq Khan declared a state of emergency in London’s hospitals last week as he highlighted the immediate risk of the health service in the capital being overwhelmed, while Northern Ireland’s health minister Robin Swann has banned visits to general medical wards in Northern Irish hospitals from Friday in response to “unsustainable” growth in community transmission and the continued strain on the health service.

We talk about the prospect of the health service being overwhelmed, or reaching capacity, or running out of ICU beds, as though it is a simple, stark threshold that we risk breaching in the coming weeks: an awful prospect on the horizon. If we reached a point where the health service couldn’t provide care to everyone who needs it, we would be failing as a developed country. It wouldn’t be “state failure” as we typically conceive of it, but there is a case that that is what it would be. Every time we have locked down in the UK it has been because Boris Johnson is convinced of the risk that the NHS might tip over its capacity: an inviolable red line for any prime minister or politician. 

But the awful reality is that, depending on your precise definition of “capacity” and “overwhelmed”, we reached that point many weeks ago. “We have and we haven’t”, is how exhausted doctors and nurses describe the paradox: “We reached capacity weeks ago but we just keep on expanding.” Care continues, more ICU beds are created, staff are called in to work ever-longer shifts on less sleep across a greater number of patients, and staff are redeployed from other parts of the hospital to meet demand. But the threshold that would sensibly describe the capacity of an individual hospital has in many cases already been breached.

The health service is already overwhelmed. The reason we aren’t calling it state failure is because of the heroic efforts of everyone working in our health service to go beyond their capacity.

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[see also: Personal Story: On the Covid front line]