In which I annoy everyone

I believe we’re in for a serious collapse¹ of NHS capabilities in about 2-3 weeks now. This is a few days earlier than previously suggested - mostly because COVID is accelerating a touch faster than I thought it would - but the picture is pretty much the same.

That is:

• There is a COVID wave which will fill ~6,000-8,000 general and acute beds by ~end of December (up from ~3,000 latest read)

• There is a flu wave which will fill ~2,500-3,500 general and acute beds with flu patients by ~end of December (up from ~450 latest read)

• The NHS is under such strain already that it cannot handle a surge of that size, and emergency care will collapse to December 2022 levels.

So, during this time, if you have a stroke or heart attack, then an ambulance simply won’t arrive. Not until hours (literally, hours) later. And - associated with this - there will be an utterly appalling spike (like +30%) in excess mortality: some will be down to the flu, some will be down to COVID, and some down to the collapse of NHS emergency care (however hard it is to tease these apart).

It seems to me that something like this likely to happen, pretty much whatever is done at this point.

There is absolutely no sign of the measures that the government promised at the beginning of last year. Most of them simply haven’t been done, despite the promises. The others aren’t making any difference. The only doubt now is whether one or other of the flu or COVID waves peaks early and makes the combination less bad than it could be. They might. But this is out of everyone’s hands now.

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The bit where everyone hates me - I make a suggestion

There is also a junior doctors’ strike planned. From Wednesday 20 December to Saturday 23 December 2023 and Wednesday 3 January to Tuesday 9 January 2024 (7am on each of the days). So either right over the worst peak, or - perhaps more likely - falling either side of the worst peak.

I think this is a terrible idea, and they should postpone it.

Not particularly because I believe the strike will massively worsen the situation for patients, or significantly affect the amount of excess mortality. I don’t know whether it will or not. There will be consultant cover, and a lot of elective procedures will be cancelled. Paradoxically, it’s possible that this last bit might even make the situation slightly better, by freeing up beds.

However, I think that whatever the actual effects, the junior doctors are about to get rolled by a massively cynical government and NHS leadership who can see perfectly well that a(nother) disaster is coming; one they have utterly failed to prepare or invest for, despite all their promises. So their only move is to blame someone else.

That is, junior doctors are about to be made scapegoats for a disaster that has nothing to do with them; it was going to happen already. And so, rather than being pressured by the prospect of this strike, I think it’s the only ray of light from the government’s point of view. It gives them a “line” to take: i.e., that they had in fact prepared well and invested, but who could have prepared for the [insert some combination of “greedy”, “cynical”, “unreasonable”, “radical”, “left-wing”] doctors taking advantage of the situation and putting lives at risk, etc, etc.

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To be clear, I don’t think it makes any difference whether the junior doctors’ union believes that a strike really will have a significantly negative impact on patient care or not - it’s still a bad idea.

If they believe it does have a significantly negative effect, then it is pretty morally dubious to time it at the worst time in the year, especially as the outlook gets worse and worse, plus they’ll be blamed for an enormous number of deaths, most of which were not their fault.

If they do not believe it has a negative impact on patient care, then it makes no difference when it’s timed, and they’ll simply be blamed for an enormous number deaths, none of which were their fault.

In both cases, all that is happening is that their strike is throwing the government a public-opinion lifeline. Which - last time I checked - was not a good negotiating tactic. And in one case, it could also make patient outcomes significantly worse.

So, whatever you believe about the effects of the strike, it seems much better to postpone to later in the year, and help as much as possible to mitigate the effects of an upcoming disaster. It could also save lives. Which is what junior doctors got into this business to do in the first place.

1. By “collapse” I mean: as bad or worse than December 2022.