Winter Is here (again): The predictable A&E Crisis no one solves..

Ah, Christmas, a time of tradition. Carol services, Slade on the radio, stressed shoppers in M&S and the BBC’s Marie-Louise Connolly standing in a hospital A&E unit expressing grave concern as trolleys of patients on trollies pile up around her.

At this stage, the annual A&E crisis is darkly farcical. I mean, who could predict winter? You know that season that happens every year? There has been a winter A&E crisis for at least the last 10 years, and we act like it’s something new every time.

The frustrating thing is everyone knows what the problems are:

• Not enough people take the flu and other vaccines, and then they are surprised when they get the flu and end up in hospital.
• Anxious patients go to A&E because they don’t have the patience or common sense to stay in bed and let whatever bug they have pass.
• Patients pitching up in A&E because they can’t see their GP.
• And the big one. Bed blocking. There is not enough social care to discharge patients, so they end up staying in the hospital. More than 500 people considered medically fit were unable to be sent home from Northern Ireland’s hospitals on Sunday night.

The health service should ask Toyota nicely if they can borrow one of their executives. What on earth has the world’s number one car company got to do with health, I hear you ask? Well, it’s all to do with processes. Toyota is number one for a reason. Over decades, they have continually refined their processes for making cars to a massive, efficient process. Every business school student learns about Toyota and their Just in Time manufacturing and Total Quality Management—their obsessive commitment to continually improving every element of the process.

In Northern Ireland, we have embraced the management culture of “Task deferral optimisation” – that is, management speaks for skillfully postponing everything. Heath service managers engage in “Dynamic inaction” – Staying busy… by avoiding actual decisions. “Strategic idling” – Waiting for the perfect moment not to act. “Outcome-independent stakeholder alignment” – Endless meetings and no action. “Reactive productivity avoidance” – Only springing into action when someone notices. I could go on, but you get the idea.

To improve the health service you need to zoom out and look at the entire process. How patients flow through the system, where the blockages are and how the process can be improved.

We don’t even need the wee Japanese fella from Toyota. The health service is full of smart people who rightly know how to improve the system. The problem is that no one listens to them, and they don’t have the power to make the necessary changes. Instead, we have a battle of Stalingrad approach to the crisis where we shove the poor doctors and nurses to the front lines and hope they survive the onslaught.

Well, patients and health service workers are sick of this bullsh*t every year, nay every day.

Would someone somewhere in this f*cking place make a f*cking decision for f*cks sake.

Brian O'Neill

I help to manage Slugger by taking care of the site as well as running our live events. My background is in business, marketing and IT. My politics tend towards middle-of-the-road pragmatism, I am not a member of any political party. Oddly for a member of the Slugger team, I am not that interested in daily politics, preferring to write about big ideas in society. When not stuck in front of a screen, I am a parkrun Run Director.