So, why is there a variation in waiting times for a GP appointment and ambulance handovers… and there is… and it’s big.

The mess we’re in

Variation… the enemy of quality…

That’s our old friend, Edwards Deming talking…

… he’s right. Variation always tries to tell us something. We just have to figure out what it is.

There are five types:

  1. Controlled… when we want things to be different
  2. Random… when things are unexpectedly different
  3. Predictable… when we can expect things to be different
  4. Common cause… when something happens to make all things different
  5. System… when the process causes variation

So, why is there a variation in waiting times for a GP appointment and ambulance handovers… and there is… and it’s big. 

For example; in winter 2021, 45% of ambulance handover delays occurred in 15 Trusts.

Yesterday, when No21 (Thérèse Coffey) presented ‘Our Plan for Patients’, to the House, not unreasonably, she asked; why are there variations?

The Department of Health are collecting data and that is very good!

If the data gives us a random pattern, it’ll be a failure from within the system but I’d be looking for indicators in the three ‘C’s; 

  • communities
  • capacity 
  • competence

How does it work;

Communities; their demography, a higher incidence of the elderly or deprivation, for example. 

Capacity; the practices are using all their available appointments and can’t expand for reasons of resources, staffing or constraints on planning.

Competence? Face it, some practices just aren’t run very well and can probably learn from places that are.

In the meantime, this; 

‘…We expect that patients, who need an appointment with their GP practice within 2 weeks, should get one and that patients with urgent needs should be seen on the same day.

It’s worth pointing out there were 26m GP appointments in July and 44% were seen on the day they were booked. 


… [we will] open-up time for more than a million extra appointments over winter.’

Last year GPs delivered over 300m appointments. An extra million is less than one percent.

To be frank… this is not much of a plan. It’s largely the response to Covid, rebadged. 

A chunk of it is stuff already being done; more call handlers, fall prevention, volunteers, making a return to practice easier, treatment hubs, fixing the pension rules.

There’s a promise of 7,000 more beds but…

… without more people to look after the seven thousand people in the beds, nurse-to-patient ratios will fall, risks will go up and more good people will get fed up and go to work for Marks & Sparks.

Four hundred people a week are leaving, now.

There’s a promise of £500m, for an Adult Social Care Discharge Fund:

… [this ] first step will inform our further action from next year to rebalance funding across health and care, to establish a strong and sustainable social care sector, with greater accountability for use of taxpayers’ money.

What does this mean? Dunno…

I do know, it’s partially funded from the NHS reserve for the employer’s NI increase, no longer being paid. Described as a ‘downpayment’.

Where is more likely to come from? Dunno…

I do know, without an allocations model…

… and a handle on using the money to improve the wages and training for front-line care staff, I can see it used for paying off the over-draft of some nearly-broke domiciliary-care companies and create care-package cost inflation.

This report is pretty thin, just over 3,500 words. 

But, here’s the point. What else is there? In all honesty, what is there that this or any government can do, right now, that is going to change anything, right now.

Health and Social Care are suffering the effects of twelve years of neglect. Twelve years of inattention and most of it in a period of austerity funding.

We didn’t;

  • train enough people,
  • keep enough people,
  • build enough,
  • repair enough,
  • innovate enough,
  • do enough…

… and when Covid caught us out there were already signs of trouble. Tens of thousands of vacancies and 4.5 million waiting for care.

Now, vacancies are in the hundred thousands and 7million are waiting. 

No matter how much money you have, it can’t buy time…

… and it is time that we need to train and rebuild, innovate and make an ambulance arrive at your house, instead of queuing outside the hospital.

This report describes what we can do with what we’ve got.

The final paragraph says:

We will design and deliver our long-term workforce plan.

We will review our education and training requirements and…

… will come forward with proposals to meet the changing needs and expectations of patients in the future.’

When? Dunno… but note the word, ‘deliver’…

… and it’s about the only thing that will solve the longterm mess we are in.

Have the best weekend you can.

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