This is the 39th #WILTW

The health system in the UK remains in a perpetually fine balance. In acute care the constant inflow of ill patients requiring care is only just met by the availability of hospital beds for them. The winter crisis of 2015 demonstrates what happens when the system becomes utterly overloaded and capacity is breached resulting in patients spending prolonged times in Emergency Departments.

It is often argued that hospitals need to run at 85% capacity in order to function efficiently (although trying to find the facts behind this is hard). This means that there must always be a good excess of empty beds at any given time (with available staff to care for patients  who may be placed in them). Without this whenever the system is faced by increasing inflow i.e. lots of patients requiring admission in a short space of time it just grinds to a halt because there is no where for patients to go. Often hospitals in the UK run at 95% capacity or more meaning there is absolutely no flexibility in the system. The challenge of keeping beds empty is a difficult one and one which NHS England have been trying to plan for. For managers or clinicians wanting to utilise spaces for surgical procedures or other non-urgent tasks it can be frustrating but failure to maintain adequate capacity can cause problems with the quality of care.

Having ‘capacity’ is not just a concept that can be applied to health systems. This week I completely ran out of capacity. This wasn’t an inability to do things – I’d hadn’t lost enthusiasm or suffered from acute writers block – I had simply not allowed any extra space to deal with a couple of unexpected tasks. I think for a couple of months I have been trading an ever dwindling capacity to accommodate what appeared to be an ever increasing work load. In hindsight I am now not actually so sure my workload was actually increasing; I was just failing to protect anytime to deal with ‘acute inflow’ as it were. This gradually weaned down the capacity I did have until suddenly everything ground to a halt.

So along with being research resilient, insightful, avoiding narcissism, and not being as busy as a Backson I now have a new #WILTW behaviour to add to weekly reflections. Will it be possible though to create space, which might not be used, within any given week? This I think will be a personal challenge that may take many winters to solve….

What have you learnt this week? #WILTW