What is it about?

Health service demand is influenced by the nearness to death effect in which 45% and 55% of a persons lifetime admissions and bed occupancy respectively occur in the last year of life. Hence the trend in deaths is important in understanding the marginal changes in demand. Application of a rolling 12-month total of deaths shows entirely peculiar trends across all parts of the UK (and internationally). These peculiar trends are then reflected in excess winter mortality (EWM) which can be used as a summary measure of winter workload pressures. A sudden and unexpected shift down in deaths across the entire UK in late 2018 led to a very low EWM in the winter of 2018/19. However, shift down is inevitably followed by shift up and this implies that the winter of 2019/20 may show particularly high service demand. That fact that so many local authority areas showed a shift down at roughly the same time implies that they may also shift up in synchrony. This is part of a far wider series on health service capacity planning.

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Why is it important?

It is important to be able to forecast the likely level of health service winter demand. The trends in deaths can enable a degree of forecasting. It goes without saying that deaths are the apex of the morbidity/mortality pyramid, hence, any agent(s) capable of increasing deaths will also increase medical admissions among those who are not in the last year of life. Given the high spatial granularity of these events some areas carry a disproportionate cost which is not reflected in the current NHS funding formula.


The highly peculiar trends in deaths have had unexpected effects on health service demand (see http://www.hcaf.biz/2010/Publications_Full.pdf); unfortunately there has been no official recognition to this link and health service managers are therefore left without the information or ability to conduct detailed planning. One can only hope that organisations such as NHS England communicate this reality more widely - even if the exact cause may be somewhat of a mystery.

Dr Rodney P Jones
Healthcare Analysis & Forecasting

Read the Original

This page is a summary of: Will the winter of 2019/2020 have unusually high service demand? Part 1: Lessons, Journal of Paramedic Practice, November 2019, Mark Allen Group,
DOI: 10.12968/jpar.2019.11.11.492.
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