Global medical knowledge database is proposed

Politics surrounding last winter's flu crisis NHS's fundamental problems must be solvedEditor-The NHS Confederation and the BMA have argued that the recent problems in dealing with emergency demand conceal more fundamental problems: the NHS has too little capacity run at too high a rate of use. 1 Running hospitals at the current rates of occupancy is not efficient.Bagust et al show that hospital occupancy of more than 85% will guarantee periodic bed crises and the cancellation of hospital admissions. 2 NHS occupancy information excludes patients who stay less than one day and therefore underestimates the true picture.In critical care a growing body of evidence suggests that there is insufficient spare capacity in the system.Many NHS staff have a ridiculous workload.They are required to cope with the chaotic results of high levels of admissions and occupancy and, in particular, the problem of patients on outlying wards.There is no time for staff to muster new resources, and nurses have had the parts of their work that allowed recuperation devolved to other staff.There is growing evi-dence that these problems affect outcomes and lead to staff seeking employment elsewhere, further exacerbating the pressure on those staff who remain.These problems have arisen because for 20 years the NHS has sought to do more work for less money.The measures of efficiency used by the government have in general paid little attention to the quality of the result, although there has been more of a move in this direction recently. 3The tight finances of the NHS have meant that improvements in efficiency can lead to a dilution of quality services, overstretching staff, being slow to adopt new medicines and technology, and failing to invest in major change that could improve the quality of what we do.Unfortunately, the latest planning guidance issued by the NHS Executive requires a further 3% increase in efficiency, which could make the problems worse. 4he absence of good baseline data means that it is difficult to prove that this will cause problems, and there is a danger of appearing to complain without evidence.We need to look at the way we measure performance and relate this more closely to broader measures than simple efficiency.

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