Winter of Discontent

Winter is a particularly tough time for UK NHS trusts and GP practices. This year is likely to be no exception, with the British Medical Association (BMA) predicting that the NHS is “almost certain to endure the most pressurized winter on record,” with increased emergency admissions, more trolley waits, and an increased number of emergency department stays longer than four hours. The BMA advises that the “government must act now to prevent an unprecedented NHS crisis” (1).

The incidence of respiratory tract infections, including those caused by the influenza virus, increase during the cold winter months. These conditions vary in severity, but are leading causes of death and disability in children and adults worldwide and place huge demands on healthcare systems. Although the UK flu season is difficult to predict, the situation in the southern hemisphere, which precedes that of the northern hemisphere, may provide clues (2). Australia has just had a notably bad flu season – with over 300,000 cases recorded for 2019 as of late November (3) – and this, given that the NHS is already under pressure following a difficult summer, is of concern to many health leaders.

Although winter projections are important for allocating resources and future planning, they are not enough to ease ongoing NHS pressures. Public Health England has recently announced that this year’s flu vaccination campaign will be the biggest ever, with 25 million people offered free vaccines (4). The effectiveness of the flu vaccine varies from year to year (in the UK, last year’s was 44 percent effective among all age groups), but the latest offer of free vaccines to 600,000 primary school children and a new cell-based vaccine for over-65s may provide greater protection than in previous years (5).

Improving efficiencies and productivity within the NHS may also ease ongoing pressures – for instance, by ensuring that patients flow through hospitals as swiftly and smoothly as possible. For that, we must recognize the potential value of diagnostics in the global fight against flu and its role in supporting clinical decision-making. Diagnostic tests, including point-of-care testing (POCT) devices, enable healthcare professionals to quickly test for multiple strains of influenza A and B, and to effectively triage and treat patients appropriately. A recent study evaluated the potential impact of introducing influenza POCT on operational workflow, accurate diagnosis, and potential cost savings during the winter of 2017–2018 (6). POCT adoption may lead to faster emergency department discharge decisions and avoid unnecessary isolation of suspected cases – which is estimated to have significant cost savings and may reduce the spread of the virus in hospital settings.

There is no single fix to the perennial problem of the winter healthcare crisis. Nonetheless, a better and faster understanding of a patient’s diagnosis frequently leads to better decision-making on admission, better bed management, an improved clinical workflow, and more appropriate treatments. This winter may well be more chaotic than most, but in the future pressures may be eased by combining vaccination campaigns, diagnostic influenza testing, and other innovative solutions. Health services should continue to work with healthcare businesses to support the adoption of innovative diagnostic products that can help the system operate at its best when a crisis hits. This leads to better outcomes for everyone – especially the patients.