NHS winter workload and on/off switching of deaths

This winter, the pressure was on (Scobie, 2018). Ambulance crews had a get-together and those from area X were complaining about what a hard winter they were experiencing. Those from Y (just down the road) were sniggering in their cups of tea at those lightweights up the road.

The concept of on/off switching in deaths (and hence end-of-life acute and ambulance demand) was introduced in Part 3 of this series (Jones, 2019). In on/off switching, deaths and associated end-of-life demand suddenly jump to a new and higher level; they remain high for around 12 months and then switch-off and revert back to the usual baseline position. In view of this series on the role of nearness to death in the marginal changes in NHS workload, it may be useful to investigate just how variable winter workload can be in adjacent districts. Hospital admissions peak in the last month of life (Jones et al, 2016; Thorn et al, 2016); hence monthly deaths become a good measure of workload.