‘This is your captain speaking: I am afraid there is going to be a sixty minute delay to the start of our journey’.

The fuselage shudders under the collective groan of the 240 disappointed passengers hearing these words over our plane’s PA system. Until a moment ago the Boeing 757 appeared ready for departure to Gatwick, via the island of Skiathos. However the airport at Skiathos only has capacity for two planes, and there are already two planes in situ. We cannot depart for this 15 minute ‘hop’ until space has been created…..’for safety reasons’.  For some this now means a delay to the start of their holiday; for others like me, our arrival home from Greece will be later than expected. The Captain reiterates his apology, followed by a reassurance that ‘your safety is our top priority’.

My mind turns to thoughts of what is probably going on in hospitals across the UK right now: it is Friday afternoon, so the deluge of pre-weekend emergency referrals will have started. Clinicians and bed managers will be working hard to create the necessary capacity to receive those patients for whom admission will be required. But the wards are already full, and inevitably some will arrive before that capacity has been created; a backlog will soon start to build up in the waiting rooms and corridors of acute medical units and emergency departments. Triage processes will ensure that the sickest patients will be allocated to areas in which they can be seen and treated most quickly, but some will face delays. As the patient:staff ratio rises, the amount of time which can be afforded to each patient will fall; there is a danger that someone, somewhere, will miss something important….

The airline industry is heralded as the paragon of safety to which healthcare systems should aspire, but as the temperature rises on this hot Greek afternoon, the stark contrast in our approaches when capacity is ‘full’ cannot be clearer. There is a reason for the difference: airline delays are inconvenient for passengers, but can always be ‘trumped’ by safety concerns. A short delay is an acceptable price to pay to ensure that you eventually reach your destination unscathed. In urgent healthcare, delays can also compromise safety; waiting is generally bad for your health. If paramedics announced to their passengers that they’d been asked to wait on the patient’s Tarmac until hospital capacity had been cleared, the resulting groans might represent more than just disappointment.

Clearly there are times when a delay to admission may be an acceptable option – safety in healthcare often requires different levels of risk to be balanced; managing this balance is a key skill for senior clinicians working at the interface between primary and secondary care. However until there is a recognition of the need to maintain empty capacity in acute receiving areas of all hospitals there will often be a feeling that we are selecting the ‘least bad’ option at times when the number of admissions exceeds the number of discharges.

My flight proceeds uneventfully and we touch down the predicted hour later than scheduled. As we taxi to Gatwick’s South terminal, a quick scan through my 200 unread emails reveals a staffing challenge for the weekend ahead: two vacant medical SpR shifts remain unfilled and the usual  locum agencies have been unable to help. There is a plea for colleagues to help the on-call medical consultant, who will need to ‘act down’ to provide cover. I am left wondering what announcement our Captain would have made if his First Officer had been absent and no replacement could be found. I suspect I would still be sitting on a very different piece of Tarmac.

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