In UK, healthcare was told that we should learn from aviation. Healthcare was told we should learn from other fields such as industry.
Healthcare was told we should learn from the armed forces.
The concept of healthcare learning from other fields can be confusing or exciting or both.
The core activity of the armed forces is fighting an adversary. All other activities are in preparation for fighting the enemy.
How often does the British Army, Navy or Air force face active combat or deploy a weapon against an adversary? Best reasonable estimates are a maximum of 20% of soldiers will face active combat over a lifetime and about 10% would deploy a weapon (give a command, press a button or fire a personal weapon) at an adversary.
In theory or even in practice is it possible for someone to join the defence forces as a soldier (not a back office person) and retire without ever fighting the enemy? The answer is an obvious yes.
What does a soldier do when not fighting? Training, preparing and similar. Essentially a lifetime or a career full of training and repeated training.
During that training, taking the case of marksmanship the ‘pass standard’ can be as low as 40% for long range and 80% for short range.
In actual combat the accuracy of marksmanship falls to as low as 5% but thought to be no more than 25%. The forces have a great explanation for this – apparently the poor accuracy is due to most of the firing being suppressive (‘suppressive firing’). Okay, lets exclude the suppressive firing and look at the data – no great data exists (and to some extent expected due the understandable chaos in active combat)
After a lifetime of repeated training.
Now look at whether training is safe for a soldier – ‘Between 2014 and 2022, 34 UK service members died during training exercises—more than were killed in hostile action during that period’ (Ian Overton, AOAV, 18 Oct 2024).
Versus Healthcare
Healthcare clinical staff do not spend most of the time in training or preparation – the nature of their work means they spend their time in ‘active duty’ of delivering healthcare to their patients – every day, every week, all through the year.
If you are an A&E staff, you will deal with trauma every hour, if you are an on-call surgeon you could deal with operating on someone every day of your on-call. If you are a ward doctor you could see a patient whose physiology changes adversely every hour.
Active duty at all working times – unremitting.
Some groups such as senior doctors get a portion of their time for development (which could be as low as less than 4 hours a week in self directed personal development) and most doctors have a study leave in their contracts which is about 10 days in a year with such limited budgets allocated to the study which probably is enough for about 3 days worth of study leave.
Given the status of ‘active duty’ all through the year – healthcare seems to function very effectively. Taking one of the core activities of healthcare – saving lives – as an example and looking at the sharp end (active combat comparison) the NHS has a mortality rate of 5% to 8% for emergency admissions with nearly 70% of those who died being above the age of 70 years. Well, even for major emergency surgical operations the overall mortality seems less than 10% and again predominantly in the elderly. Given the fact that death is one of the consequences of acute illness needing emergency admission to a hospital especially among the elderly – we may assume that the NHS is doing really well.
Let us look at culture
The recent NHS staff survey shows that staff face bullying harassment rates of 9% from managers and 18% from colleagues; with BAME staff facing higher levels of B&H
For the armed forces it seems to be 12%. There seems no significantly higher rate for BAME staff in the forces.
Overall bullying rates - Not a great difference
Rate of sickness and absence in NHS 5.3% (2025); the armed forces don’t seem to have a well published sickness absence but discharged for medical reasons seem to be 1.4% - again on balance perhaps similar. Healthcare frontline staff are increasingly from an older age group.
Money
Given that UK spends about £300000 per employee for the armed forces and £125000 per employee on the NHS, with the NHS delivering millions of active engagements of core duties per day – the NHS compares well.
The point of training is to deliver your core role in an effective and efficient manner. The information above suggests that the NHS seems to be doing fine. We have in the NHS people from the airlines and military talking to us on how it is done there; we actually need more of people from the NHS to be talking to other industries on how we do it given the constraints and complexities.
Having said all this, the NHS undeniably needs to do better, far better. The NHS also needs to learn from non-healthcare sources. The crux is what should the NHS learn and from whom – the NHS does not get that right though (we will look at this hopefully in a future post).
