As a means of coping with excessive demand, the age-old follow of forming a protracted, orderly queue has one thing to be mentioned for it: simplicity, transparency and equal remedy for all. However regardless of how a lot the British are mentioned to like a queue, you’ll be able to have an excessive amount of of a great factor. The UK’s public providers are underneath pressure in all types of how and it’s placing how lots of the issues could be described as a gridlock of hidden queues.
Take into account ambulance response instances. Ambulances in England are speculated to arrive inside a given goal time, relying on how pressing the state of affairs is. In “class 2” conditions equivalent to coronary heart assaults and strokes (aka fairly damned pressing), the goal is to reply in 18 minutes on common. The unhealthy information is that the NHS isn’t hitting these targets: in November final yr, the typical response for class 2 calls was greater than 32 minutes, the worst since final January. The excellent news is that issues have been a lot worse than that in latest reminiscence: on the finish of 2022, the typical response time was greater than an hour. That’s the results of a queue that not even the British may love.
Why is that this taking place? The plain rationalization is that there should not sufficient ambulances, however the deeper downside is that ambulances themselves are being delayed in discharging sufferers into A&E items, that are themselves typically overwhelmed: within the first quarter of 2014, 134 sufferers waited greater than 12 hours in A&E earlier than being admitted; 10 years later the determine was 141,693. The lengthy delays in A&E are partially the results of the hospital beds all being full and that, in flip, is partially as a result of hospitals generally wrestle to discharge weak sufferers into an overstretched social care system. All of those issues are a type of queue they usually all work together in a shocking means: you’ll be able to die ready for an ambulance as a result of there aren’t sufficient nursing houses in your space.
What’s placing is that the identical sample emerges in different elements of the general public sector. For instance, the jail system is full nearly to capability. That’s partly the results of three many years of successive governments deciding that sentencing pointers ought to be punitive, whereas additionally being unwilling to construct sufficient prisons. However it is usually the results of interacting queues: about one-fifth of the jail inhabitants is both awaiting a trial or awaiting a sentence, which signifies that delays within the courtroom system feed into crowding within the jail system.
The examine of queues dates again greater than a century, with the preliminary spark coming from a mathematically gifted Danish phone engineer named Agner Ok Erlang. Erlang mixed his elegant mathematical concepts with a sensible method. He wandered across the streets of Copenhagen accompanied by a ladder-bearing assistant in order that Erlang may descend by way of manholes to measure currents. (The unit of load on a queue-processing ingredient, whether or not a phone line, a grocery store checkout or a bathroom cubicle in a theatre, is the erlang. So now you understand.)
Since Erlang, the modelling of queues has blossomed, together with an alphabet soup of acronyms, together with PQ (precedence queuing), FCFS (first come first served — as any true Briton would advise) and the suspiciously continental-sounding SIRO (service in random order). The queuing literature has produced many concepts and, whereas a few of the conclusions are apparent (queues type when there isn’t sufficient capability to match demand), there are subtleties price pondering.
First, when bottlenecks feed into bottlenecks, some strategic considering is required to repair the system. There’s typically a couple of bottleneck in a congested system and opening that bottleneck will generally imply the identical queue builds up someplace else.
Second, the optimum queuing time most likely isn’t zero. Generally, demand arrives at irregular intervals and it’s prone to be impractically wasteful to have a lot capability (so many docs, so many ambulances, so many crown courts) that even after a sudden surge in demand, no one has to attend.
That mentioned, the optimum queuing time ought to most likely be stored fairly quick. Think about a state of affairs the place an emergency physician can see 4 sufferers an hour and sufferers arrive each quarter-hour. At first all the things is okay: each affected person could be seen instantly. Then one thing goes improper. Maybe there’s a sudden rush, when 5 sufferers unexpectedly arrive collectively. Maybe the physician takes an hour off for lunch. The ready time out of the blue will increase from nothing to an hour, regardless that the physician remains to be seeing 4 sufferers an hour and 4 sufferers an hour are nonetheless arriving.
The ethical of this quite simple story is that even when the capability of the system is the same as the demand for it, queues can develop after which keep at disagreeable lengths. What’s wanted is slightly further capability to work by way of the inevitable queues that construct up infrequently. Sadly, techniques underneath intense strain hardly ever have slightly further capability hanging round.
Third, it may be arduous to extend the capability of a system. Let’s say that we have now a million nurses and every nurse trains for 2 years earlier than working for 20. Arithmetically, that requires 100,000 nurses to be in coaching at any given second. What whether it is determined that we want 1.1 million educated nurses and we want them as quickly as attainable? That might require an instantaneous recruitment increase, doubling the variety of nurses in coaching.
Would that be attainable? Despite the fact that the enlargement in nursing personnel appears modest, it requires nursing programs to double in dimension after which to shrink once more after a few years. An much more dramatic enlargement will probably be wanted on the superior coaching faculties at which the lecturers of nursing are themselves educated. It may be simpler to steer nurses to remain slightly longer within the occupation or to recruit from the Philippines.
This disagreeable arithmetic makes it all of the extra irritating when the obstacles to capability enlargement appear pointless. My colleague Sarah O’Connor lately described the big inventory of pissed off foreign-qualified dentists within the UK who can’t follow dentistry as a result of they’re ready to take a registration examination. There are 8,000 dentists on the ready listing; 350 of them scrambled by way of the chaotic registration course of in 2024. At this price everybody now on the ready listing will have the ability to practise dentistry earlier than 2050.
Queuing generally is a fiendishly troublesome downside to unravel, however not all the time. Typically the free lunch is correct in entrance of us, ready to be eaten.
Written for and first printed within the Monetary Instances on 7 Jan 2026
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