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Tuesday, January 25, 2022

Is this NHS crisis really worse than ones before?


The headlines were terrifying. Hospitals facing intolerable pressures as patients left dying in corridors, the BBC reported.

It got so bad that 68 leading A&E doctors wrote to the prime minister to spell out their concerns.

This is not now though. It was the winter of 2017-18 – the last bad flu season when more than 300 people a day were dying from that virus at one point.

And that was not even a one-off. In January 2016 hospitals were cancelling routine operations, telling patients to stay away from A&E if they could, and emergency treatment areas were being set up outside some units – just as they are now.

The truth is the past decade has been a story of lengthening waits and declining performance.

A&E wait times are the best indicator of this. The proportion of patients who wait less than four hours – a key metric in determining NHS effectiveness – has gradually declined.

It’s a similar storey elsewhere in the UK, with Wales and Northern Ireland performing even worse.

This should come as no surprise given the NHS’s budgetary constraints.

Between 2010 and 2019, health spending was significantly lower than it had been since the NHS’s inception, making it difficult to meet the needs of an ageing population.

During that time, the Conservatives were in power, albeit with the help of the Lib Dems for the first five years.

However, it is worth noting that Labour did not propose any tangibly higher spending increases in its election manifestos in 2010 or 2015.

After the 2008 financial crisis, all of the major political parties agreed that spending needed to be cut.

This parliament has seen a shift: annual increases are now expected to be close to 4%, with the total amount expected to be higher once pandemic spending is factored in.

However, as a result of the 2010s squeeze, we have fewer doctors and nurses per head of population than our Western European neighbours.

The beginning of the year is always the most difficult. And, with the most recent A&E data only covering November, we must look elsewhere to determine how concerning the current pressures caused by the Omicron variant are.

There have been reports of hospitals declaring critical incidents since Christmas. One in every seven hospital trusts in England was in this situation as of Wednesday evening.

It is, however, difficult to determine exactly what these declarations mean. They are typically not made public and are instead used to notify local health systems that a service requires assistance. We have nothing with which to compare them.

Looking at the delays ambulances face when dropping off patients at A&E – data available in England until last weekend – we can see that the current difficulties are worse than the previous winter before the pandemic hit.

However, despite the headlines, it is also fair to say that this does not represent the NHS’s demise.

The truth is that the health-care system will not suddenly become overburdened. Instead, the quality of care is deteriorating gradually.

Patients suffering from heart attacks are having to wait longer for an ambulance, more elderly patients are spending nights on a trolley in A&E, and an increasing number of people are waiting for hip and knee replacements.

The difficulties are, of course, different from previous winters. After all, it is a pandemic.

A mass vaccination campaign is underway, while the level of staff absence at Covid is adding another layer of complexity – it is nearly double what would be expected – and explains why the army was called in.

Hospitals have also had to completely redesign their wards in order to separate Covid and non-Covid areas.

And the sheer volume of people arriving is a problem. Historically, around 1,000 admissions per day for all types of respiratory infections occurred during the winter.

Currently, the NHS is seeing more than double that for Covid alone – though some of those are people who are ill for other reasons, such as broken arms, strokes, and cancer, and may have come in anyway.

Even if you exclude these patients, you are still well above the 1,000 mark.

However, lower pressures elsewhere have aided the NHS. The flu is at an all-time low. In England, there are fewer than 50 patients in hospital with the virus.

So, what can we draw from this? The challenges are unquestionably worse, and this is resulting in lower-quality services.

However, this is not the first year that care has been jeopardised. What matters now is the peak of Covid infections, which will determine how bad this winter will be.

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