The number of people in England waiting for planned hospital care could hit 10.7 million by March 2024, leaked projections prepared for ministers and NHS bosses show. NHS figures for England that cover the period until January 2022 show that there are now a record 6.1m people on the waiting list – a rise of 36,730 on the previous month. Of these, 311,528 have waited over a year for treatment, with 23,788 people waiting for more than two years. Covid hospital admissions are rising across the UK. Reported cases are now also on the rise, with 61,900 reported last Tuesday, the highest daily figure for a month. While the booster dose has been shown to provide the strongest protection against Covid, including the Omicron variant, some waning of immunity is expected after six months which immediately also envelopes others around them into increased chances of infection.
Youngsters waited with life-threatening disorders
Latest figures are likely to fuel calls for the fourth booster shot – due to be rolled out in April – to be brought forward. The NHS performance data also showed that 73.3% of people who attended A&E in January were treated within four hours – the joint lowest ever figure – even though the target is 95%. Ambulances are taking longer to respond to 999 calls, both for emergency and also urgent calls. More than a third of young people needing treatment for potentially life-threatening eating disorders are waiting more than 12 weeks. Furthermore, waiting times for cancer care in England are the longest on record, and tens of thousands of patients are waiting every month to see a specialist or start treatment.
With continued staff shortages, thousands have been urged to sign up as ‘NHS reservists’ to help clear the Covid backlog. Anyone can enlist to work 30 days for paid roles including vaccinating and caring for patients discharged from hospital, regardless of experience, and will get training, as ministers try to alleviate pressures of 100,000 staff shortages.
The mistake
Amitava Banerjee, Professor of Clinical Data Science, University College London, and Consultant Cardiologist at University College London Hospitals and Barts Health NHS Trusts told Asian Voice, “I think the main issue is that in retrospect, during the pandemic we have focused on hospital admissions and deaths, in particular. The main metric that we judge whether things are severe or mild, that's a mistake because we know that there have been indirect effects of Covid which is causing the backlog now.
“There was some backlog before the pandemic, but because of our changes in behaviour, as well as the huge strain on the system, whether it's operations, cancer treatment, routine health checks in primary care, there is a strain on the system. We have not been monitoring that for the last two years and we haven't been tackling that in the same way. We just thought that if we can reduce the death, then the job is done. That's not the case.” Banerjee is also worried that Long Covid may cause potential organ impairment that is beyond the short term and may affect other organs. It could lead to an increased risk of diabetes and could lead to cardiovascular disease, which really leads to more strain.
Ironically, Britain spends £4m a week to store unused Covid gowns, face masks and gloves, and yet the infrastructure isn’t equipped to hire skilled workers to provide genuine medicare beyond Covid and with Covid as well as Long Covid. Britons will start paying 1.25 per cent more national insurance from April as part of a £12-billion-a-year NHS Covid recovery plan.
Last week, Health Secretary Sajid Javid unveiled a set of measures aiming to reduce the backlog, which rose by more than 30 per cent, from 4.4 million, due to lockdowns and Covid restrictions. However, critics argue that this won’t be solved by reforms.
4 in 10 adults surveyed reported delaying of emergency medical care
Speaking about the ongoing NHS Backlog and its consequences, Prof Parag Singhal, Consultant Endocrinologist-UHBW, National Secretary BAPIO and Co-Chair PHDCC Health Committee told the newsweekly, “People with underlying co-morbidities appeared to be more susceptible to higher severity of disease and risk of death. These patients, therefore, were shielded during the pandemic with a reduction in emergency department visits and inpatient clinic visits of chronic diseases. During the pandemic, 4 in 10 adults surveyed reported delaying or avoiding routine or emergency medical care. Cancer screenings, for example, dropped during the pandemic resulting in the diagnoses of fewer cases.
“In addition, we found that the pandemic adversely affected clinical decision-making by limiting laboratory testing and physical examination in both primary and secondary care. Now with the backlog and increased demand due to emergency and elective cases, both primary and secondary care are under tremendous pressure to continue providing prevention, identification, and management of chronic disease,
“This disruption of care has a long-lasting impact on chronic health outcomes that are likely to surpass the duration of the Covid-19 pandemic, which has created a new group of patients with chronic diseases with worsening health outcomes and further health inequalities.
Lack of care for chronic infections
In hindsight, Prof Singhal said that the lack of care for chronic conditions was compounded by the decision taken by most hospitals to cancel elective care as part of the pandemic preparedness plan. However, to most front line clinicians, it was a knee jerk response and plans to tackle the impending challenges should have been made and implemented in a staged approach. This would have ensured that the care for chronic conditions would have continued.
According to him, another important issue is Vitamin D deficiency which is very common in the Asian population. Initial observational reports had suggested that people with low levels of Vitamin D were observed to have the severe disease but with adequate levels, the impact of Covid-19 was rather mild. “Now with more evidence around the protection offered by Vitamin D, a more robust and high dose Vitamin D replacement programme could have been implemented and possibly avoided hospital admissions,” the National Secretary BAPIO told Asian Voice.
Reduce the cost of healthcare
As the UK government continues to investigate the handling of Covid-19 in its Spring Inquiry, Prof Singhal said, “What the future healthcare requires is meaningful integration of primary and secondary care, not only at strategic but also at the level of delivery. One such innovation would entail integrated urgent care clinics in primary care, supported by secondary care clinicians. This will not only reduce hospital attendance but also reduce the cost of healthcare. BAPIO has already established training programmes in India to ensure that clinicians can work seamlessly in both settings. This will go in a long way to address the workforce crisis in the NHS, one of the main barriers in delivering optimal care.”
To fulfil its international obligations the UK has now agreed to accept refugees from Ukraine. “Whilst it is welcome news but does add to the challenges given that a vast majority of them are likely to be unvaccinated. Having a programme to vaccinate the refugees is very important not only for their own health but also to prevent the spread of infection. The UK is fully capable of overcoming this challenge,” Prof Singhal told us.
24,000 have been waiting for more than two years
The figures by NHS England also showed that the number of people waiting for operations such as hip and knee replacements and cataract removals has risen again to just over 6.1 million – yet another new record high. Almost 24,000 have been waiting for more than two years.
For example, while 93% of people who GPs suspect may have cancer should be seen by a specialist within two weeks of their urgent referral, in January just 75% were – the lowest proportion ever. While 152,093 of the 202,816 people GPs referred to the hospital were seen within two weeks, another 50,723 – one in four – were not.
Similarly, although 96% of people with confirmed cancer should start treatment within 31 days of doctors deciding to treat them, just 89.6% did so. That means that 2,644 of the 25,524 patients had to wait longer than a month to start receiving chemotherapy, have radiotherapy or undergo surgery.
And an even smaller proportion of people with cancer who should start treatment within 62 days of being referred by a GP did so in January. While the target is 85%, hospitals only managed to treat 61.8% of them in that time, which meant that 5,161 people had their care delayed.
Over the last 12 months a total of 424,382 people with suspected cancer have not seen a specialist within two weeks, 19,861 of those diagnosed with the disease did not start treatment within 31 days and 50,049 had to wait longer than the supposed maximum 62 days.
A dilemma
In a joint statement for Asian Voice, Transplant Lead Nurse, Charlotte Crotty and Transplant Consultant Surgeon, Leicester, Dr Atul Bagul shared their perspective on the ongoing backlog, the dilemma and the government’s Spring Inquiry.
Crotty and Bagul told us, “Patients with chronic/long term health conditions have significantly been impacted as they rely on regular NHS care and interventions due to their lifelong health needs. Patients with chronic renal disease, kidney transplants are amongst the most clinically vulnerable in our society but are the cohort of the population that has seen significant impacts due to Covid-19.”
Like other healthcare experts, the two also agree that patients with multiple health conditions, which patients with renal disease have, will have seen delays in outpatient referrals, appointments, and subsequently procedure admissions and in case of transplants a further impact on the availability of suitable deceased organ donors and live donors.
They further added, “The NHS has addressed the pandemic backlogs by making service delivery adaptations, such as virtual clinics and use of the private sector for NHS activity, although this is not applicable across all specialities within the NHS, as renal and transplant patients require face to face hospital interventions and lack of specialised treatment like dialysis.
“Advances in technology and accessing medical treatment virtually, where possible, has its advantages for patients, but there needs to be a consideration for patients where English is not their first language, it can also alienate patients who do not have access to such technologies.
“Additionally, a large proportion of community services are now run on a virtual basis, which could delay patients accessing NHS care in a timely manner, and subsequent referrals onto secondary care.
“Furthermore, people with chronic health conditions often rely on the support of family and friends to assist in their medical care, but relatives/carers have largely been unable to attend appointments or visit when patients are receiving inpatient care, which has led to further psychological implications for these patients needing complex care management.”
According to the duo, NHS staff have largely been the unheard voice of the Covid-19, global health pandemic. “We would hope that the PM’s spring 2022 inquiry on the handling of pandemics will recognise areas where improvements can be made for patients, so that preparedness can be advanced if there is another global health pandemic, as patients are at the forefront of NHS delivery. Therefore greater public resources need to be prioritised for NHS training, in order to recruit more doctors and nurses as there was already a significant staffing crisis prior to the pandemic, but the professional voices need to be heard too and not be an afterthought by the government to attract people to enter the medical and nursing professions. Emphasis on enhanced retention capabilities needs to be prioritised and implemented. Without this, the impacts of the Covid-19 pandemic will not be addressed and patients from all backgrounds will face delayed treatment and significant impacts in their care,” they added.
According to a survey by GP Online, some 92% of 322 GPs responding to their survey said the growing NHS waiting list was leading to more work for practice teams, with many describing workload levels as 'unsustainable'. 81% said that their practice was experiencing an inappropriate transfer of work from hospitals. A total of 73% of GPs said that this was 'somewhat' or 'significantly' higher than at the same point in the previous year.
BAPIO GP Forum Chair Dr Kamal Sidhu told Asian Voice, “We already have seen evidence that many patens did not or could not attend their long term condition reviews and many did not want to burden the system in the pandemic pressures e.g. the number of cancer referrals went significantly down.
“We have also been prioritising at-risk groups such as people whose diabetes, asthma or COPD was not well controlled during the last two years to review their conditions.
He admitted that there is still a significant backlog of such patients which will probably take a couple of years at least to catch up with. General practice is working to more than its capacity to clear the backlog and to meet the demand. The staff including nurses are exhausted and tired of two years of relentless pressure and a demoralising narrative that surgeries have not been open.
“This combined with a number of GPs leaving the profession and staff shortages as well as ongoing Covid absences means that any catch up is going to be an uphill task.
We are all worried about less than optimal control of the health conditions and the profession needs urgent and critical support from the government to recognise this and give us the space and resources to be able to catch up.
“We are all supporting cancer awareness campaigns etc to encourage those with any alarm symptoms to come forward and contact their practice. The intent so far appears to be to set up a national centre for vaccination as per the health secretary and if general practice is involved, we would fully support the programme as well as all displaced from their homes in Ukraine by this tragic war.”
The key targets of the government include ensuring that by July no one has been waiting more than two years, 18-month waits are eradicated by March next year and one-year waits – 306,996 patients have recently faced a delay of that magnitude – banished by March 2025, and that the waiting list starts shrinking by March 2024, two months before the next election. However, it is not known how many of the estimated 10 million did not use the services of the NHS during the pandemic.
