The NHS figures for December were a truly shocking read.
People who suffered heart attacks or strokes waited more than an hour and a half for an ambulance to arrive, on average, the longest in history for more than half an hour. People with life-threatening conditions also waited longer than at any other time on record.
More than half of the people who attended the A&E majors waited more than four hours to be seen and screened, again for the first time in history.
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And once assessed, almost 55,000 people waited 12 more hours in the ER to be admitted.
This is not only an all-time record, but it is higher in one month than the total recorded for 11 years from August 2010 to September 2021.
These delays could be responsible for hundreds of unnecessary deaths every week.
Pandemic vs general decline
But how much of this underperformance—the backlog of operations, burned-out staff, and sicker patients—can be attributed to the pandemic?
And how much of this is part of the general decline of health care over the past decade and its inability to keep up with the demands of an aging population?
Throughout the 2010s, the number of people tested at A&E within four hours remained fairly stable each month, despite more people attending.
Demand increased while treatment capacity did not, so waiting times increased.
Since the pandemic, there have been fewer people attending A&E than before (on average, it has increased more recently), but even fewer people are receiving treatment within four hours.
Demand has actually gone down, but capacity has gone down even more. Despite different demands, wait times have increased at a similar rate.
It’s a similar story with the waiting list.
The number of people starting treatment each month gradually increased throughout the 2010s, but the number of people being added to the list has steadily increased.
The demand was increasing, but the capacity was not at the same level.
Now the number of referrals for treatment each month is lower than it has been for at least six years, but the number of treatments starting has also decreased.
The pandemic is one reason for this difference: sickness and staff absence reduce the amount the NHS can do, and the sickest patients take longer to treat. But the problem was already very present before.
Tim Gardner, senior policy researcher at the Health Foundation, said recent data showed that “the NHS is facing an emergency, but its roots lie in policy decisions made over the last decade, not cold weather or seasonal flu”.
“The pressures on the NHS are the result of a decade of underinvestment in the NHS and other public services, the failure to address chronic staff shortages, assaulted capital budgets and the prolonged neglect of adult social care.”
Shortage of staff, money and resources?
As the population increases, the number of staff caring for patients must also increase to keep up.
England’s population grew by 6.5% between the 2011 and 2021 census, but that doesn’t tell the whole story.
The number of people between the ages of 20 and 50 fell slightly, while the number of people over 65 grew by almost 20%. There are 40% more people over 90 years of age.
The aging of the population is a victory for public health in general, but it carries the responsibility of meeting greater demand.
Older people generally have greater health care needs. They get sick more often and when they do get sick it takes them longer to recover.
Funding, staffing and resources need to increase to the same level as the older part of the population just to maintain previous standards of care, before thinking about improvements. Even if the patient/staff relationship is maintained, the resilience and experience of those NHS staff is also critical, something that appears to be at risk at the moment.
Andy Curran, emergency medicine consultant at Lancashire Teaching Hospitals NHS Foundation Trust, told Sky News he fears for the future as staff retire or work less to protect their own well-being: “I’ve struggled with it (my mental health ) personally, but many colleagues who have been working full-time have had to reduce the hours they work just to maintain their own well-being.
“We see young staff coming in who are leaving us earlier than ever to go work somewhere else.
“If we’re not careful, we’ll make it such an unattractive workplace that we won’t have anyone to come take care of us when we’re in crisis.”
Overall, the number of NHS doctors and nurses has grown more than the aging population in the last ten years, thanks mainly to strong increases in recent years. That’s some rare good news. But the number of managers has not kept pace.
The Institute for Fiscal Studies says this could be contributing to a slowdown in healthcare efficiency.
“The whole system could be working less effectively due to insufficient or ineffective management. To greatly simplify, managers can improve productivity by taking over operational tasks, leaving clinical staff to focus on treating patients – their comparative advantage,” says IFS.
“Managers, in turn, can stick to what should be their comparative advantage: scheduling staff, for example, or scheduling the use of the operating room.”
Health care financing
Funding has increased in the last ten years, but not to a level that is responsive to this growing and aging population.
Data from the Nuffield Trust, an independent UK healthcare research group, shows how spending ground to a halt in 2010, relative to the changing population, after growing during the 2000s and before.
Nuffield’s John Appleby and Sally Gainsbury said that even if the latest spending pledges come to pass, it will “still only bring the average annual increase between 2009/10 and 2024/25 to 0.5%”.
“This is well below the long-term average of 2.6% and comes against the backdrop of the health service trying to recover from a pandemic.”
So while the number of doctors has increased over time, the efficiency of their work seems to be hampered by a lack of managerial direction and a lack of funds and equipment.
One of the most striking examples of this lack of resources are beds.
In 2012 there were 99,562 beds available in English hospitals on average every day in December. By 2022, this had increased by less than 500, to 99,927.
Along with social care, a lack of beds could be one reason A&E is unable to discharge patients to different parts of the hospital. Hence the long waits in the ER and the ambulances that cannot unload their patients.
Is there a way back for the NHS?
We are seeing the first signs of a change in the fortunes of the waiting list. It fell in October for the first time since May 2020, from 7.21 million to 7.19 million. The number of waits of more than a year, more than 18 months and more than two years has been reduced, but there is still a long way to go.
More than 200 times as many people have been waiting a year for treatment compared to when the pandemic began.
These longer waits have been targets for the NHS for several months, with Prime Minister Rishi Sunak saying delisting was one of his top five priorities by 2023. He also announced £250m of additional funding for the health service. .
It seems like a difficult challenge, but there is a precedent.
In August 2007, when the figures began to be compiled, there were 4.2 million people on the waiting list and almost 600,000 of them had been on it for more than a year, more than even in the worst stage of the pandemic.
In just two years, the waiting list had been cut nearly in half, to 2.3 million. The number of waits of more than a year was 18 times lower than it had been, just over 30,000, and would be below 1,000 before the end of 2012. However, as Nuffield’s spending data shows in the previous graphic, did not arrive. cheap.
In 2003, the Labor government increased National Insurance by 1% to help pay for a £6.1bn increase in spending, dwarfing the £250m currently committed by this government. Even then, it took years before the waiting list began to dwindle.
A spokesman for the King’s Fund, an independent charity that works to improve health and care in England, welcomed Sunak’s recent announcement of more funding, but said it must be maintained to see the same levels of success as his predecessors now. quite distant from the 2000s: “Given the current crisis, the government’s £250m emergency cash injection this week will be welcomed by the health care system, but there remain real concerns that this push in the short term The deadline is so late in the winter and it will take time to reach frontline services and improve patient care.
“Ultimately, short-term solutions will not solve long-term challenges. A timeline on the next workforce plan would be a good starting point for signaling the government’s longer-term thinking.
“Waiting times can be reduced, as seen in the early 2000s, if services have a clear focus and the right levels of investment and staff. Without these conditions, sustained pressures across the board are unlikely to abate.” the system”.
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