The NHS is facing what health leaders say is the worst crisis in its history. Hospital trusts and ambulance services in England are declaring critical incidents, and waiting times for admission to accident and emergency departments have reached unprecedented levels.
The Royal College of Emergency Medicine estimates that between 300 and 500 people a week die as a result of delays in emergency care, a figure disputed by England’s NHS but supported on Tuesday by Sir David Spiegelhalter of the University of Cambridge, one of the country’s leading health statisticians. . “It is quite plausible that hundreds of deaths per week are associated with admission delays,” he said.
Experts identify a complex set of interrelated factors that have come together to undermine the health service, from simultaneous waves of winter infections to a depleted and demoralized workforce.
What are the key factors contributing to the crisis and how can they be addressed?
Multiple waves of winter infections
The fifth wave of Covid-19 infections since the appearance of the Omicron variant in late 2021 is spreading across the UK. At the same time, influenza is on the rise, fueled by greater social mixing as distancing precautions taken during the pandemic are relaxed. The combination led England’s top doctor to warn last week that the country was in the grip of a “twins”.
“There are around 100,000 acute and general hospital beds across England,” said Stuart Hoddinott, a research fellow at the Institute of Government think tank. “Based on data through Christmas Day, about 7 percent of them are full of people being treated for flu or covid.”
Other infections, such as respiratory syncytial virus and norovirus, are also circulating at higher levels than in a normal winter, in part because reduced exposure over the past three years has given people lower-than-usual immunity.
Although mandatory anti-Covid measures no longer exist, health leaders are urging people to help limit infections by retaining some behaviors learned during the pandemic.
“If your child is unwell and has a fever, they should stay home from school or daycare until they feel better and the fever is gone,” said Susan Hopkins, the Safety Agency’s chief medical adviser. UK Health. “Adults should also try to stay home when they are not feeling well, and if they have to go out, wear a face covering.
Too few hospital beds
Adrian Boyle, president of the Royal College of Emergency Medicine, said if he had to point to just one cause of the NHS crisis, “it is that we don’t have enough beds in our hospitals.”
OECD figures show that the UK has the lowest number of hospital beds per capita in Europe after Sweden, and only a third of the number in Germany.
Although building hospital capacity requires long-term investment, the UK could make much better use of its existing beds by discharging patients more quickly into the community. According to Boyle, between 12,000 and 13,000 patients, representing 10 to 12 per cent of NHS beds, are medically prepared to leave hospital but must stay there because they have nowhere else to go.
He added that the fastest way to increase hospital capacity would be to train more people in social care. “That would have a faster impact than recruiting doctors and nurses for the A&E departments, although we certainly need them as well,” she said.
“Staffing remains one of the biggest challenges in the [social care] and it has a ripple effect within the NHS,” agreed Mike Padgham of industry body Independent Care Group.
“Right now there are around 165,000 vacancies within the sector. Lack of adequate local funding means homes struggle to attract staff at adequate salaries, understaffing means a home is limited in the number of patients it can serve, even where physical capacity exists. Vulnerable patients cannot be transferred from hospitals to more specific care.”
All parts of the NHS workforce, from doctors and nurses to ambulance workers and auxiliaries, suffer from staffing shortages that have been exacerbated by Brexit, making it difficult to attract and retain staff from the EU.
Although the government says there are now 34,100 more doctors and 44,800 nurses working in the NHS than in 2010, health leaders say this has not been enough to care for the growing number of patients in an increasingly sick and elderly population.
Burnout and demoralisation of staff are making matters worse, but NHS unions point to low pay as a fundamental problem. Nurses and ambulance drivers went on strike to demand higher wages and better conditions in December and are Ready to go again this month.
“The government must immediately address recruitment and retention issues by paying health and social care staff a fair wage for the work they do, reversing more than a decade of successive wage cuts in real terms and setting the absurd pension rules who are driving our most experienced staff to reduce their hours or leave the NHS altogether,” said Vishal Sharma, chairman of the British Medical Association’s advisory committee.
He added: “While this will not address the increased demand, it will encourage employees who want to remain in the NHS to continue working and provide some stability to the workforce while helping recruit additional staff to cover the record number of vacancies. ”
Insufficient funding in the long term
The core of the NHS’s problems is that growth in demand for healthcare has outpaced increases in government funding since the 2008 financial crisis.
A report from Health Foundation The think tank in October 2021 found that NHS funding over the next decade would have to grow at twice the historical rate of the 2010s to meet expected demand. This would require an annual funding increase of at least 3.2% in real terms, increasing spending by £70bn by 2030/31.
“The underlying causes of the pressures facing the NHS are not new and are the result of political decisions,” said Hugh Alderwick, director of policy at the Health Foundation.
“They include a decade of underinvestment in the NHS and broader public services, staffing shortages in health and social care, weak capital investment, prolonged neglect of adult social care services and more. These issues interact and have a cumulative effect on the system and its ability to operate.”