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Covid risks deepening NHS ‘permanent winter’

Britain’s NHS is not growing the number of patients it treats fast enough to reduce its large non-urgent care backlog because it suffers from the effects of the Omicron variant, Financial Times research shows an epidemic. besieged by manpower shortages and imposed constraints. by Covid-19.

Boris Johnson’s notification on Sunday that all over-18s will be offered a boost at the end of December has drawn harsh attention to the NHS’s ability to cope with the many needs they currently face. must face to face. Our research shows that even before facing this new obligation, the health service has entered the winter with its worst ever.

The emergence of Omicron is likely to exacerbate this trend. In its first annual audit of the NHS, the FT in 2017 identified a health service living in “permanent winter” with intense strains on the mostly taxpayer-funded system. as dormant even for months that had previously given it a chance to catch its breath.

Five years on, after experiencing the then unimaginable shock of Covid-19, the waiting list has grown more than 2m high. People with suspected cancer are waiting longer, call times for ambulances are skyrocketing, and the requirement that most people wait no more than four hours for treatment in emergency departments is being abandoned. passed by record levels.

Matthew Taylor, chief executive of NHS Confederation, which represents health organizations across the UK, said: “The NHS and the care system face an emergency and the emergency will continue. continue until at least the end of winter.”

Part of the reason why we’re where we are is due to the impact of the decade of austerity, he says. ‘ he said, adding that it was ‘the slowest decade of health service spending growth since the NHS was founded.

So far, there is little sign that the NHS will be overwhelmed by Covid alone. In the UK, the number of daily hospital admissions for the disease peaked at 4,134 in January 2021. The most recent data shows the equivalent figure is now 696.

However, the impact of the virus on the health system is profound. Infection control measures have reduced bed occupancy and drained the energy of key staff, including anesthesiologists, who would otherwise be free to treat patients in the hospital. waiting list.

Sajid Javid, the health and social care secretary, acknowledged on Monday that activities such as hip and knee replacements will be postponed until the new year as staff focus on the vaccination campaign Covid supercharged.

However, what emerges most strongly from the FT’s official data analysis is that even before Omicron changed the calculus, the health service was unable to pick up the pace to prevent the waiting list from growing any higher. again.

While referrals and admissions have come close to pre-pandemic levels – evidence of a system that is driving the missing – just by treating significantly more people each month than before the pandemic. coronavirus crisis, new NHS can ease ever-expanding care queues.

Richard Murray, chief executive officer of King’s Fund, suggests that the idea that this is achievable in the short term may never materialize. Even before Covid hit, every indicator was flashing red, with long waiting lists and missed treatment targets.

“If the NHS can’t turn the tide in 2019, what do we think has changed so much that it can be done in 2021? I think there’s always a bit of magic in suggesting the NHS will be able to ramp up operations above pre-Covid levels,” he said.

The growing backlog presents clear political risks for ministers, who are anxious to demonstrate that service is improving as they prepare to raise the bar. national insurance contributions to help fund an additional £30 billion for health services.

A 12-month rotating moving average (%) graph showing the percentage of people with cancer treated within two months of a GP referral fell to a new low

John Appleby, chief economist at the Nuffield Trust, said of particular concern was the evidence showing the number of people waiting more than two weeks to see an oncologist and two months to start treatment after being treated. introduced, on the rise. “They’re the urgent ones and you can see how they’re on target and how they’re going up,” Appleby said.

Queues are getting longer and longer despite the fact that oncology is an area where the NHS has managed to make more appointments than it did before the pandemic “but it still hasn’t kept up with the flow of referrals from GPs”. faculty,” Appleby noted.

Problems across the broader system tend to peak in hospital emergency departments. Dr Adrian Boyle, a frontline A&E specialist and vice-president of the Royal College of Emergency Medicine, said the service had just recorded its worst performance ever with the goal of being as little as possible. At least 95% of A&E patients should be treated within four hours. . Nearly four in 10 people waited longer – although the number of arrivals at A&E in November this year was down by about 50,000 from two years ago.

He highlighted bed shortages as the main cause of congestion, estimating that 10-20% of hospital beds are occupied by people who don’t need to be there “basically a lack of social and community services.” . In addition, about 7% of the national bed reserve is used by Covid patients, he added.

As a result, delays in admitting patients brought in by ambulances delayed teams reaching other patients in need of an emergency. “We hear more and more about people dying because ambulances don’t arrive in time,” Boyle added.

Waiting times for ambulances have increased.  The graph shows Ambulance waiting times across 5 categories from most urgent to least urgent.  Immediate life-threatening increased from 7 minutes in January 2020 to 9 minutes in November 2021 Immediate life-threatening, transportation to hospital increased from 10 minutes in January 2020 2020 to 12 minutes in November 2021 Emergency increased from 20 minutes in January 2020 to 45 minutes in November 2021 Urgent calls, patients can be treated on the spot increased from 60 minutes in January 2020 to 160 minutes in November 2021 Less Urgent has increased from 80 minutes in January 2020 to 190 minutes in November 2021

The backdrop of these pressures is an acute workforce crisis, with approximately 100,000 vacancies across the health sector. Vacancies for paramedics have increased by 15% in the past year, while for nurses, the rate has increased by 7%.

Murray says this reflects the UK’s lean approach to public services, where the priority is to avoid unnecessary spending. “If you look at many European countries, they are overtrained, they are very worried about the shortage of the workforce,” he said. “I think this country is the opposite. We have accepted repeated workforce shortages.”

The key question for health ministers and leaders is whether the NHS can find a way to treat more patients in the coming years by lifting its performance above the trendline levels of recent years. or not.

The so-called “selective rollback” plan, which was due to be announced at the beginning of the month but delayed because of Omicron, is expected to suggest a rethink of how some services are delivered. for better use of resources. This includes reducing outpatient appointments through a “Patient-Initiated Follow-up” system, using surgical centers to provide routine operations, and encouraging hospitals to do more more work.

But Murray cautions that staff shortages are likely to undermine such initiatives: “It just keeps repeating the workforce problem,” he said.

Taylor suggests that the way the NHS takes care of patients over the next decade could be changed by technological advances and better collaboration between different parts of the healthcare system and society to improve people’s health.

But he warned that it was important for government and NHS leaders to be upfront with the public about how long it would take to resolve the backlogs. “Unfortunately, one of the things that we’ve seen during Covid is an abusive trend in terms of testing and tracking or whatever that might be. . . I think the public can totally hear those two messages: realism about current challenges but excitement about where we can be in the future. ”

NHS England said staff were “continuing to make progress on electives”, with nearly 150,000 people starting treatment in October compared with the same month last year.

At the end of October, patients had to wait an average of 12 weeks to start treatment, compared with a peak of 19.6 weeks in July last year.

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