‘THIS Easter will be worse than any winter for the NHS,’ warned Alastair McLellan, the editor of Health Service Journal (HSJ), in a leading article on the 7th April 2022.
He pointed out that the transmissibility of the Omicron variant caused a large surge in Covid case numbers in January 2022, and again in March 2022, which has resulted in high numbers of Covid patients occupying hospital beds.
In the week ending 25.4.22, the number of Covid positive patients in UK hospitals was reported as 15,882 with 326 on ventilators. Also, 2,297 patients died with a positive test for Covid-19 in that week. The Covid pandemic is not yet over in the UK.
With only 95,600 acute and general beds in England, made less available because of separate cohorts for Covid patients, the 12,000 or so of Covid patients in England’s hospitals greatly impairs the ability of those hospitals to provide all other ‘non-Covid’ services.
Back on 5th November 2020, as the second surge in the pandemic took hold, Simon Stevens, the then Chief Executive of NHS England, likened the 11,500 Covid in-patients at that time, to ‘22 hospitals worth’ of coronavirus patients, and said that this put huge pressure on the NHS.
He warned that the NHS might have to abandon its ambition to provide normal ‘non-Covid care’ and that some trusts had already stopped planned surgery.
So, this Easter there has again been at least ‘22 hospitals worth’ of Covid patients in England’s NHS hospitals. The Covid pandemic continues to have a huge effect on ‘non-Covid’ services, causing continued delays to the ability of the NHS to tackle the over 6 million backlogs of patients waiting for tests, outpatient appointments and planned operations.
The situation is exacerbated further by significant levels of staff absences due to Covid, because the prevalence of Covid infections in the population remains very high. The Office for National Statistics (ONS) estimates that one in 17 people across the UK were infected with Covid in the week ending 16th April.
McLellan continued: ‘The NHS goes into the Easter Break in a more fragile state that in any previous winter since, at least, the 1990s.’
He added: ‘The situation in the national Accident and Emergency departments is grimmer than in any winter experienced for at least two decades. Long waits in A&Es have for some time been at levels unheard of before the pandemic.’
In the first week of April, 20 hospitals diverted ambulances to other hospitals as they were too full to accept them. When they arrived at a hospital more than a quarter of ambulances were waiting over 30 minutes to handover patients.
Also, the demand for ambulances has soared, because the number of 999 calls being received are very high.
The East Midlands Ambulance Service, director of quality improvement said their service received 25,000 more calls in March 2022 than in March 2021. (20.4.22 HSJ)
Nationally, the numbers of patients presenting in A&E are very high. There were 1.4m A&E attendances in March 2022, the highest since June 2021.
Delays cause patients to suffer dangerous complications and deaths.
On 18th April, Chris Hopson, the chief executive of NHS providers, which represents NHS trusts, reported after a board meeting, that hospital trust leaders agreed that this was the longest most sustained period of NHS pressure they had seen in their careers.
He warned that there were very long delays in answering 999 calls, in conveying patients to hospital, at ambulance handovers to A&Es and for 12-hour waits on hospital trolleys.
The East of England Ambulance Service Trust, for example, reported that in 2021 compared to 2020, there were three times higher numbers of serious incidents related to delays. There were 36 cases of ‘severe harm’ in 2021 whereas in 2020, there were none. (20.4.22 HSJ)
The West Midlands Ambulance Service Foundation Trust reported that half of its ‘serious incidents’ were due to ‘delays in reaching patients resulting in harm, serious harm, and deaths’.
The ambulance service produces target times for ambulances to respond to 999 calls. The most urgent Category 1 includes those with cardiac and respiratory arrests. For Category 2 patients, which include those with heart attacks or strokes, the target response time is 18 minutes on average.
By 14 April, it was reported that ambulance response times were the worst ever. (HSJ 14.4.22) Ambulance waits for heart attack and stroke reached nearly two hours. No ambulance trust fulfilled the 18-minute target.
For South Western Ambulance Service Foundation Trust, the average was 1.01 hours for Category 2 patients, but 10% of patients were not reached for 4 hours.
The head of the Stroke Association said: ‘We are extremely worried that stroke survivors’ lives and recoveries are being put at extreme risk.’ Stroke patients are supposed get to hospital within one-hour of onset of the stroke.
In 2020 and 2021, it was much more difficult for patients to access their GPs and regular hospital care and outpatient clinics, so patients were often unable to get their health problems addressed. This has caused a groundswell of demand for the more urgent illnesses which have since developed, causing patients to present at A&E.
The toxic combination of record 999 calls and attendances at A&E, at hospitals that are already full to capacity, and short of staff, has led to a meteoric rise in the numbers of patients waiting for 12 hours or more on an A&E trolley for a hospital bed.
The number of trolley waits for 12 hours or more, was held at less than 5,000 per month from October 2019 through to September 2021. However, since September 2021 the numbers have shot up from 5,000 per month to 22,506 in March 2022.
But many patients are waiting much longer, as the 12-hour wait period excludes the time the patient waits to be assessed by the doctor, before they can be admitted. Some hospitals, such as Lancashire Teaching Hospitals have been harbouring patients in their A&E departments for 60 hours or more. (4.4.22 HSJ)
This situation was rife in the 1990s, when entire ward rounds were performed in the A&E Dept for days, while patients waited for a ward bed. This NHS bed crisis was one of the reasons why Labour won the 1997 general election.
NHS hospitals are simply jammed full of patients and cannot fulfil their proper emergency responsibilities, let alone provide all the other services they should be delivering; caring for elective cases, doing cancer work, maternity paediatrics, outpatients etc.
Katherine Henderson, President of the Royal College of Emergency Medicine, described the situation as follows: ‘But hospital crowding isn’t just a minor inconvenience to dignity – it’s dangerous and puts lives at risk. With too few staff and too little capacity the risk of patients deteriorating and not being spotted by staff greatly increases.
‘For staff this reality is distressing and heart breaking. This is neither the standard of care we are a trained to deliver, nor the quality of care we want to deliver… She added: ‘This is the state of the health service with a shortfall of 10,000 beds and 110,000 staff. In emergency medicine alone we have a shortfall of around 2,500 consultants. And widespread shortage of nurses, middle grade and supporting staff.’(Guardian 10.7.22)
She said the barrier is ‘political unwillingness’ and called for ‘a plan that outlines how it will increase bed capacity and a plan for ‘a robust fully funded long term workforce’.
The Tory government, however, has a different perspective. On 31st March, MPs voted down Amendment 29, to the Health and Care bill going through Parliament, the first part of which states: ‘The Secretary of State must, at least once every two years, lay a report before Parliament describing the system in place for assessing and meeting the workforce needs of the health, social care and public health services in England.’
Instead, the government is focussed on ‘reforms’ to the NHS in the Health and Care bill, which will separate the provision of emergency care from elective care.
Emergency patients frequently have serious illnesses and may require complex treatments and after-care in intensive care units. High quality medical input is needed and it is expensive.
The government’s Health and Care bill, aims to separate the more profitable ‘elective’ care from emergency care, so that the elective care can be provided by ‘long term partnerships’ with the private sector.
The government has already published a ‘Delivery plan for tackling the Covid-19 backlog of elective care February 2022,’ setting out these objectives.
As a sign of its lack of concern for emergency patients, NHS England and the London Ambulance Service (LAS) are forging ahead with a new ‘pilot’ next month, to get volunteers to drive 999 patients to hospital.
The proposal is that St John Ambulance would train up ‘Community first responders.’ £100,000 will be provided by NHS England and NHS Improvement, so that a prototype can be developed in London for a ‘National volunteer Transport Model.’
An LAS spokesman explained: ‘These fully trained volunteers who already respond to 999 calls in their communities, will help patients who have been assessed not to need an ambulance, but may need more support than a taxi can provide.’ Clearly the Unison union is right in saying that there is clinical risk in using unqualified people to convey patients to A&E.
What the ambulance service needs is much more investment, not further cuts, and sticking plaster use of non-fully trained paramedics.
This absence of concern for the care of urgent and emergency patients in the NHS is paralleled by the government’s rush to impose its ‘Living with Covid’ plan.
The latest news is that the UK Health Security Agency, may be about to end employment for 800 of its 2000 health protection staff, as the government cuts down on the regular asymptomatic testing of workers in health and care settings, and imposes huge cuts on the infection control budget. (Guardian 27.4.22)
Thousands of patients are being harmed by the horribly pressurised state of NHS emergency services and are also being forced to put up with excessive waits for all other NHS services, including cancer care.
This government is only interested in its privatisation reforms. It has used the pandemic to run down every facet of NHS care.
Mass action by the trade unions and the whole working class is needed to remove this capitalist government and replace it with a workers government pledged to socialist measures of public ownership and provision.
The NHS bed base must be immediately restored and the 110,000 missing NHS staff recruited and retained with good terms and conditions, to bring back a high standard of emergency and elective care for all.