In Britain, the pandemic health disaster is worsened by the NHS crisis, with insufficient staffing in all areas of health care and a frightening increase in deaths in ambulances, GP surgeries and A&E departments, while waiting times get longer.
Waiting times
Since the start of the coronavirus pandemic, waiting times for NHS treatment have grown by a fifth. In May 2021 there were 5.3 million people waiting for treatment in England, compared to 4.4 million in February 2020. It is more than twice the January 2009 figure of 2.3 million. In February 2020, 1,600 people had been waiting over a year; by May 2021, this was 340,000. The King’s Fund research has shown that people in the most deprived areas are 1.8 times more likely to be waiting over a year for hospital treatments including knee and hip replacements and cataract surgery. Waiting lists grew by an average of 55% in the most deprived areas and by 36% in the least.
In the first ten months of the pandemic there were three million fewer elective admissions and 17 million fewer outpatient appointments compared to the same period in the previous year. Overall, between March 2020 and May 2021, 7.4 million fewer people joined the waiting list than would have been expected from pre-pandemic patterns. How many of these missing millions still need treatment and when they will try to obtain it is a complete unknown. But the Institute for Fiscal Studies says it could mean that waiting lists reach 14 million people by Autumn 2022. Only by increasing capacity by 5% for the next two years, and by 10% from 2023 onwards, would pre-pandemic waiting times be seen by 2025. This is catastrophic. It can’t be solved by money alone; it requires addressing staffing issues urgently.
Staffing crisis
The NHS has fewer beds, doctors and nurses and allied health professionals per head of population than almost any country in the EU. Morale is low, staff are exhausted and services are understaffed.
The Tories’ 2019 election pledge of 50,000 more nurses is not going to be met. 11% more 18-year-olds have applied to study nursing since the pandemic began. However, one in four nursing students drop out, about 20% of newly trained nurses leave in their first year and 24,000 nurses leave every year. Hospital trusts spend about £1.5bn annually on agency staff and overtime. Britain has just over eight nurses per 1,000 head of population. This is near the bottom of the international scale. In the eight years before the pandemic, Britain lost 50% of the district nurses.
England is 50,000 doctors short, worse than similar European countries with 2.8 doctors per 1,000 people versus an EU average of 3.7.
A survey of radiologists in 2020 found the workforce to be 33% short-staffed. Just under half of all NHS Trusts do not have the staff they need to run safe 24/7 interventional radiology services. Without action, England will miss the 2028 cancer targets set out in the NHS Long Term Plan. Of the eight commonest cancers, the proportion diagnosed early fell from 44% in 2018/19 to 38% in May 2020. During the pandemic, it is estimated that 19,500 cancer diagnoses have been missed because of lack of referrals.
The Tories’ 2019 election manifesto pledge to increase GP numbers by 6,000 in England by 2025 has been abandoned, with the knock-on effect of not being able to offer 50 million more GP appointments per year as promised. A survey in May 2021 showed that a third of responding GPs planned to reduce their working hours. An annual increase of more than 1,200 is needed to meet a target of 6,000 more over five years.
The Royal College of Psychiatrists have called for extra funding and staffing to meet the pandemic mental health catastrophe. New referrals among people of all ages were up by 24%, with 1.5 million people in contact with mental health services in June 2021 and 1.6 million people waiting. Two fifths were forced to contact emergency or crisis services, with one in ten ending up in an A&E department. England has one consultant psychiatrist for every 12,600 people; one in ten psychiatrist posts are not filled.
Waiting costs lives
In September 2021 2.1 million people attended NHS A&E departments, the highest number ever recorded for September, and over 900,000 calls to 999 for an ambulance were answered, a 30% increase compared to the previous September and unsustainable. Handover from ambulance to A&E delays are the longest recorded, meaning hours lost to the ambulance service rising from 4,700 hours in April 2021 to 35,000 hours in September 2021.
Spokespeople for the Royal College of Emergency Medicine and the Association of Ambulance Chief Executives have expressed anger and dismay at the recent figures of avoidable deaths at home, in ambulances waiting to unload and in overcrowded A&E departments. It is estimated that over 4,500 people in England, over 700 in Wales and over 300 in Scotland in A&E in 2020-2021 died after receiving less than ideal care or waiting to start treatment. Overcrowding delays care and reduces its quality. The longer a person spends in A&E, the higher their risk of dying. In England, in October, 7,059 people spent at least 12 hours on a trolley or chair waiting for a bed on a ward, the highest figure ever. One in five beds in hospitals are occupied by older people who are waiting for a care package from social services, while there are over 105,000 vacancies in Social Care in England.
People in GP surgeries with life-threatening emergencies are also waiting hours for ambulances, in the care of highly trained clinicians but in practices not appropriately equipped for the care of such emergencies. Capitalism is bad for our health. The pandemic has exacerbated and exposed the crisis in the NHS. Only a movement for socialism will help secure our future.
Hannah Caller
Fight Racism! Fight Imperialism! No 285, December 2021/January 2022
