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Inside the NHS: part two

Tuesday 1 December 2020


You can read Inside the NHS: part one here

Covid-19 isn’t the only killer in town. Thousands of patients have missed cancer screenings and checkups during the crisis and mental health issues have escalated. Is there a silent secondary pandemic waiting in the wings for the NHS?


The health service started at a disadvantage.

Even before coronavirus, the NHS faced a backlog of patients and was substantially behind targets on waiting times. Following the freezing of non-urgent procedures, an enormous backlog has built up: there have been more than 4 million fewer diagnostic tests less this year than by the same point last year.


Catching up will be a serious challenge:

  • Nearly 1,600 working-age health and social care staff died with symptoms of Covid-19 between 9 March and 25 May alone.
  • 92 per cent of NHS trust chief executives are concerned about staff wellbeing, stress and burnout following the pandemic.
  • Looking ahead, nurses, doctors and assistants will be expected to take on a large part of the effort to administer covid vaccinations, with staff from 6,813 surgeries due to be allocated on a rota basis to vaccination centres

While Covid cases and deaths are constantly being tracked, it’s much more difficult to quantify the scale of the challenge of what comes next for the NHS. After over half a year of cancellations and delays, the waiting list for non-urgent procedures now stands at over 4 million people. Meanwhile, the number of patients who have waited over a year has surpassed 120,000.


The backlog buildup: a timeline

5 March: Chief Medical Officer Chris Whittey says the UK doesn’t have enough hospital beds to cope with projected covid infections.

17 March: NHS England seeks to free up 30,000 beds for coronavirus patients by telling all trusts to cancel non-urgent surgeries for three months from 15 April.

22 April: Cancer Research warns that 2,300 people a week may be missing cancer diagnosis as people put off seeking help.

25 April:  Government launches campaign saying NHS is “open for business” and urges patients to stop missing treatment.

28 April: Trusts advised to to step up non-Covid-19 urgent services as soon as possible, reversing earlier instructions to pause them for three months.

By June, the share of people waiting over 18 weeks for treatment had tripled since January. While delays technically only affect non-urgent procedures, GPs have reported that patients are dying while waiting for treatment.

A modest but significant number of patients have also ended up waiting for longer for procedures that weren’t formally stopped during the pandemic. Around 1 in 20 people diagnosed with cancer waited over a month for treatment over the summer.


Diagnostic Delays

While the media focussed on counting Covid tests, the number of non-Covid tests in the UK fell sharply. The result was a growing number of health problems left undiagnosed. 

The NHS usually carries out around 2 million diagnostic tests a month, including procedures such as ultrasounds and MRIs, but in April this figure fell to 600,000. In aggregate, 4.6 million fewer diagnostic tests have been carried out by the NHS in the first nine months of this year than during the same period in 2019. 

The pandemic also saw a large dip in the number of urgent cancer referrals, with 80,000 referrals made in April, compared with 170,000 in the same month last year.
Often, delayed diagnoses are a matter of life and death, while the cost to the NHS is added pressure further down the line.


A secondary pandemic 

Adding to the demands on the NHS is a “rising tide” of demand for mental health services. Mind, the mental health charity, said calls to its helpline were twice the usual volume in November, while urgent and emergency referrals in June and July were the highest since records began.

Mental health doctors have reported a rise in both the severity of disorders as well as the number of emergency interventions.

Across the UK, the number of people suffering from depression has jumped, with rates in June rising to almost double normal levels.


Back to normal

Backlogs are nothing new for the NHS. In fact, its targets on waiting lists for non-urgent procedures had not been met for four years prior to the start of the pandemic. But the fact that the service went into the pandemic with delays will make it harder to get back to normal. Another factor that will make it harder to get back on track is that the NHS’s baseline capacity on key measures such as beds, nurses and doctors was already low compared with other wealthy countries, according to a briefing note by the Nuffield Trust.