7 December 2022

The worst of the pandemic may be past, but the NHS is struggling to recover

The total number of patients waiting for some form of investigation or specialist treatment has topped 7 million.

Viewed from the perspective of the NHS, the Covid pandemic has had three phases, roughly divided along annual lines. In Year One, 2020, we were confronted by a new pathogen, capable of causing overwhelming waves of severe disease, against which we had precious few defences.

In Year Two, 2021, the cavalry arrived in the form of effective vaccines. As well as contending with fresh waves of infection, the health service made huge efforts to immunise the adult population, prioritised according to vulnerability. The efficacy of the vaccination programme in protecting against severe disease dramatically reduced rates of mortality and hospital admissions from Covid. Year Three seemed likely to be an altogether better proposition.

Only it hasn’t worked out like that. If Covid has been a hurricane, then 2022 has been a journey through the devastated landscape left in its wake. The starkest headlines concern the impact on cancer care. Immediately before the pandemic, 93 per cent of patients referred with suspected malignancy were being seen in hospital within a fortnight. Of those proving to have the disease, 75 per cent were starting treatment within two months. These figures have been sliding inexorably as 2022 has ground on. In September – the most recent figures available – only 73 per cent of suspected cases were being seen by a consultant within two weeks, the lowest level on record. Barely 60 per cent of those requiring treatment were commencing it inside the two-month target.

What is true regarding cancer care applies across the NHS. Most departments in my area have built up waiting lists of around a year for routine outpatient appointments; the longest I’m aware of is 78 weeks. Referrals are frequently rejected. Scans I could previously obtain in a matter of weeks now take months to come through. Even simple X-rays, which I used to be able to arrange on the day, are subject to weeks-long queues. The total number of patients waiting for some form of investigation or specialist treatment topped 7 million in August. Patients stuck in limbo continue to suffer and seek help, increasing pressure in primary care: GP surgeries delivered a record 36 million appointments in October. Wait times in A&E departments and for ambulance attendance are rising exponentially.

Although the majority of patients waiting more than two years have been dealt with during 2022, virtually every other metric is deteriorating. “Hidden” patients, whose conditions might otherwise have presented during 2020-21 but who stayed away, continue to come to light, often in a far worse state. Covid is still with us, and has been joined by an all-star cast of other pathogens, bouncing back after lockdowns suppressed the usual levels of transmission. The Brexit-accelerated disintegration of social care means hospitals are having to accommodate patients who cannot be discharged, while also precipitating further admissions – as even a minor illness can cause a precarious home care package to fall apart. We have been in an unremitting state of winter crisis throughout 2022, and now winter-proper is upon us – a winter that will lead to levels of fuel poverty like we’ve never seen before.

NHS England (NHSE) is compounding the situation. The public is being bombarded with adverts that stoke fears about malignancy: “If something in your body doesn’t feel right, don’t carry the worry of cancer with you. Tests could put your mind at rest.” It’s difficult to imagine a symptom less specific than something not “feeling right”. Raising the expectation that tests will be required to “rule [cancer] out” is adding yet more work to overstretched diagnostic services.

A mother of a one-year-old consulted me recently about his lingering cough. She wasn’t worried until she checked NHSE’s website, where she learned that because it had been present for three weeks it supposedly needed medical attention. She was bemused to learn this message was designed with lung cancer in mind. NHSE is now paying pharmacies to check blood pressures. We get referrals every week for people with normal fluctuations in pressure, put on high alert by this fear-mongering.

This third pandemic phase is not unique to the UK: the World Health Organisation (WHO) states that every European country is contending with a backlog. But the NHS was in a parlous condition before Covid struck, with 4.5 million waiting for hospital care. GP numbers have been falling since 2015 and practices were collapsing with alarming regularity for several years before the pandemic struck.

The WHO has published a blueprint for European health systems to recover: invest in general practice and social care to enable more healthcare needs to be met in the community; recruit and – crucially – retain staff by improving working conditions and pay; increase capacity and productivity through financial incentives to clear backlogs; and expand the use of telehealth technologies. It reads like the antithesis of everything that’s happening in the UK. Even the madness of pension tax penalties that are prohibiting senior consultants from undertaking extra work seems beyond the Rishi Sunak government to resolve. This third phase of the Covid pandemic will be with us for many years to come.