This week the BMA published a report revealing the sheer scale of the hidden impact of the COVID-19 pandemic – with millions of patients not receiving planned operations, treatments and appointments.
With the health service already overstretched and waiting lists at record highs prior to the pandemic, the NHS was forced to cease most routine services to create capacity for treating COVID patients. The results of this shutdown of non-COVID care, revealed by the BMA, are staggering. Through comparing figures provided by NHS England with equivalent figures for the past two years, the BMA has estimated that between April and June 2020 there were:
- Up to 1.5 million fewer general and acute admissions
- Up to 2.6 million fewer first general and acute outpatient attendances
- Around 280,000 fewer urgent cancer referrals
- Up to 25,900 fewer patients starting first cancer treatments following a decision to treat
- Up to 15,000 fewer patients starting first cancer treatments following an urgent GP referral.
Throughout the pandemic, daily press briefings have spoken of hospital admissions and deaths of COVID patients but failed to mention or recognise the impact on millions of patients whose access to healthcare had been halted.
When dealing with an organisation as vast as the NHS policy makers may be liable to forget that the statistics revealed by the BMA this week are not just numbers – these are our patients. And this means people living with often life-threatening conditions, such as cancer or heart disease, who have had treatment postponed or cancelled and many of whom may not have survived – contributing to the huge excess mortality during this period.
Others have not had vital assessment and diagnosis or may be in significant pain or dealing with huge disruption to their lives. Even patients whose care is considered non-urgent, like those waiting for a knee replacement or cataract operation, will be suffering – especially older patients losing out in their quality of life in the precious last years of their lives
The NHS now faces an unprecedented backlog of an extra several million patients on top of the record 4.5 million on waiting lists before the pandemic. More than 26,000 patients had been waiting longer than a year consultant-referred treatment at the end of May compared to 1,032 at the same time last year. This, in a health service which has a constitutional standard of a maximum wait of 18 weeks.
Patients and their loved ones will be anxiously waiting and wondering when they are likely to receive treatment. In our latest COVID tracker survey, doctors are equally concerned with 16 per cent of respondents saying they were 'not at all confident' and 31 per cent saying they were 'not very confident' about their own practice or department’s ability to manage patient demand as normal NHS services are resumed.
It is therefore crucial that the government is honest and transparent with the public and frontline staff about the size of the backlog and how – in practical terms – it will be managed, including through setting out timescales. This will require an objective, clearly understood and national, systemic approach to care prioritisation. Patients should not suffer because of postcode variation and inconsistencies.
The NHS will require additional resources to have sufficient capacity to deal with the backlog whilst continuing to provide care for COVID patients. The Government must also do all it can to avoid a second spike of this pandemic which could overwhelm the health service especially if it coincided with winter pressures and seasonal flu. This must involve urgently pursuing an aggressive ‘COVID elimination’ strategy such as that followed by countries including New Zealand, with rigorous measures to ensure the control of spread through continued social distancing, infection control and appropriate wearing of face coverings by the public.
There must also be a package of support for NHS staff who have given so much to patient care, and have worked to exhaustion, while facing a genuine and constant threat to their health during this crisis.
Sadly, the scale of this backlog was not unavoidable and comes partly as the result of political choices made by successive governments. NHS capacity has consistently lagged behind that of many other EU countries whether in terms of bed numbers, critical care facilities or workforce numbers. At the onset of the pandemic, we had just a quarter of the intensive care unit beds of Germany. And resourcing in primary and community care has also been far behind that of comparable nations. The NHS was forced to take drastic decisions due to a decade of underinvestment by cutting services in order to deal with the pandemic.
It is now the time, then, for the chancellor to come good on his promise to give the NHS 'whatever it needs' to deal with the impact of this pandemic. This means ensuring hospitals, primary and social care have the workforce, facilities and resources needed to manage this backlog, provide ongoing NHS care as well as prepare for winter and future COVID waves and pandemics. Swathes of services cannot be allowed to close down again, leaving millions of patients in the lurch and forcing doctors to work until they burn out.
The Government must now demonstrate that it has learnt the lessons of the first wave of this pandemic. To do anything less would be to let down patients, NHS staff and the country.
Chaand Nagpaul is BMA council chair