Hospital pressures

Lockdown Backlog: NHS Waiting List Hits New High of 6.2 Million as Stroke and Heart Attack Victims Wait Over an Hour for Ambulance

The number of patients waiting for routine hospital treatment in England has soared to a new record of 6.18 million, as ambulance and emergency department waits also reach all-time highs. MailOnline has the story.

NHS data show one in nine people were in the queue, often in pain, for elective operations such as hip and knee replacements and cataracts surgery by February – up from 6.1 million in January. 

Separate data show A&E performance plummeted to its worst ever level in March, with a record 22,506 people waiting 12 hours to be treated, three times longer than the NHS target. Just seven in 10 patients in casualty units were seen within the four-hour threshold, marking the worst performance yet.

Ambulance figures reveal heart attack and stroke patients were left waiting for more than an hour for paramedics to arrive on average – another record.

Health bosses argue the NHS has faced its busiest ever winter and a slight drop among the longest waiters show it is tackling the backlog.  

NHS leaders said the health service needs more cash to fill its 110,000 vacancies and ongoing problems in social care, despite receiving a record £136.1 billion this year to help it recover from Covid.

Ministers announced an elective recovery plan earlier this year, setting out how waiting lists will finally start to fall from March 2024, while two-year waits would be scrapped by the summer. But experts today warned “it is hard to imagine an end in sight, with lengthy waits for healthcare firmly here to stay”.

It comes as doctors today say record-high Covid infection are leading to operations being cancelled across England, despite daily admissions and the number of infected patients in hospital trending downwards. 

How can this winter have been the “busiest ever” when excess deaths were trending below average throughout. Surely last winter, with the Alpha Covid wave in full swing, was much busier. Hard to sort the truth from the exaggeration in the messages coming out from the health service, particularly with health bosses lobbying for the return of restrictions.

Have they forgotten it’s the restrictions that got us into this mess, by telling people to stay at home when they’re ill, cancelling operations ‘because Covid’ and storing up the mother of all backlogs?

Worth reading in full.

If Hospitals Are Currently Under Pressure, They Only Have Themselves to Blame

There follows a guest post by our in-house doctor, a former senior NHS medic, who says the latest ‘perfect storm’ causing pressure on the health service in parts of the country is more a self-induced squall.

In the middle of last week, several NHS Trusts issued warnings about the acute strain their services were under. The South Central Ambulance Service went so far as to declare a critical incident – normally reserved for a situation in which demands on the service exceed the capacity to manage those demands. I was surprised that so many NHS bodies spread over a wide geographical area issued public warnings about their failure to cope at the same time. Statements referred to high demand on services (hardly news) and lacked any specific detail about critical capacity constraints. Accordingly, the Daily Sceptic asked me to interrogate the available data to work out the extent to which a Covid resurgence might be responsible for the latest ‘perfect storm’ to hit the NHS.

Graph 1 shows daily admissions of Covid positive patients from the community. Admissions have risen in the last few weeks, but seem to be tailing off. Data from Graph 1 have been the subject of hysterical articles in the mainstream press implying the latest Omicron BA.2 subvariant may be triggering a new wave of acute Covid infections. It’s not sensible to interpret Graph 1 as a stand-alone figure without considering contextual information from other datasets.

Hospitals Clogged With ‘Well’ Patients – 16% of Patients Are Fit to Be Discharged But Are Blocking Beds

NHS beds are being blocked by “well” patients, new figures show, with three quarters still on wards, adding to hospital pressures. The Telegraph has the story.

Of the 87,775 patients in ward beds as of April 5th, around one in seven (16%, 14,487) had Covid, the highest proportion since February 17th.

But separate figures published on Thursday by NHS England show 71% of patients deemed medically fit to leave remained stuck. 

Only 5,178 of the 17,968 deemed medically fit on April 3rd were discharged. 

In response to increasing pressures, one NHS boss has asked families to help discharge their loved ones from hospital even if they’re still testing positive. 

Dr. Derek Sandeman, Chief Medical Officer for Hampshire and Isle of Wight Integrated Care System (ICS), said staff sickness rates, rising Covid cases and “high numbers” of people needing treatment has created a “perfect storm” across the region.

If hospitals are ‘under pressure’, as was reported this week, then rather than telling sick people to stay away, promptly moving well people on would seem a good place to start.

Worth reading in full.

EIGHT More Nightingale Hospital Hubs Stand Empty as Surge Predicted by Government Models Fails to Appear

Eight Nightingale hospital surge hubs were built by the Government this winter for an undisclosed amount of money that now stand empty in anticipation of a wave that never came. MailOnline has more.

This is the first look inside one of the NHS‘ new Nightingale surge hubs – which officials concede might never be used as the Omicron wave continues to recede.

The temporary site on the grounds of Royal Preston Hospital is one of eight commissioned across England last month, when the fourth wave looked as if it could threaten the health service. 

It has been assembled in the car park at the city’s biggest hospital in less than four weeks and can house roughly 100 Covid patients – but it is currently empty. 

Local NHS bosses have indicated that the new hub might never be used and medical unions have warned it could swallow up staff and pull resources away from other parts of the health service. 

Other make-shift structures are being built in London, Leeds, Solihull, Leicester, Stevenage, Ashford and Bristol for an undisclosed amount of money.

England’s original Nightingale hospitals, built in 2020, cost a total of £500million, which included running costs, stand-by costs and decommissioning costs. But they saw only light use before being mothballed.

The new, smaller sites will remain on standby to look after Covid sufferers who are not well enough to go home but need minimal supervision during their recovery.      

Kevin McGee, chief executive of Lancashire Teaching Hospitals Trust which looks after the Royal Preston, previously said: “My hope is that we never have to use it. We’re planning for it, and that’s quite right because we need to make sure that we put the appropriate capacity in place should we need it, but I’m hopeful we can manage within our core bed base.”

However, Dr Brian McGregor, of the British Medical Association (BMA), said staffing more beds would mean “falling further behind” on routine work.

Worth reading in full.

Unprecedented Low Hospital Demand: NHS Data Show a Quarter of ICU Beds Unoccupied in Mid-January

There follows a guest post by our in-house doctor, who notes the NHS has revealed that almost a quarter of ICU beds in English hospitals are unoccupied in the middle of January, which is unprecedented in recent history – normal ICU bed occupancy at this time of year is well over 90%. Why then the continued narrative of fear and doom in some quarters?

On Wednesday January 19th, Boris Johnson announced in the House of Commons that the majority of ‘Plan B’ restrictions would end in England on January 26th. Any objective analysis of the U.K. data confirms the information from South Africa in early December in relation to the mild nature of Omicron was correct. Finally, the Government has been persuaded that our South African colleagues did know what they were talking about.

After a brief incursion onto the territory of Libertaria, the forces of Hysteria have been repelled and British citizens partially regain their sovereignty. Time to hang out the bunting and open the champagne? I think not.

Reaction by lockdown zealots to removal of societal restrictions has been tediously predictable. In an echo of July 2021, a range of commentators are again using compliant mainstream media outlets to predict imminent catastrophe if societal restrictions are lifted and to condemn the Government for putting public safety ‘at risk’. Before looking at warnings of doom in more detail, I will briefly examine the data which have led to the volte face by the Government. I will not dwell too long on these numbers as most readers will already be aware that the “nailed on tsunami of admissions” has simply failed to show up. Again.

Graph 1 shows the most important information this week from the Primary Diagnosis spreadsheet. Readers will recall this shows the total numbers of patients in hospital on vertical orange bars, versus the number of people in hospital with acute Covid on blue bars. The ratio between the two is depicted by the grey line. Notice the blue bars (people ill with Covid) are falling on the right-hand side of the graph, as is the ratio. So, when the BBC reports that Covid inpatient numbers are about 15,000 and static, the true picture is there are fewer than 8,000 patients and the numbers have been falling for the last 10 days.

Graph 1

Graph 2 shows the true numbers for London, which front runs the rest of the U.K. True numbers of Covid patients are 40% of the daily reported figure and numbers have been falling steadily since January 4th.

Pressure on Health Service is “Abating”, Says Michael Gove, As He Refuses to Rule Out End of Free Lateral Flow Tests

In what may be a sign of things to come, arch-lockdown fanatic Michael Gove has begun to pivot, contradicting Education Secretary Nadhim Zahawi by refusing to rule out the end of free lateral flow tests and saying the pressure on the NHS is “abating”. “We are moving to a situation where it is possible to say that we can live with Covid,” the Housing Secretary said. Sky News has the story.

But when asked by Kay Burley on Monday for how long the [lateral flow] devices will remain free for all, Mr Gove said: “It is the case that in this country lateral flows are free – unlike in many other jurisdictions – they are a vital tool in making sure that we can curb the spread of the infection and also that people who need to isolate do so.

“But, as you pointed out right at the beginning of our conversation, we are moving to a situation – we are not there yet – but we are moving to a situation where it is possible to say that we can live with Covid and that the pressure on the NHS and on vital public services is abating.

“But, it is absolutely vital to recognise that we are not there yet. And as the health secretary has reminded us there will be some difficult weeks ahead and that is why we all need to continue to test, continue – if we are positive – to isolate, and continue broadly to support the NHS as it goes through a challenging period but one in which the frontline professionals are doing an amazing job.”

Pressed once more on whether the Government is considering phasing out lateral flow tests but not for the coming weeks, Mr Gove replied: “As the Prime Minister and others have said, we will do whatever it takes.”

Sounds like he may be preparing the ground for the wind-down – and it is being reported that Boris is indeed drawing up plans for “living with Covid”. Let’s hope so. Mass testing has long outlived any usefulness it might have had.

Worth reading in full.

Stop Press: Boris says he’s looking at cutting the self-isolation period to five days, according to MailOnline.

Covid ICU Occupancy is Less Than a Quarter of its Peak Last January and Declined Further in the Past Two Days. Time to Declare the Pandemic Over

Despite the record numbers of reported infections in the U.K. and hospital admissions rising in the past few weeks (though up to half are incidental admissions being treated for something else), Covid ICU occupancy has barely budged since the summer, and even declined in the past two days. In London, total Covid hospital patients also declined in the past two days. This time last year, with a third of the infection rate (according to the ONS) Covid ICU occupancy nationally was three and a half times higher, at around 3,000 patients, rising to a peak of 4,000 two weeks later.

Whether due to greater population immunity, a milder strain, or better treatments, this is obviously very welcome. It is also confirmation that the pandemic is well and truly over – we are basically now expending vast resources tracking the spread of a cold – and it is time for the Government to acknowledge this fact, lift all restrictions, end all emergency powers, and bring the state of emergency to an end.

England’s NHS Waiting List Hits 5.6 Million

Few will be surprised to read that the number of people in England alone waiting to begin hospital treatment has risen again to a record high. 5.6 million people were waiting to start treatment at the end of July, an increase of almost half a million from the end of April. And the figure will not stop rising yet, with the Institute of Fiscal Studies estimating that the waiting list could reach 14 million by next autumn. The Guardian has more.

A total of 5.6 million people were waiting to start treatment at the end of July, according to figures from NHS England. This is the highest number since records began in August 2007 and includes those waiting for hip and knee replacements and cataract surgery.

The number of people having to wait more than 52 weeks to start treatment stood at 293,102 in July 2021, down from 304,803 in the previous month, but more than three times the number waiting a year earlier, in July 2020, which was 83,203. …

The data shows the total number of people admitted for routine treatment in hospitals in England in July 2021 was 259,642, up 82% from a year earlier (142,818), although this reflects lower-than-usual figures for July 2020, which were affected by the first wave of the Covid pandemic. The equivalent figure for July 2019, before the pandemic, was 314,280.

NHS England said many more tests and treatments had been delivered this summer compared with last, while hospitals cared for thousands more patients with Covid. It said there were 3.9 million diagnostic tests and 2.6 million patients started consultant-led treatment in June and July, compared with 2.7 million tests and 1.6 million treatments over the same time last year. …

NHS England also pointed to data showing that almost half a million people were checked for cancer in June and July, among the highest numbers on record. …

The new data showed that more than 325,000 patients in England had been waiting more than six weeks for a key diagnostic test in July. A total of 325,229 patients were waiting for one of 15 standard tests, including an MRI scan, non-obstetric ultrasound or gastroscopy.

The equivalent number waiting for more than six weeks in July 2020 was 489,797, while pre-pandemic in July 2019 there were 37,206.

Tim Mitchell, the Vice-President of the Royal College of Surgeons, said the overall data showed 7,980 patients waiting more than two years for treatment. The longest waits were for trauma and orthopaedic treatment such as hip and knee replacements, followed by general surgery such as gallbladder removals and hernia operations.

Worth reading in full.

NHS Waiting List Could Hit 14 Million in England by Next Autumn, According to IFS Report

A new report by the Institute of Fiscal Studies (IFS) says that the NHS waiting list in England could reach 14 million by next autumn and could then continue to increase “as the number joining the waiting list exceeds the number being treated”. And this, according to the author of the report, is just the beginning: “Much longer waiting lists [could] be with us for years to come.” Sky News has the story.

Currently, the number of people waiting to start routine hospital treatment is at a record high – 5.3 million, according to latest figures.

But the IFS has warned in its new report that there is a massive backlog of people still to come forward for treatment, largely caused by Covid [what about lockdown?].

Health Secretary Sajid Javid said the number of people on waiting lists could rise to 13 million in the coming months, but the IFS projects that the total could eventually surpass the Health Secretary’s figure.

“In our first scenario, 80% of the approximately seven million ‘missing’ patients return over the next year, the NHS operates at 90% of its 2019 capacity this year and next, and then at 100% capacity from 2023 onwards,” it says.

“Under this scenario, waiting lists would soar to 14 million by the autumn of 2022 and then continue to climb, as the number joining the waiting list exceeds the number being treated.”

The IFS said while it is unlikely all patients will return due to the fact some will have died and others might have had private treatment, most will probably require treatment at some point soon, especially as virus cases decrease and “people are more willing to seek health care”.

Max Warner, the author of the analysis, said: “There is a real risk that if the NHS cannot find effective ways to boost its capacity – a challenge at the best of times, let alone after a major pandemic – then much longer waiting lists will be with us for years to come.”

Worth reading in full.

England’s NHS Waiting List Hits Five Million for the First Time

In striving to “protect the NHS”, we have instead placed it under record levels of pressure. The number of people waiting to start hospital treatment in England alone continues to rise and has passed five million for the first time. The number waiting for more than a year remains significantly higher than before Covid – and lockdowns – began. The number of people who actually require treatment will be higher still since many are expected to be living with undiagnosed diseases, such as breast cancer, having been reluctant to burden the health service with check-ups during the pandemic. The Guardian has more.

NHS England’s latest set of monthly performance figures, published on Thursday, show that the waiting list stood at 5,122,017 in April – up 171,720 in a month.

The total has risen from the 4.95 million who were on it in March, which was itself almost 252,000 up on the 4.698 million recorded in February – a month-on-month rise of 5.4%.

The number of people being forced to wait at least a year for treatment in hospital, especially surgery, has fallen for the first time in over a year but remains a serious problem. Thursday’s figures also show that 385,490 people have now been waiting more than 52 weeks, 50,637 down on the 436,127 who were in that position last month.

Such long waits are a new phenomenon. In contrast, in March last year – before Covid triggered a suspension of much NHS care – just 3,097 patients had faced such an unusually long delay.

Ministers, NHS chiefs, medical groups and health charities are worried that growing numbers of patients are facing lengthening waits for vital care including cancer treatment, a hip or knee replacement, heart operations and surgery to remove cataracts to improve eyesight.

Worth reading in full.

Stop Press: Professor Karol Sikora, on Lucy Johnston’s “Sketch notes on a pandemic” podcast, says: “I’ve been working in oncology for nearly 50 years and I’ve never seen a crisis like this before.”