NHS

A Doctor Writes: The NHS Is Concealing Important Information from the Public

We’re republishing a post from our in-house doctor, formally a senior medic in the NHS, on the unreliability of official figures on ‘Covid inpatients’ . This was first published in July and only now has the mainstream media finally cottoned on to the fact that the NHS’s Covid inpatient figures are unreliable. Since we published this, there have been at least three updates to the ‘primary diagnosis schedule’, all showing a consistent overstatement of 25%.

On Thursdays, the NHS release the weekly summary data in relation to Covid patients. Normally this is a more granular version of the daily summaries – it has some hospital level detail and figures on non-Covid workload for comparison. Usually interesting but not especially informative.

Yesterday was an exception. Placed down at the bottom of the page, almost like a footnote, was a “Primary Diagnosis” Supplement. Graph One shows the information contained in that spreadsheet. I find it astonishing. In essence, it shows that since June 18th, the NHS has known its daily figures in relation to ‘Covid inpatients’ were unreliable at best and deliberately untrue at worst.

The Yellow bars are what the NHS has been informing the nation were Covid inpatients. The Blue bars are the numbers of inpatients actually suffering from Covid symptoms – the difference between the two are patients in hospital who tested positive for Covid but were being treated for something different – where Covid was effectively an incidental finding but not clinically relevant.

For example, on July 27th, the total number of beds occupied by Covid patients was reported as 5,021. However, until today, we were not permitted to know that only 3,855 of those were actually admitted with Covid as the primary diagnosis. There has been a fairly consistent overestimate of the true number by about 25% running back to mid June – figures before that date are ‘not available’.

Why does this matter?

Well in one way it doesn’t matter very much. Whether the burden of Covid inpatients is 5% of the available beds or 3.5%, isn’t massively significant – it’s still a relatively small proportion. NHS managers are already arguing that even patients with Covid being treated for another condition still need isolation procedures and present an extra burden on the system. They may argue that the NHS is still under strain from staff absences, stress levels and the waiting list backlog – so it doesn’t really matter if the published figures are somewhat inaccurate.

But it matters hugely.

Almost a Quarter of ‘Covid Inpatients’ in England Are Primarily Being Treated for Something Else

It’s not been a good week for followers of conventional wisdom. The official lines on face masks and long Covid have (once again) been brought into question and now Government figures have shown (also not for the first time) that hospitalisation numbers are being skewed by the fact that almost a quarter of ‘Covid inpatients’ in England are actually in hospital for a different reason.

Given that “increasing Covid hospital admissions” could trigger the Government’s ‘Plan B’ of mask mandates and vaccine passports (and even perhaps ‘Plan C’ of another lockdown), the implications of this distortion of the truth could be huge. MailOnline has more.

Health service statistics show there were 6,146 NHS beds taken up by people who were Covid positive on September 14th, the latest date data is available for.

But just 4,721 patients (77%) were primarily being treated for the virus, with the remaining 1,425 receiving care for other illnesses or injuries. They could include patients who’ve had a fall or even new mothers who tested positive after giving birth.

In NHS hospitals in the Midlands, around a third of Covid patients were mainly being treated for another reason on September 14th.

Separate NHS figures suggest as many as half of daily hospitalisations only test positive after being admitted for a separate condition.

Hospital numbers have become the key metric for ministers and their scientific advisers, now that vaccines have taken the emphasis away from infection numbers.

Boris Johnson has said lockdown curbs may have to be reintroduced if Covid hospital numbers rise sharply as part of his winter blueprint to tackle the virus, which could see masks and working from home mandated again.

But he did not put a firm figure on the threshold that would trigger the return of restrictions when he announced the contingency plans earlier this week.

The latest figures suggest the standard Covid hospital numbers have become a less reliable way of gauging the outbreak and NHS pressure. [Have they ever been reliable?]

Worth reading in full.

Robin Hoodwinked

We’re publishing another guest post by Charlotte Niemiec, a freelance journalist. This one is about the unseemly haste with which the Government raised National Insurance earlier this week and the flimsy rationale for doing so. How can the Government ask us to fund a financial shortfall in the NHS when it has wasted so many billions of taxpayers’ money through its mismanagement of the pandemic?

Earlier this week, the U.K. Government voted to increase national insurance contributions by 1.25% from April 2022 – a “fair and reasonable” amount that will raise £12 billion a year in extra funding for the health and social care sector, according to PM Boris Johnson. It is hardly unexpected.

I suspect many of us would willingly contribute what we could to the public purse in the face of a serious humanitarian crisis. Most stoically accept year-on-year rises that reflect inflation and population growth, especially when that money is invested in services we or those we love use now or will one day. We’re told the hike is a regrettable consequence of an unforeseen pandemic that has served to reveal cracks in the system, most notably a lack of resources in our ‘world-beating’ NHS. This should sound perfectly reasonable.

Why then, if Twitter is anything to judge by, do so many people on both sides of the political divide feel totally shafted? Perhaps it’s because we don’t have bottomless pockets and altruism only goes so far when we see our money being wasted. Forcing us to pay more to deal with a backlog that is a direct result of the government’s own poor decision-making feels like something of a cheek. The NHS needs extra funds primarily because it chose multiple, short-term, ineffective lockdown policies instead of strategies that safeguarded public health, the NHS and the economy in the long-term. Alternatives, such as the Great Barrington Declaration or the Swedish model, have always been available, but never considered.

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.

Unvaccinated NHS Workers to Be Barred from Seeing Patients

The Government is due to publish a consultation today on mandatory Covid vaccination for NHS staff, with the Times reporting that workers will be legally obliged to get ‘jabbed’ in order to see patients – or face getting sacked.

The Government will publish a consultation today on plans to make vaccination a condition of employment for 1.2 million frontline NHS workers. Those who refuse will be barred from working with patients, meaning that they will need to be redeployed or could even lose their jobs.

Official figures show that 8% of NHS workers, equivalent to 116,717, have not received their first dose. In London 14% of NHS workers have not received their first jab.

The Government has already announced that from November 11th vaccination will be compulsory for all care workers, prompting warnings that tens of thousands of care workers could leave the profession.

The NHS confederation, which represents organisations in the health service, has argued that compulsory vaccination is unnecessary because NHS staff are “overwhelmingly doing the right thing”. However, Boris Johnson is said to be concerned about the role of unvaccinated staff in the spread of the virus in hospitals. …

Johnson spoke about people who were unvaccinated during a hospital visit yesterday. He told the BBC: “What I’m particularly concerned about is that in great hospitals like this, 75% of the people who are succumbing to Covid are not vaccinated. What I would really say to everybody is come on now. It’s a great thing to get a vaccination.”

A study by The BMJ in February found that inoculation rates among ethnic minority doctors and healthcare staff were significantly lower than among white staff. Health and care workers were in the first and second priority groups for vaccination.

A Government source said that the Prime Minister personally backed the plan for mandatory vaccination, adding: “It’s only right that those who are caring for people who are particularly vulnerable to coronavirus should be vaccinated. This will save lives.”

The move could face legal challenges. Lawyers have said that employment contracts would have to be redrafted and that a blanket policy that all employees must be vaccinated would run the risk of being ruled unlawful discrimination.

Worth reading in full.

Spike in Number of Mental Health Referrals in U.K. After Lockdown

The number of mental health referrals made in the U.K. in March this year is almost a fifth higher than the number made in February 2020, before the imposition of numerous, long-lasting lockdowns. At the same time, the number of patients actually receiving care has fallen. MailOnline has the story.

Around 300,000 Britons were recommended for treatment in March this year, a rise of 18% compared to February 2020…

Referrals more than doubled in hardest-hit areas in England, including Leeds, Redbridge and Greater Preston, according to the analysis by the BBC.

Urgent referrals to crisis care teams – which include suicidal patients – have also risen 15% in the same time period, nationally.

However, the impact of the pandemic on mental health referrals in England seems less clear when looking at the entire year. There were roughly 3 million in the 12 months to March 2021, about the same as the previous year.

Charities fear patients have suffered in silence and put off coming forward for care during the pandemic, and warn there could be huge increases in referrals to come.

Despite the spike referrals this March, the number of patients actually receiving care was 9% below pre-pandemic levels.

Limited capacity due to social distancing is said to be partly to blame, as well as reduced services during lockdowns.

One suicidal mother who tried to take her own life last spring said she felt “abandoned” by the NHS when it shut down services to focus on Covid in the first wave.

Experts have long warned that a silent mental health epidemic has been brewing amid the pandemic, particularly in the young.

Worth reading in full.

More Than a Million People Waiting at Least Six Months for Vital NHS Services in England Alone

Close to 1.2 million people in England alone are being forced to wait for at least six months to access vital NHS services. So much for “Protect the NHS”! And “the waiting list figures are going one way only – up”, warns the Chief Executive of the Patients Association. The Guardian has the story.

The May 2021 figure is almost five times that recorded in the same period in 2019 , before the pandemic hit, and also includes patients requiring gynaecological services.

Senior doctors said such long delays were causing patients to be left in pain, while experts said the full impact of the pandemic may not yet be known. …

Rachel Power, the Chief Executive of the Patients Association, warned: “The waiting list figures are going one way only – up. And they won’t come down until the NHS can deliver activity faster than patients are presenting with new need.” …

Though the vast majority of patients are supposed to be seen within 18 weeks, six-month waiting lists have doubled for ear, nose and throat services and gastroenterology services when compared to the same period in 2020.

The number of patients waiting for gynaecological services stood at 15,647 in May 2019, rising to 48,168 in May 2020 before reaching 87,628 in the same period this year.

Dr Edward Morris, the President of the Royal College of Obstetricians and Gynaecologists, said the college was very concerned that women were having to wait far too long to be diagnosed.

“The current backlog we are facing in gynaecology is made up of people needing clinically urgent treatment, so many women are being left in pain with these benign conditions.” …

In May, more than 336,000 patients were waiting for treatments for at least a year, with almost 21,000 in Birmingham university hospital alone.

The hospital also recorded the longest median wait time, with patients waiting an average of 18 weeks, while some patients were waiting even longer for certain treatments. …

The figures come just before NHS England releases its latest monthly statistics on waiting times for treatments including A&E care, surgery and cancer care, which officials believe will be grim reading.

An NHS spokesperson said: “Despite the significant disruption caused by the pandemic, with staff treating 410,000 seriously ill Covid patients and launching the biggest and fastest vaccination programme in our history, NHS services continued to be available for patients who needed them, and are now making good use of the £1 billion in additional funding for elective recovery.

“The number of routine treatments and operations performed by NHS staff is increasing, with cancer and mental health services back at pre-pandemic levels, and so we continue to urge anyone who needs the NHS to come forward so we can help you.”

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.

The Figures Don’t Match Up To the Fear, a Doctor Writes

There follows a guest post from our in-house doctor, formerly a senior medic in the NHS, who says the widely trailed tsunami of hospitalisations has not only failed to arrive after ‘Freedom Day’, but we seem to be on the downslope of the ‘third wave’.

The philosopher Soren Kierkegaard once remarked: “Life can only be understood backwards, but must be lived forwards.” I have been reflecting on that comment, now we are three weeks since the inappropriately named July 19th ‘Freedom Day’. Readers will remember the cacophony of shrieking from assorted ‘health experts’ prophesying certain doom and a tidal wave of acute Covid admissions that would overwhelm our beleaguered NHS within a fortnight. Representatives from the World Health Organisation described the approach as “epidemiologically stupid”. A letter signed by 1,200 self-defined experts was published in the Lancet predicting imminent catastrophe.

Accordingly, this week I thought I should take a look at how the apocalypse is developing and then make some general observations on the centrality of trust and honesty in medical matters.

Let’s start with daily admissions to hospitals from the community in Graph One. Daily totals on the blue bars, seven-day rolling average on the orange line. Surprisingly the numbers are lower than on July 19th. How can that be?

Perhaps there are more patients stacking up in hospitals – sicker patients tend to stay longer and are hard to discharge, so the overall numbers can build up rather quickly. So, Graph Two shows Covid inpatients up to August 5th. Readers should note that Graph Two includes patients suffering from acute Covid (about 75% of the total) plus patients in hospital for non-Covid related illness, but testing positive for Covid (the remaining 25%). How strange – numbers seem to be falling, not rising. This does not fit with the hypothesis – what might explain this anomalous finding?

Maybe the numbers of patients in ICU might be on the increase – after all, both the Beta variant and the Delta variant were said to be both more transmissible and more deadly than the Alpha variant. Graph Three shows patients in ICU in English Hospitals up to August 5th. It shows a similar pattern to Graph Two – a small fall in overall patient numbers in the last two weeks. I looked into the Intensive Care National Audit and Research Centre ICU audit report up to July 30th. This confirms the overall impression from the top line figures. Older patients do not seem to be getting ill with Covid. Over half the admissions to ICU with Covid have body mass indices over 30. Severe illness is heavily skewed to patients with co-morbidities and the unvaccinated. Generally speaking, the patients have slightly less severe illness, shorter stays and lower mortality so far.

Finally, we look at Covid related deaths since January 1st, 2021, in Graph Four. A barely discernable increase since the beginning of April.

So, whatever is going on with respect to the progress of the pandemic, the widely trailed tsunami of hospitalisations has not arrived yet – in fact, we seem to be on the downslope of the ‘third wave’.

Slowing Vaccine Take-Up Means 170,000 Moderna Doses at Risk of Expiry

The NHS is looking to redistribute thousands of Covid vaccine doses as slowing take-up rates among young Britons, who don’t appear to be moved by petty bribes, could result in doses being thrown away after reaching their expiry dates. The Guardian has the story.

An internal email seen by the Guardian warned of 170,000 doses of the Moderna vaccine at risk of expiry within the next fortnight, as doctors across England have raised alarm at the unpredictability of vaccine take-up among young people meaning more doses will go to waste.

The Government is to unveil a raft of new initiatives to increase vaccine uptake among young people, including discounts on car-hailing companies such as Uber and Bolt, as well as the delivery service Deliveroo.

It is understood the NHS has managed to redistribute 40,000 of the spare Moderna jabs. However, concerns have been raised about the number of jabs wasted as uptake slows among younger people eligible for the Moderna and Pfizer jabs.

The Joint Committee for Vaccination and Immunisation recommends an interval of eight to 12 weeks between doses, initially as a way to offer more people first doses because of limited supply, but studies have since shown that the larger gap could give longer protection.

One NHS doctor in the north-east, Dr Alison George, said colleagues had been forced to routinely discard Pfizer doses, rather than give second shots early to people who requested them. “We have very high rates of infection here and the local hospital is already under significant pressure with some elective surgery cancelled,” the GP said. …

Beccy Baird, a Senior Fellow at The King’s Fund, said it was getting more difficult to predict vaccine uptake.

“Uptake is getting lower as the cohorts get younger and matching the supply of vaccines to demand will get harder as demand becomes less predictable. This is made all the harder as the vaccines have a limited shelf life,” she said. …

“In the early stages of the rollout, you could be confident that wherever vaccines were delivered there would be sufficient demand for them. Now that a majority of adults have been vaccinated, and with uptake getting lower as the cohorts become younger, demand for the vaccine is more unpredictable, making it harder to know exactly where the doses are needed.” …

Pfizer and Moderna vaccines are now mostly distributed to the under-40s, who cannot receive the AstraZeneca vaccine. Those vaccines have a shorter shelf life of up to one month in the fridge, compared with the AstraZeneca vaccine, which can last for up to six months.

Worth reading in full.