Even in pre-COVID years the health service would struggle to treat the sheer number of ill people at winter. Sky News analysis of the latest NHS data shows that last month, usually one of the quietest times, it fared worse than any winter peak.
Senior data journalist @danieljdunford
Thursday 14 July 2022 17:36, UK
The phrase “NHS winter crisis” is often over-used, but in a post-COVID 2022 it undersells the emergency in the health service.
New data from NHS England covering waiting times for A&Es and other hospital treatment suggests it’s in crisis all year round.
June is typically a month when the NHS is less busy. The health service should be able to respond more quickly to emergencies and ready itself for demand to peak and for services to be stretched again a few months later.
“The summer months traditionally would have been a point where you would expect real inroads to be made on waiting lists,” explained Adam Brimelow, the director of communications at NHS Providers, which speaks for every NHS hospital, mental health, community and ambulance service in England.
This June, waiting times at A&Es in England were worse than they ever have been during a “winter crisis”, including the most recent winter which itself broke unwanted records.
12 hour trolley-waits soar
A ‘trolley-wait’ is the time between when a doctor in A&E decides that a patient’s condition is serious enough that they need to be admitted to hospital for further treatment and when the patient is actually admitted. Many of these patients will already have waited several hours before getting that assessment.
It had been getting worse in the years before the pandemic, but still, a trolley wait of over 12 hours was almost unheard of.
In June 2019, the last equivalent month pre-pandemic, there were 462. From June 2011 to 2017 there were 290 – that’s in total, not on average. The previous winter record was 639 per 30 days, in 2017/18.
In June 2022 there were 22,034, 47 times more than June three years ago, 34 times more than that pre-pandemic winter record, 76 times more than the total for eight years’ worth of Junes from 2011 to 2018.
The number of trolley waits over four hours is also higher than it ever has been per day.
Other waits in A&E
As mentioned, many of these patients will already have had a wait to see a doctor in A&E. There’s a target that no more than 5% should have to wait more than four hours before that happens.
NHS England hasn’t met that target in major A&Es since June 2013, and the last time it was less than seven times over the target was August.
It’s no better in Scotland. On Tuesday it recorded its highest ever weekly total of patients who had to wait more than four hours in A&E, overtaking the previous record set a week before. 35.1% of people exceeded the timeframe, seven times more than the government target.
The waiting list
The waiting list for hospital treatment – the list that is meant to be cleared during the summer months – has been growing for two full years. In May it included 6.6m people, 11% of the population. Previously, the record number of months of back-to-back growth was eight.
There are an extra 2.75m people on the list compared with before the pandemic started. Two hundred times more people have been waiting over a year compared with before the pandemic began.
The NHS has eaten in to the two-year backlog – it’s dropped by almost two thirds since February, from 23,000 to 8,000. But they only started collecting figures on two year waits last April, how rare they had been before then.
Yesterday health minister Maria Caulfield told the Commons that the heatwave was causing the ambulance service to see “the sort of pressures we would normally expect to see in winter.”
But these figures we’re talking about aren’t skewed by the heatwave, we’ll get those next month.
There are about 13,000 people in hospital with COVID, and cases have been rising among staff. Presence of the disease limits how quickly NHS staff can perform, but it is not causing the intense disruption it has done over the last few years.
“It’s really worrying. It’s really really worrying. It’s not a safe proposition,” said Tim Gardner, Senior Policy Fellow at the Health Foundation, an independent health care charity.
“It may be felt in loss of life, or in the amount of misery and distress that is inflicted on patients, and in exhaustion, stress and burnout among the workforce.”
What’s causing the problem?
It is not possible to focus on one particular part of the health service as in need of repair. The NHS is struggling under increased demand and reduced capacity, staff vacancies and absences, and difficulty discharging patients.
And problems that exist in one service make it more difficult for the others.
“It’s not an A&E problem, it’s the whole system. There are people in hospitals who are fit enough to be released but still need some sort of care, but there is no space in social care settings for them to go to.
“That means you can’t admit people from A&E that need to be admitted. That means A&E is busy, and when ambulances come along they have to wait outside because A&E is full. There is a lack of capacity throughout the system.
Read more: Funding cuts left the social care system in crisis even before COVID
Mr Brimelow warns that the crisis is driving staff out of the profession and that means the situation could get even worse.
“The starting point of all of this is a situation where we have funding pressures and there were more than 100,000 vacancies in the NHS.
“We’re now seeing high levels of emergency demand and mental health, and the pressures of addressing the backlogs. It feels like relentless pressure.
“The worry has to be that some staff will burn out or decide it is too much for them and pursue their careers elsewhere.”
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