By Peter Warrington
In this document I will look at the effect of COVID-19 and the effects of it and its associated lockdowns on access to public services, such as healthcare. Healthcare for instance is an area where there have been many concerns in the media that COVID has reduced the number of people getting treatment out of fear of wasting public resources or catching/spreading the virus.
This article from the health foundation analyses the effects of COVID-19 and lockdowns on elective care – Healthcare services that are planned in advance, for example in cancer treatment. It notes that data and understanding of the full impact is still emerging, and uses data based on 18-week waiting times.
For people finishing treatment, the article notes that “during the initial peak of the pandemic, the number of completed pathways fell substantially”, referring to the number of people completing treatment, and that 3.5 million fewer “pathways” were completed in 2020 compared to the same months in 2019. It does however note that that still means 7.6 million pathways were completed, and that “given the circumstances, continuing this volume of treatment was a major achievement. Had hospitals been overwhelmed by COVID-19, the reduction would have been even larger.”
For those already on waiting lists, the article notes that waiting times have got significantly worse than the same time last year:
“1,959,684 (46.4%) of those waiting had already exceeded the 18-week standard by the end of August, almost three times more than August 2019.”
“In total, 111,026 patients had waited longer than 52 weeks – compared with just 1,236 in the same month in 2019.”
For people starting treatment, it notes:
“The most plausible reason for the sharp drop in new pathways is that the pandemic has created new barriers to accessing elective care”
As for our area, it notes:
“The South West and East of England are the regions closest to returning to pre-pandemic levels of activity.”
However, it notes that before the pandemic, healthcare was already being stretched making it more difficult to respond:
“Before COVID-19, the standard that at least 92% of patients should wait no longer than 18 weeks to start elective treatment had not been achieved for nearly 4 years”
“Before the pandemic, meeting the 18-week standard would have required the NHS to treat an additional 500,000 patients a year for the next 4 years – an unprecedented increase in activity, which looked unrealistic before COVID-19 and looks even harder now.”
It does however state that almost all other European countries put in measures to create capacity at the expense of waiting times for elective care.
The article highlights the need to reschedule elective care and increase hospital activity beyond COVID. It cites the case of Ontario, Canada which expects to take 84 weeks to clear its backlog. It also states that some progress has already been made, with the NHS already beginning the process in April 2020, and while milestones have been met, activity remains below levels prior to COVID-19
As for going on from COVID, it emphasises the importance of the independent sector in taking on the workload, although notes that there are concerns about this undermining public hospitals. As well as this it points out:
Expanding the use of remote consultations can be done rapidly to address the problems
Creating “Community diagnostic hubs” could prove effective at undertaking work outside of hospitals
Many treatment services can be consolidated to increase throughput
“There is a need to move quickly. Every day activity lags behind demand, the backlog will continue to grow.”
https://post.parliament.uk/mental-health-impacts-of-covid-19-on-nhs-healthcare-staff/
5th October 2020
Many have pointed at news stories of the large negative effects on NHS staff’s public health as a concerning example of how the NHS has been stretched with not enough support for its workers.
“The COVID-19 pandemic has placed many NHS staff under extreme pressure.”
“Some staff have also had to make difficult decisions around the allocation of limited resources.”
“In a survey of over 2,000 staff working in mental health services during the pandemic, over half of those working in community services declared their biggest challenge to be the delivery of care using digital platforms. Some staff felt unable to adequately assess patients in the absence of face-to-face contact.”
“Evidence from previous outbreaks suggests that up to a third of staff will experience high levels of distress”
“In the NHS, pre-pandemic reports indicate high levels of staff stress and burn-out… which can reduce the healthcare provider’s capacity for empathy and in turn negatively impact on their ability to provide high quality care.”
In July 2020, the Royal College of Nursing revealed that “36% of nurses were contemplating leaving the profession”1
14th May 2020
This article focuses on a survey of healthcare experts on their concerns going into the pandemic.
Here are some pull quotes regarding experts concern for the impacts on the NHS:
“Experts are concerned that the closure or reduction of clinics may increase deaths from non-COVID-19 issues.”
“Some experts note that people may also be reluctant to access emergency healthcare because of fears about the virus. This could result in worse health outcomes for people if issues are left untreated, which would add extra burden to the NHS.”
“They express concern that some of these patients [those accessing services such as for mental health and addiction] will deteriorate or die while waiting for services.”
“They are also concerned about how effective the current structure of the NHS is at responding to public health crises.”
As for social care, which has been constantly highlighted in the media as an area of concern throughout the COVID crisis, for example for a lack of PPE and support, with a significant amount of COVID deaths occurring in care homes, here are some pull quotes:
“Experts note that funding for social care was not sufficient to meet demand before the COVID-19 outbreak.”
“As with the NHS, many experts are concerned that the social care system may not have adequate funding in the long-term to deal with ongoing COVID-19 cases alongside backlogs and increasing demand.”
“They note that deaths in care homes have been far higher than in the general population.”
https://www.bma.org.uk/media/2487/ten-principles.pdf
May 2020
In May 2020, the BMA published a document setting out there concerns and suggestions for restarting non-COVID care, at a point where the UK had passed the peak of the first wave.
“We know that fewer patients have been seeking care from the NHS during the pandemic. For example, in April 2020 there were 1.2 million fewer attendances at A&E departments than the same month last year (a 56% decrease).”
“The government must support local public health services and ensure there is adequate capacity to test, trace and quarantine.”
https://www.bbc.co.uk/news/health-52985446
11th June 2020
The BBC in this highlights what has been seen as one of the most concerning knock-on effects of healthcare the UK has seen. It highlights a 60% drop in cancer referrals comparing April 2020 to April 2019, while those starting cancer treatment drops 20% below 2019 – all these being considered as urgent referrals.
It also points to reports from Cancer Research UK which estimates “a backlog of more than two million people waiting for screening across the UK.”
As for routine operations, it states “just 41,000 underwent surgery - down from 280,000 in April 2019.”
10th December 2020
This article is more recent than other sources referenced in this document, and leads with:
“Number of patients on waiting lists for more than a year is 123 times larger than 2019”
This reflects many of the concerns looked at earlier, and it says this “comes amid warnings that access to treatment will take years to get back to normal.”
It quotes the Labour shadow health secretary who said the surge in year-long waits was “staggering” as well as an official from the BMA who said “It is quite frankly alarming that the number of patients waiting more than a year for care is now 123 times higher than last October. These are patients in pain, distress and needing treatment.”
It also points to NHS performance statistics from that month showing that “1.533 million people in October were waiting for treatment for more than 18 weeks” And that “4.44 million people were waiting for hospital treatment, the second highest figure on record”.
TODO: Look at statistics, particularly for
Cambridgeshire, as well as Cambridge news reports. As well as this, I
would like to summarise what I have found through this area of
research.
See NHS collated stats.xlsx for data
I thought I’d look at official NHS statistics to get a more reliable and up to date, primary source on statistics indicating how NHS services are being used, including specifically for Cambridgeshire.
Accident and Emergency departments help to take on some of the most urgent health emergencies and have generally seen a fall throughout the pandemic, as shown on the graphs on the right. England and Cambridgeshire seem to have shown a very similar trend, following mostly the same shape as nationally, although Cambridgeshire sees a marginally larger drop into April from February.
This does not show that A&E Services in Cambridgeshire have been affected much differently than in the rest of England.
GPs play a crucial role in providing support for patients and are often a first port of call, treating patients and referring to specialist services. They therefore saw a significant fall in April through to June, as shown on the right, before they gradually start to take on more patients, eventually more than in February, presumably to deal with the backlog and patients waiting to seek their GP over lockdown. This does however mean that GPs were and might still be taking on more patients than usual at a time where they may already be stretched because of COVID. This does however start to fall a bit into November as we entered into the 2nd lockdown.
No significant difference is shown between Cambridgeshire and Peterborough.
25th November 2020
I first saw this article when I was working on my timeline of the pandemic, and it immediately stood out to me as a very serious reflection of the state of healthcare in Cambridgeshire during COVID. It is one of Cambridgeshire’s largest hospitals and is part of the University hospital trust.
The article reports of a “leaked staff memo” from the hospital which “warns the situation is ‘unsafe’ and could cause "’significant harm’ to patients”. It also refers to “unacceptably long waits in our emergency department” , while a whistle-blower claimed the hospital was "on the brink of a major incident that will cost lives" according to the newspaper.
It also refers to a report that said in one week “52 patients waited more than 24 hours and almost 200 had to wait more than 12 hours, according to the report”.
Cambridge Labour MP Daniel Zeichner in the article points to Conservative cuts to social care and a lack of preparation as being factors to blame.
12th May 2020
The article refers to a Cambridge university study on hospital staff at Addenbrooke’s hospital which tested 1200 NHS staff to discover 3% ended up testing positive where most of them were not aware they were carrying the virus. This reflects concerns about people receiving healthcare services being put at risk.
During the initial peak of the pandemic, the number of people completing treatment fell sharply
3.5 million fewer treatments completed in 2020 compared to 2019
46.4% of those on waiting lists have exceeded the 18-week supposed maximum waiting time by August 2020 (3x more than 2019)
“In total, 111,026 patients had waited longer than 52 weeks – compared with just 1,236 in the same month in 2019.”
“The South West and East of England are the regions closest to returning to pre-pandemic levels of activity.”
It already looked unrealistic for the NHS to meet the 18-week standard before the pandemic, requiring it to treat an additional 500,000 patients a year for 4 years
Ontario, Canada expects to take 84 weeks to clear it’s backlog
NHS staff are widely quoted as being under “extreme pressure”
Previous outbreaks indicate up to a third of staff will experience high levels of distress
36% of nurses were contemplating leaving the profession according to the royal college of nursing
56% decrease in those attending A&E from 2019 to 2020
60% drop in cancer referrals April 2019 to 2020
“just 41,000 underwent [routine] surgery - down from 280,000 in April 2019.”
“Number of patients on waiting lists for more than a year is 123 times larger than 2019”
“4.44 million people were waiting for hospital treatment” in December 2020
Total A&E attendances and GP appointments have fallen, although have restored to some degree, with broadly the same pattern nationally and locally
GPs have been facing a backlog of patients where they are already stretched
In November 2020, Addenbrooke’s circulated an internal memo claiming there was a chance of “significant harm to patients” with the 2nd worst waiting times in the country
Cambridge Labour MP Daniel Zeichner points to Conservative cuts to social care and a lack of preparation as being factors to blame.
3% of Addenbrooke’s staff tested positive for Coronavirus without believing they had it
https://www.rcn.org.uk/news-and-events/news/uk-members-have-spoken-survey-shows-increase-in-those-considering-leaving-the-profession-170720↩︎