NHS services under pressure – What legacy will Covid-19 leave?

A cursory look at the NHS cancer statistics might suggest things have improved slightly. April to June last year saw the 2-week-wait target holding up well on the previous year, albeit with a 54% reduction in referrals (down by 244,325). In the three months to November 2020, the target was met in 87% of cases, with overall referrals down only 1.1% on the same period in 2019/20.

The 31-day target for beginning treatment for confirmed cancers also held up in the Spring despite a 27% drop in activity (down by over 20,000 cases). Fast forward to November and cancer treatments have only reduced by 5.6% on the equivalent three-month period last year (down 4,491), with 95% of patients being treated within 31 days.

Of course, these relatively encouraging headlines do not come close to telling the full story.

The three big concerns for the NHS as we currently grapple with this bleakest of midwinters are:

• What happened to the ‘missing’ patients who were not seen back in the Spring – can we expect to see more late-stage diagnoses and poorer outcomes throughout 2021?
• What will be the impact of this appalling spike in covid-19 we are now seeing?
• What has been the impact on NHS services other than cancer?

To take the last question first, there are two obvious areas which point to difficult times ahead.

The first is A&E activity. April 2020 saw a 57% reduction in attendances on the same month in 2019. While that might have been good news for the short-term management of Covid patients, we are now very definitely moving into mid-term considerations. December 2020 still saw almost a third fewer attendances than December 2019 (down 32%) and we must now start to think about the implications of this for unmet need out there in the community. Those with long-term conditions not seeking medical help for fear of Covid, remain some of the most vulnerable in society.

The second obvious measure of how wider services have been impacted is surgical waiting times. The fact that we are talking less about the 18-week target for treatment, tells its own chilling tale. Instead, we now see increasing numbers of patients who have been on the waiting list for over a year. The changes, and underlying implications, wrought by the pandemic are truly staggering:

• In April 2019 there were 1,055 patients who had been waiting for over a year. By November 2019, that had risen to 1,570
• In April 2020 the number had increased tenfold to 11, 532 and as of November 2020 it stood at 192,712

When we consider the impact of the current Covid spike, the situation becomes all the more worrying. The seven day rolling average for Covid infections at the time of writing stands at around 42,000 and we are seeing in the region of 3000-4000 hospital admissions daily. There are currently around 39,000 Covid patients in NHS hospitals, exceeding the spring peak of around 22,000. While the roll-out of the vaccination programme gathers pace and offers hope that the end is in sight, the remaining weeks of winter are likely to prove extremely difficult.

The fight against Covid-19 must remain the priority, however it is also clear that we will be dealing with the aftermath for years to come. Some thought needs to be given now to how we move beyond the crisis, or the final number of victims of the pandemic may be even higher than already appears.