The looming NHS crisis | Is Covid to blame?

For the ease of reading I have grouped all the graphs at the end of the blog in the order they are referred to in the text

The House of Commons Library has released the latest NHS performance data.  It describes where the NHS is right now, heading into what might be the worst winter in it’s history.

Waiting lists and times

There are currently nearly 6m people waiting for hospital treatment, more than double the number in 2010. Sajid Javid has made tackling this his number one priority.

These waiting lists have gone up sharply since Covid, but had been rising since 2010.   

Waiting lists however don’t tell the whole story, we need to know how long people have been waiting.   I would rather have 10m people waiting a month for treatment than 1m people waiting 5 years for treatment. 

Waiting times have got a lot worse since Covid, but performance was deteriorating years before Covid hit. 

The 18 week target hasn’t been hit for 6 years.

The Cancer waiting times target hasn’t been hit for 7 years

The A&E 4 hour wait target hasn’t been achieved for a decade

Staffing

It will come as no surprise that the total number of GPs in the UK has fallen by 2.2% over the last 6 years. GPs per 100,000 population has been falling since 2010, and is nearly 10% lower than that peak. Psychiatrist and Public Health specialist numbers have fallen too.

The big surprise is hospital Doctors whose numbers have risen sharply over the last 11 years – there are 20% more than in 2010.  Overall Nursing numbers are up too. 

This is amazing news, but it begs the really obvious question – if the number of Hospital Doctors is going up why is it harder and harder to get to see them?

There are a number of possible explanations

  1. 1. The net increase in total Doctors isn’t that much overall, and isn’t enough to keep pace with a growing elderly population – the number of over 65s is increasing much faster than the number of Doctors:

2. We still have very few Doctors compared to similar countries

The current figure is just under 2.9 Doctors in the UK for every 1000 population. This is roughly the same as the US, but less than the OECD average (2.9), and the average for the EU (3.7). We have fewer doctors relative to population than Mongolia or Azerbaijan.

3. The Lansley reforms of the NHS made it much less efficient. 

There does seem to be a correlation between the introduction of the 2012 Health and Social Care Act and declining NHS performance. It was certainly a bad piece of legislation but the NHS is a complex system and it is not always easy to map cause and effect. My instinct is that big cuts in public health services increased the number of very sick people a few years down the line, which required more NHS resources. 

4. Poverty

The main factor behind the long term rise in waiting lists is demand. Demand for healthcare in the UK has been increasing rapidly year on year. 

It turns out that if you take a poor and vulnerable population and make them hungrier, colder, less well fed and less securely housed you increase their usage of healthcare services, particularly secondary care.

This shouldn’t be controversial – we have known about the link between poverty, ill health, and usage of hospitals for over a century, but the Government still don’t want to talk about it. Successive cuts to the incomes of the poorest since 2010 has increased pressure on the NHS. Additional resources in the last few years have been welcome but over the last 11 years funding hasn’t kept pace with the rise in demand.

I was working at DWP when the coalition came in, and I did warn loudly that the changes to the benefit system would have implications for the NHS that hadn’t been thought through. Under New Labour this kind of thing was taken seriously and carefully modelled. Under the coalition changes were crashed through to generate headlines without proper analysis or thought. If anything politics is even more untethered from reality today than it was under David Cameron, problems are just wished away. 

This is important because the NHS is currently under huge pressure. The levels of demand in the service are way beyond anything that I would regard as safe or manageable.

And yet the Government has pushed ahead with cutting £20 per week from Universal Credit claimants, and ended furlough all at the same time. This will inevitably increase ill health, and will feed through into more patients turning up at the GPs and at A&E, mostly likely A&E.

I accept that there are good fiscal arguments for making these cuts, even if I don’t agree with them. But from an NHS perspective this is utterly bonkers. The last thing the NHS needs is an increase in poverty, homelessness, and ill health right now.

And yet that is what the Government are set on. 

Monaco7.5
Georgia7.1
Lithuania6.4
San Marino6.1
Greece5.5
Austria5.2
Belarus5.2
Portugal5.1
Israel4.6
Estonia4.5
Switzerland4.3
Germany4.2
Iceland4.1
Czech Republic4.1
Italy4.0
Sweden4.0
Denmark4.0
Russian Federation4.0
Bulgaria4.0
Spain3.9
Finland3.8
Australia3.7
Korea, Dem. People’s Rep.3.7
European Union3.7
New Zealand3.6
Netherlands3.6
Hungary3.4
Slovak Republic3.4
France3.3
Ireland3.3
Andorra3.3
Latvia3.2
Moldova3.2
Belgium3.1
Slovenia3.1
Serbia3.1
Romania3.0
Ukraine3.0
Croatia3.0
Luxembourg3.0
Malta2.9
North Macedonia2.9
Norway2.9
United Kingdom2.8
Canada2.6
United States2.6
Japan2.4
World Health Organization’s Global Health Workforce Statistics, OECD

https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/january2021

https://www.commonslibrary.parliament.uk/research-briefings/cbp-7281/

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