The NHS is being squeezed in a vice

Since Covid-19 took its first English life in March 2020, the country has recorded around 120,000 more deaths than would have been expected over the same months of three typical, non-pandemic years.

This is a huge number but one that, for the first year of the pandemic, was relatively straightforward to explain. A novel and deadly infectious disease was spreading through the community. In a population with no immunity, it wreaked havoc.

Since then, however, the picture is much less clear. Between July and December 2021, England recorded 24,000 more deaths than in a typical year, but only two-thirds of these could be attributed to Covid. And this year, less than half of the 10,000 excess deaths accrued since May were Covid-related. In total, there have been just over 12,000 additional non-Covid deaths across the two periods.

There has been much debate over the cause of this unexplained excess. But as the crisis engulfing the UK’s health service has come into focus, it is increasingly difficult to avoid the conclusion that the excess is linked to the failure to address the failings of a chronically under-resourced and overburdened system.

A 2022 British Medical Journal study found that the risk of death in the month following A&E attendance was 16 per cent higher for those who waited over 12 hours than those seen within four. By combining this with data on the long waiting times currently seen in NHS emergency departments, it is possible to estimate how many of the extra deaths may be the result of the A&E crisis.

During June of this year, 102,000 people waited 12 or more hours in A&E, almost four times the pre-pandemic average for the same month. A further 441,000 waited between four and 12 hours, double the typical number. By my calculations, June’s waiting times alone are likely to have resulted in more than 2,000 additional deaths during the following days and weeks due to the significantly elevated mortality risk associated with waiting so long for urgent care or admission. The total number of additional A&E-linked deaths since waiting times rocketed is an almost perfect match for the missing 12,000.

Chart showing that social care funding in England is still below its level in 2010, while the population it serves has grown by more than 60 per cent

England’s hospitals are being squeezed in a vice. On one side, the race to work through the enormous backlog of care means an unceasing stream of new patients into fewer beds. On the other, a decade of flatlining funds for social care means that even when treatment is concluded, thousands of patients remain in hospital beds waiting for follow-up care.

Chart showing that one in seven beds in English hospitals is now occupied by a patient who no longer requires a bed, but has not yet been discharged

Casualty departments have no beds to send new arrivals to the wards, patients with urgent needs wait for hours on end, ambulances cannot hand over patients, and stroke or heart attack patients are left waiting an hour for a paramedic, stuck in a queue of ambulances outside A&E.

This week it is energy costs dominating UK headlines. But every week that goes by without addressing the crisis in the NHS risks making an already dire situation even worse.

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