Doctors at times – whether we like it or not – must be the unflinching bearers of bad news. When a patient locks their eyes on yours and asks: “How long have I got, doctor?”, or “Is it cancer?”, or “Tell me, am I going to die?”, the temptation to shrink from your duty of candour has to be resisted. The truth, told with compassion, is the least a patient deserves, no matter how much you hate to see their face crumple.
On 20 October, in the first national Covid press conference to be held in five weeks, the Health Secretary Sajid Javid looked the population in the eye and claimed: “We are a lot closer to normal than we were a few months ago.” I suppressed the impulse to swear in front of the children, but only barely. The truth is that, in the week ending 17 June, the number of Covid hospital admissions numbered 1,220. By the week ending 17 October, that number had surged to 5,250 patients. As I write, the daily Covid death toll has reached a seven-month high, and one in five intensive care beds are occupied by patients gravely unwell with the virus. Javid may deny on camera that the NHS is facing unsustainable pressures, but even he has to be aware that this is disastrously far from “normal”.
The truth – and it’s a truth the government seems to be doing everything in its power to deny – is that the NHS has been in the grip of a crisis ever since early summer. For months, events have been regularly occurring that should never take place in a properly functioning health service. Hospitals cancelling cancer operations because there are no free intensive care beds for the patients after surgery. Patients dying in the back of ambulances trapped outside hospitals, because there isn’t a single bed for them inside A&E. Patients inside those overwhelmed A&Es waiting nearly 50 hours – two whole days – for a bed. Even the military, no less, being called in to help. This is about as normal as nurses taking emergency weapons training. My hospital, like many, has been on black alert virtually continuously since the summer. There are no more beds – for anyone.
We are here – with all the dire consequences for patient safety – because the government’s strategy since “Freedom Day” has been to close its eyes and hope Covid goes away. Despite the phenomenal successes of vaccines in preventing serious illness, when you permit a highly contagious virus to let rip through the population – as the government has elected to do – a tiny percentage of a huge number (almost 50,000 new cases a day at present) equates to a significant death toll: around 1,000 patients per week, or over 50,000 deaths a year. Anti-vax disinformers, who deliberately prey on the public’s fears, only exacerbate the problem by stoking vaccine hesitancy.
If there is one lesson the government should have learned by now it is that, in a pandemic, decisive early action is always better than prevarication. Yet while Covid cases have surged since the summer, there has been no meaningful action to improve ventilation in schools and workplaces, vaccines for teenagers were carelessly delayed and there has been no return to mandatory masks in indoor settings. This last point is particularly iniquitous: masks have no economic downside but palpable public health benefits. The government can only be opposed to them for ideological or populist reasons.
If the government cares about NHS patients, it must urgently change course. Even if it has covertly deemed an annual Covid death toll of 50,000 acceptable – merely the culling of the herd’s most expendable members – all patients are currently at risk. The pandemic’s grim legacy of postponed care is driving the crisis in our hospitals and GP surgeries now. We are struggling to deal with delayed cancer diagnoses, an epidemic of mental health problems, and over 5.5 million people on waiting lists for treatment of conditions that, though non-urgent, are often painful and disabling. We face, in short, a perfect storm. Every additional case of Covid risks reducing NHS capacity to meet all non-Covid needs. We are desperate to treat everyone and are failing to do so – because we have been set up to fail.
This article appears in the 27 Oct 2021 issue of the New Statesman, Our Fragile Future