Even before the Covid-19 pandemic, there was a running joke among some NHS staff that every year brings the “worst winter ever” for Britain’s hospitals.
Now, doctors talk about the seasonal chaos as if it applies all year round, referring to the “winter crisis/summer crisis/current crisis” – delete as applicable – in much the same way.
After Covid-19 paused planned procedures, a record backlog of over six million patients has built up, meaning the NHS is now experiencing winter in Easter. Quietly, our hospitals are in the grip of a spring crisis – the worst spring crisis ever.
As the horror of coronavirus patients filling hospital wards has subsided, media focus on NHS pressures has drifted. Yet the latest data available tell a dramatic story.
A&E waiting times are at a record high, and long waiting times for beds have also hit a record level:
Data by Ben Walker
There has been a downward tumble in available overnight hospital beds since 2010 – the occupation rate is now 86.4 per cent, which NHS insiders describe as at near full capacity.
The work is “Sisyphean”, according to Billy*, an administrative staffer who works in an endoscopy unit in a north-west NHS hospital. Every day, he and his team hack away at their list of patients waiting for the procedure (which allows doctors to see inside the body with a small camera).
The next day, the list is even longer. When we speak, he has 1,715 procedures over six weeks overdue (some are urgent, and many originally scheduled for 2020).
“It doesn’t matter how much work I do in a day, it feels like the next day there is going to be at least as much if not more,” he tells me. “The number of people on the waiting list for routine procedures just keeps increasing.”
This situation is “horrendous and immensely stressful” for hospital staff – by July 2021, most of the team had resigned and they had to re-recruit. Billy does not plan to work long-term in the NHS himself because of the impossible workload and constant feeling of letting ill people down.
Yet it’s even worse for patients. My source reveals more people are dying because of delayed referrals and long waits for such routine procedures.
“There are definitely, frankly, people dying because of this,” he says. “They are in danger.”
A late or missed analytical endoscopy procedure, for example, can mean cancer tumours aren’t spotted, and they spread.
Whenever timely and effective treatment is hampered, a patient suffers. Dr Dolin Bhagawati, a neurosurgeon at a London hospital and vice-chair of Doctors' Association UK (DAUK), lays out the scenario: "Patients are being harmed in direct and indirect ways, for example an increase in waiting time for physiotherapy will lead to increased patient need for painkillers, giving rise to a potential opioid dependency problem in the future and all the problems associated with this.”
Last winter, the New Statesman uncovered how lives were endangered by ambulance delays. By November 2021, ambulances were taking longer than ever to reach patients across most of England. Queues of ambulances were building outside emergency departments, which had no beds free. The problem continues, even as winter – the usual danger zone – has given way to spring.
“Our ED [emergency department] has multiple patients who have been there for over 24 hours and patients in ambulances waiting over five hours to even get into the building,” says Dr Matt Bigwood, an anaesthetist at Northampton General Hospital, and spokesperson for the DAUK.
Even before Covid-19, regular ambulance call-outs weren’t hitting their 18-minute target, and delays to the most life-threatening call-outs have been building since last June.
The problem isn’t just the backlog itself – it’s that there aren’t enough staff to tackle it. There are an estimated 110,000 vacancies across the health service, according to NHS Providers.
“Without more funding and staff, patients will suffer harm, including deaths,” warns Bigwood. “This means cancelled elective lists as there are no beds and the backlog grows and grows.”
Indeed, my contact at the endoscopy department says extra cash to bring down the NHS backlog – supposedly coming from the recent tax rise – won’t work. “I don’t see how any funding rise can solve this problem. The sheer quantity of work we have to process, we essentially need more capacity somehow,” he says. "I can't see how our department can get out of the mess we're in now."
Spring crisis? What spring crisis? ask insiders. The crisis is all year round.
“Unfortunately this now a permanent state of affairs, and at the moment every part of the NHS is under strain,” says Bhagawati.
“The bigger picture is that the crisis is more than a spring crisis,” says Dr Deanna Evans, a GP at Llanilar Health Centre surgery in Aberystwyth, west Wales, and DAUK spokesperson. Recently in her practice of 3,500 patients, just one GP held the fort while she and a fellow doctor were off in Covid isolation for 10 days.
“Are we able to provide as good a quality of care as I’d like? Is that even a choice anymore?” she asks. “We provide the best care we can under the circumstances we all find ourselves in.”
This state of affairs is sapping the goodwill and wellbeing of staff, who worked around the clock during the devastating Covid waves.
“Each patient-facing member of staff faces moral injury on a daily basis having to apologise for systemic factors far beyond their own control,” says Bhagawati. “Silently, several colleagues are burning out and not coping.”
Described by former Conservative chancellor Nigel Lawson as the closest thing the English have to a national religion, the NHS’s place in the public imagination is also shifting. There is compelling evidence that patients are increasingly turning towards private healthcare. Anecdotally, I hear people’s attitudes towards the NHS are becoming more pessimistic – unable to book an appointment for weeks, bumping up against repeated postponements.
“It [the backlog] has increased the frustration people feel towards the NHS, its ability to provide care is limited by the backlog,” says Billy from the endoscopy unit. “It makes people feel much more cynical towards the NHS and its ability to provide care, not only to them but to their loved ones. It’s very sad.”
[See also: State of the Nation: The NHS crisis in numbers]
*Name changed on request of anonymity.