The crisis in A&E, and the failure of NHS trusts to make any headway in stemming or reducing the waiting lists are not because of an increase in demand for emergency care, but a chronic shortage of front line general and acute beds, which was worsened by the pandemic, but pre-dates it and remains a major problem.
This is the clear and unambiguous conclusion from recent A&E figures compared with equivalent pre-pandemic figures.
The most recent quarterly figures show that there were 630,000 (23%) fewer of the most serious Type 1 A&E attendances in April-June 2022 compared with the same quarter in 2019: and there were 125,000 (8%) fewer emergency admissions.
But, despite this reduction in pressure, numbers of patients forced to wait over 4 hours for a bed (trolley waits) more than doubled from 186,000 to almost 385,000, and there was a staggering 49-fold increase in numbers waiting over 12 hours for a bed, from 1,320 in April-June 2019 to 65,225 in April-June 2022.
And again despite the reduced caseload, the proportion of the most serious Type 1 A&E patients treated and admitted or discharged within 4 hours fell from an already below-target 78.3% in April-June 2019 to a new low of 59.3% in the same months of 2022.
The most recent figures show 13,500 Covid patients occupying acute hospital beds in England on July 20, falling slightly from the previous day, but well above the recent low of 3,800 on June 1. While relatively few of these patients will die or need ventilation and intensive care, the numbers of beds tied up in this way is a major problem for continuing the routine and emergency work of the NHS.
Figures for June also confirm a continuing pattern in which around 12,000 beds are occupied each day by patients who “no longer meet criteria to reside” – but cannot be discharged for lack of social care support to live at home, suitable nursing home care or community health services.
So with June figures for numbers of general and acute beds showing a total of just 98,000 beds available in all acute hospitals, this means that long staying patients and Covid patients between them are occupying more than a quarter (26.3%) of available beds, so they cannot be used to treat emergency or elective patients.
And while a majority of the trusts with major Type 1 A&E are running in excess of 95% occupancy, the most recent quarterly bed availability figures show 3,358 fewer beds were occupied in the first 3 months of 2022 than the equivalent pre-pandemic figure in 2019.
Overall the time series shows a reduction of almost 7,000 available front line general and acute beds in England from Quarter 4 in 2010-11 when the Cameron government slammed the brakes on NHS funding and ushered in a decade of austerity to Quarter 4 of 2021-22, and a corresponding drop of 5,464 beds occupied – while the population, and the proportion of older people has grown and the Covid pandemic has underlined the need for far greater capacity to maintain timely access to elective and emergency services.
With 56 million population, England now has just 2.3 hospital beds per 1,000 population, and just 2 acute beds per 1,000 – the fifth lowest provision among 34 OECD countries: Germany has almost three times more and France 50% more beds available per head.
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