NHS hospitals are under the cosh as they face a rising tide of emergency attendances with a reduced number of front-line beds available, a significant continuing need for beds to treat Covid-19  patients as infection rates increase – and the challenge of tackling the growing backlog of waiting list patients that worsened during the pandemic.

NHS figures analysed by the Health Service Journal show a third of acute trusts (49/145) were operating at 95% or higher levels of occupancy last month with numbers of emergency patients higher than any time since the winter before the pandemic.

However the occupancy rates relate to the reduced numbers of front-line beds, which fell rapidly during 2020 as beds were closed or removed from wards to increase social distancing and reduce dangers of infection.

The HSJ calculates that the average number of acute beds not reserved or in use for Covid patients fell to 89,339 in May, down by over 12,000 from the numbers that had been available at the same time in the last few years before Covid.

The most recent published quarterly bed figures for the three months to March 31 show 96,000 beds available in England, of which just under 80,000 were occupied, compared with 102,000 beds open and over 90,000 occupied in the same quarter a year earlier. 

In other words NHS capacity is still hobbled by the aftermath of Covid, the lack of capital to remodel and refurbish hospital buildings to make most effective use of space, and the lack of staff with high post-Covid sickness levels adding to chronically high levels of unfilled posts – while some of the patients who opted to stay away from seeking hospital treatment during the peak of the pandemic are now being referred by GPs or arriving as serious emergencies.

However a look at the time series for waiting list figures shows that the major increase in numbers waiting took place BEFORE the Covid pandemic: indeed the numbers waiting initially fell in the early part of 2020 before rising again more sharply in more recent months as the toll of Covid patients and the lockdown have eased.

The latest figures show numbers waiting have risen by 425,000 in the past two months to a record 5.1 million, more than double the number when David Cameron’s government took office in 2010 and imposed a decade of  austerity and frozen funding on the NHS.

Indeed while the most recent figures show some of those waiting over 1 year for treatment have finally had their operations to slightly reduce that total, a worrying 2,722 are currently waiting over TWO years for treatment – a figure that had been eliminated from statistics by the decade of above inflation increases in NHS spending from 2000.

However according to a Guardian report, Boris Johnson is not willing to spend the extra money needed now to prevent a further proliferation of long waits because not enough patients are yet aware of the scale of the problem and complaining to MPs (or to put it in cynical Downing Street terms “the public are not yet ‘distressed’ about the long delays.”

The Health Foundation has calculated that to bring down the backlog of cases and meet the target of treating 92% of patients within 18 weeks of referral (which has not been achieved for 5 years) the NHS would need to spend an extra £6bn per year over three years: apparently Downing Street has estimated that the costs of bringing down the waiting times could be more than twice as high – as much as £40 billion over 4 years.

NHS Providers Chief Executive Chris Hopson has even begun pointing out that the key to bringing down waiting lists in the 2000s to a maximum 18 weeks was the “five years of 7%+ real terms increase in annual NHS funding” – in stark contrast to ministers’ meaningless boasting about much smaller cash increases.

The Health Foundation’s estimates are based on the need to open 5,000 extra beds, and employ 4,100 more consultants and 17,100 more nurses. The King’s Fund also points to England’s chronically low level of provision of scanners and lack of operating theatres as obstacles.

While conjuring up extra staff is a major problem – especially after the government’s derisory offer of a 1% pay increase – the latest figures show that thousands of extra NHS beds already exist – in hospitals that cannot fully use them without investment to reorganise clinical areas.

Instead of making a serious estimate of how much capital investment is needed to get the NHS working at the level required, the Johnson government has agreed for NHS England to divert up to £10 billion over the next 4 years on stop-gap measures to use private hospitals to treat NHS patients. This will drain funds and vital staff from over-stretched NHS hospitals.

The entire capacity of the private hospital sector is just 8,000 acute beds – and many of these are now being used for private patients as the private sector cashes in on the growing delays accessing NHS care. So there is no way at all the deal with private hospitals can compensate from the 12,000 fewer beds available in the NHS.

As The Lowdown and Health Campaigns Together have warned, in four years’ time if present policies continue the NHS will still be unable to use its full capacity, and will have become permanently dependent on private hospitals to deliver substantial levels of elective treatment.

The big question is whether ministers will be allowed to rest secure from public anger over such a major and long-running failure of the NHS which Johnson professed to love so much in the 2019 Manifesto. 

In the mid 1980s Margaret Thatcher attempted to tough out public anger over widespread delays of 18 months and more – but in the immediate aftermath of the 1987 general election came under sustained fire from right wing national press as well as local news media as stories broke of cancer patients and children with heart disease dying on waiting lists. 

Even the Iron Lady was obliged to bend to the pressure for action and increased funding: sustained campaigning at local and national level could yet force the Tin Man to do the same.


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