The latest performance figures show that the Covid disruption of the NHS continued through July, with a record 2.15million patients waiting more than 18 weeks to start hospital treatment  – triple the figure for July 2019. However, the new figures also show that services have rebounded from the extremely low levels of activity seen from March to June.

The total number of people admitted for routine treatment in hospitals in England was down by about 50% in July compared with a year ago, but this fall is not as steep as earlier in the pandemic; in June the year-on-year decrease was 67%, and in May 82%.

In July, 140,000 operations, such as knee and hip replacements, were carried out, up from just 41,000 in April. In March virtually all routine operations were stopped as staff and resources were directed to patients with Covid-19.

NHS England medical director, Professor Stephen Powis, described it as a “substantial rebound in routine appointments and operations, which have more than doubled since the peak of Covid”.

There are some encouraging signs of work increasing in other areas: 21,600 cancer patients began their treatment in July, up from 16,600 in May, but still down from 28,000 in July 2019; and A&E is getting busier, with 1.7 million visits in August, up from 916,000 in April, but still down 19% from August 2019.

Urgent cancer referrals made by GPs were at 179,503 in July 2020, down 19% from 221,805 in July 2019. However, this fall is lower than previous months – a year-on-year drop of 21% in June and 47% in May.

Powis said that “pleasingly, cancer radiotherapy treatments are now fully back to their pre-Covid levels”. There is still, however, a big issue with diagnostic tests with the figures showing that just under 500,000 patients in England had been waiting more than six weeks for a key diagnostic test in July, in July 2019 the equivalent number waiting longer than six weeks was 37,206.

The number of patients having to wait longer than a year continues to grow. July saw it at its highest level for more than a decade, with 83,203 waiting more than that length of time – the highest number for any month since November 2008.

The deputy chief executive of NHS Providers, Saffron Cordery said “Today’s figures show just how hard trusts and frontline staff are working to restore services for non COVID-19 patients.”

She added that the staff are also working under various constraints, including “a reduction in available diagnostic testing equipment and ambulance capacity due to the need for deeper and more frequent cleaning between patient treatments, and additional time needed to wear and change personal protective equipment.”

Gbemi Babalola, senior analyst at the King’s Fund, also noted that “NHS staff are working hard to restore services to full capacity, and help is available when people need urgent care and treatment.”

However, commentators have noted that we are heading into the winter months, the most challenging part of the year and Babalola called for honesty about what can be achieved in these months and predicted that “long waits for routine diagnostic and surgical procedures are likely here to stay.”

The President of the Society for Acute Medicine, Dr Susan Crossland, “implored” the government to publish full winter crisis planning proposals which include investment into staffing and estates to cope.” A major concern is the reduction in acute beds “we cannot allow corridor care to return and, therefore, again urge a focus on the advantages of same-day emergency care to allow rapid assessment and treatment of patients without needing admission.”

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