Emergency medicine consultants are again warning that NHS England’s latest A&E performance figures mean “we are seeing the sharp demise of the health service.” But there is no sign would-be Tory leaders are listening, or at all bothered by the service failures.

The official figures for July show almost 30,000 patients were kept waiting over 12 hours in A&E following a decision to admit – largely due to lack of beds, which in turn has been worsened by delays in discharging people who no longer need hospital care … for lack of social care and community health services.

A Royal College of Emergency Medicine (RCEM) press statement points out that 30,000 is more than 3.5 times the total number of 12-hour waits for the whole of 2019.”

It also points out that these figures are merely the tip of the iceberg of delays in A&E since the numbers waiting over 12 hours from time of arrival in A&E is many times higher: RCEM calculations from figures in a sample of hospitals in 2021 showed these delays were 14 times higher than the official recorded 12-hour waits.

It’s likely on this basis that the 30,000 figure in July translates into more than 400,000 patients across England waiting more than 12 hours on trolleys in July from arrival in an Emergency Department to being given a bed on a ward.

Of course this still leaves out the additional delays in ambulances queuing for many hours outside A&E departments to hand over “emergency” patients, and the thousands more who suffer falls or heart attacks and wind up waiting hours on end for ambulances to arrive.

Given the prolonged period of ‘zombie government’ and ministerial inaction pending the outcome of the Tory leadership contest, and the woeful ignorance of many of the broadcast journalists and pitiful interviewers who might ask searching questions about this dreadful systems failure but don’t, the reports covering these statistics leave many readers, viewers and listeners with more questions than answers, so the Lowdown will address three relevant questions.

Isn’t the NHS handling the biggest-ever summer workload?

No. As we have reported before, the total numbers of patients attending A&E this year is consistently lower than equivalent periods prior to the pandemic. There were over 100,000 (4.5%) fewer attendances in A&E in July 2022 than there were in 2019, and there were 30,000 fewer of the most serious Type 1 cases, many of whom require hospital beds.

Total emergency admissions via A&E were also down by almost 50,000 (12%) on 2019: but numbers of patients waiting on trolleys for beds more than doubled to 136,000, and numbers waiting over 12 hours on trolleys increased 64-fold from 452 to 29,317. The percentage of Type 1 patients treated within 4 hours plunged from 79% in July 2019 to just 57% in July 2022.

The key difference is that there are 3,300 fewer general and acute beds occupied than in the equivalent period of 2019, and fewer of the reduced number of beds are available for emergency admissions.

Isn’t this all just a knock-on from the Covid pandemic?

In part it is, but that’s because basic steps have not been taken or resources made available to enable the NHS to cope with demand or implement its recovery plan. Contrary to government rhetoric the pandemic is not over, and its consequences are still being felt on a daily basis throughout the NHS.

On August 5, 9,152 front-line beds (almost one in ten) were still occupied by Covid patients, and therefore not available to treat emergencies or help reduce the waiting list. And despite endless government claims to be spending “record amounts” (i.e. more in cash terms than the previous year) no extra capital has been made available to hospital trusts to enable them to remodel buildings and reorganise to increase bed numbers. Indeed they lack the cash to cover even basic maintenance and replacement of equipment: the backlog is now well over £9bn.

England’s NHS has 105,000 vacant posts and chronic staff shortages – so there is still no workforce plan to ensure any extra beds could be safely staffed.

But the scale of the Covid problem for the NHS is more than matched by the average of 12,900 or so beds each day being occupied by patients who should be discharged to social care but can’t be, because there is no support available for them. So even though Covid admissions have eased slightly, the combined number of beds tied up is still over 20,000 – more than one in five.

The RCEM says: “There must be total focus on promoting flow throughout the hospital and priority around our ability to provide an NHS that helps patients in an emergency. We must ensure patients are discharged in a timely way, so beds are freed and patients in A&Es are able to move through the system and be treated. Flow and discharge rely heavily on an effective social care service that has sufficient workforce – the government must get to grips with this.”

Is this all part of a cynical plan to get people to go private?

No. the private sector does not provide any emergency services and has never shown any interest in doing so (except for rip-off walk-in clinics to give pointless checks to the worried wealthy).

So if you arrive in an ambulance, no amount of private health insurance will speed you through the queue, and there’s no point at all in arriving at a private hospital: they ship their own emergency patients to NHS hospitals for treatment when things go wrong,.

It could be argued that breaking public confidence in the NHS is one way to soften people up for the introduction of some form of private insurance – but it is a risky policy, since even the right wing Daily Telegraph notes that the entire decline in performance of the NHS has taken place since the Tories took office in 2010 and slammed the brakes on NHS spending, and Tory leaders including Margaret Thatcher have recognised the political need to proclaim support for the NHS.

While the Tory leadership contest has featured a race to the bottom in cranky right wing policies, and promises of tax cuts seem to have blinded the largely elderly Tory membership to the concerns of the wider population, the Tories’ ageing voter base will increasingly fall foul of any further deterioration in the NHS, and may eventually draw political conclusions, especially if there is ever any opposition forthcoming from the currently mute Labour Party.

The soaring waiting list for elective treatment may be seen as a means to cajole those who can afford it or somehow borrow enough to pay to go private. However the private sector remains small, prohibitively expensive for the vast majority, and, as we have reported in The Lowdown the most recent figures from the private sector itself show that only a very small proportion of people on NHS waiting lists (66,000 out of 1.5 million) have taken this option even as the lists and delays have increased.

All the evidence suggests that the two Tory leadership candidates, who have made no effort to address the problems of the NHS, either believe the spurious figures and assurances that have been spewed out by shameless Department of Health and Social Care spin doctors, and have ignored or remain unaware of the warnings of crisis now coming from professionals and senior management – or they regard a collapsing NHS as a reasonable price to pay for their promised tax cuts.

The challenge for campaigners is to prove them wrong.


Cancer waiting times story to follow

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