Care bosses have warned homes will not have enough staff to deal with the NHS ordering hospitals to discharge as many patients as possible to handle the predicted Omicron surge.
In a letter to healthcare providers published late last night, NHS England said all patients in hospital beds should be discharged to care homes and even hospitals if it is ‘safe’ to do so.
Hospitals are on red alert in the wake of shocking modelling by Government scientists that warned admissions could exceed levels seen during the darkest days of the nation’s second wave last January, when 4,000 infected patients were needing medical care every day.
But the NHS guidance did not stipulate how exactly patients would be deemed ‘medically fit’ enough to be discharged, leaving the decision in the hands of medics.
And there are fears returning elderly patients to care homes could put others at risk after former Health Secretary Matt Hancock’s decision not to test all residents before they were discharged last year was blamed for the deaths of thousands.
Care England, which represents the biggest private chains in the country, told MailOnline the NHS must ensure all patients are ‘properly tested’ this time round and warned more staff are needed at some homes to make the scheme work.
Professor Martin Green, its chief executive, said: ‘If the NHS intend to discharge more people into care homes they must ensure that they are all properly tested and that the care homes are properly funded to do this work on a national tariff.
‘There is an issue about staffing in the care sector, so the NHS may well have to provide some staff in order to make this discharge scheme work.’
Nurses are being flown in from Spain and Greece to offer temporary assistance at hotels that are being converted into care sites over Christmas to help deal with the oncoming crisis, it was also revealed today.
It comes after Sajid Javid admitted even urgent operations may have to be cancelled in order to ramp up No10’s booster drive, which aims to offer a vital third dose to all adults by the end of the month.
Ministers have already warned anyone wanting to see their family doctor face-to-face for a ‘routine’ appointment will be forced to wait until the New Year so GPs can focus on delivering booster jabs. Doctors called for clear messaging on what is considered ‘urgent’, telling patients not to come in with rashes or common colds.
Cancer charities and patients’ rights groups today slammed the policy as a ‘hammer blow’ for those needing care, adding delays in seeing a GP can mean diagnoses are missed in the vital early stages of the disease. MacMillan said it fears the pivoting of the NHS to prioritising Covid will have ‘unintended consequences’.
The NHS surgery backlog is already at a record high of nearly 6million, with the crisis fuelled by hospitals being forced to cancel tens of thousands of operations during the pandemic.
Critics accused the NHS of having transformed into the ‘National Covid Service’ in the early days of the outbreak, sacrificing other elements of health care.
The NHS last night ordered hospitals to discharge all healthy patients off wards and into hotels to handle the predicted surge in Covid patients because of the Omicron variant this winter. Sajid Javid (pictured today on Downing Street ahead of a cabinet meeting) admitted even urgent operation may have to be cancelled in order to ramp up No10’s booster drive, which aims to offer a vital third dose to all adults by the end of the month
The NHS waiting list for routine hospital treatment in England has reached 5.83million, official data reveals marking the eleventh month in a row that the figure has hit a record high. Some 1.6million more Britons were waiting for elective surgery — such as hip and knee operations — at the end of September compared to the start of the pandemic
Jab chaos saw 4.4m attempts to book a slot but just 545,000 get one
Britain’s booster drive to beat the Omicron super-variant has been mired in chaos after more than 4.4million attempts were made to book top-up shots on the NHS website and furious GPs warned they had run out of doses.
Health chiefs said 545,000 appointments were secured by 8pm last night, even after the website crashed because so many people logged on. This morning Britons were stuck in up to an hour long queues.
But GPs complained they would not have enough jabs for everyone after being given until 9am to order stocks to meet Boris Johnson’s December 31 ‘boosted or bust’ deadline.
Hundreds of Britons desperate to get a booster before Christmas again stood in long queues outside jabbing centres, after waits reached five hours yesterday. In the capital lines began forming at 6am or two hours before clinics opened.
The fallout follows a chaotic 24 hours of Government messaging. Addressing MPs about the threat of Omicron yesterday, Sajid Javid told MPs up to 200,000 Britons were now getting infected with Covid every day, sparking confusion as to whether he meant the figure was solely for the variant or the virus overall.
Department of Health sources later told The Telegraph that it was for Omicron but experts have questioned the source of the figure and officials have yet to respond to MailOnline and clarify the situation.
Further chaos ensued today as Dominic Raab wrongly claimed 250 Britons have already been hospitalised with Covid, before back-tracking to say the correct toll was ten.
Ministers were yesterday accused of causing ‘unnecessary alarm’ for confirming the country’s first Omicron death without offering any more details about the patient’s age, vaccination status or whether the virus was responsible for killing them.
Boris Johnson pledged on Sunday night to offer all eligible adults in Britain a booster jab by the end of the year, and to start administering more than a million a day. The drive is currently open to over-30s only, before expanding to younger age groups.
In a round of interviews this morning Mr Raab acknowledged there were ‘teething problems’ with the drive, but said it would be ramped up over the next few days.
NHS leaders warned last night they had been set up for failure, with a senior source breaking ranks to say hitting the one million doses a day target by Christmas would be tough, let alone reaching it in the next few days.
At the height of the NHS’s vaccine drive in March, the health service never managed to get more than 850,000 jabbed every day.
In the letter from NHS England chief executive Amanda Pritchard and NHS Improvement boss Professor Stephen Powis, hospitals are ordered
It says: ‘Those patients who do not need an NHS bed, because they do not meet the reasons to reside criteria, must be discharged as soon as practically possible.
‘Working with local authorities, every system will need to put in place sufficient measures in order to reduce by half their own number of patients not meeting the reasons-to-reside criteria.
‘A significant proportion of discharge delays are within the gift of hospitals to solve. Hospitals should work to eliminate avoidable delays on pathway zero, ie straight home without the need for social care support.
‘Where necessary, this could include using personal health budgets, which has been successfully piloted in Cornwall and Lancashire; or use of hotel beds.
The letter added: ‘We encourage systems to explore surging community rehabilitation capacity and securing spare capacity from care homes.’
Health leaders said that the emergence of the variant requires an ‘extraordinary response’ from the NHS.
Pressures in the social care system mean that many patients are usually left in hospital while social care packages are arranged.
But last year care home residents in hospital were sent back to homes without all of them being tested in order to free up space for younger Covid patients.
Care England said it raised ‘the lack of testing in hospitals and in the care sector’ a number of times with the Department of Health and Social Care and NHS England in late March 2020.
Mr Hancock didn’t make testing for hospital discharges compulsory until mid-April, by which time thousands of infected residents had returned to their homes with the virus.
The new NHS guidance also ordered hospitals to make ‘full use of non-acute beds in the local health and care system’ including the use of beds in hospices and private hospitals.
They have also been told to expand the use of ‘virtual wards’.
Hospital bosses have been asked to ‘surge test’, including testing oxygen supplies, and ‘learn the lessons from previous waves of Covid, and making preparations to have the capacity in place to meet a potentially similar challenge this winter’.
Trusts have been ordered to maintain mental health, learning disability and autism services.
Meanwhile, they have been told to prioritise pre-planned care for ‘highest clinical priority patients’ — which includes those with cancer and those who have been waiting the longest.
The letter says that services should be maintained ‘as much as possible’, but recognises that some staff may need to be redeployed to support vaccination efforts.
And plans to employ more staff should be accelerated — including asking international nurses to come to work in the UK sooner where possible.
Mr Javid yesterday revealed some urgent appointments could be cancelled to accommodate Covid patients in hospitals — although he earlier insisted only non-urgent services would be postponed.
Speaking in the commons, the Health Secretary said: ‘I acknowledge that our national mission comes with some difficult trade-offs. We are redeploying NHS staff away from non-urgent services.
‘That means that, for the next two weeks, all primary care services will focus on urgent clinical need and vaccines, and some urgent appointments and elective surgeries may be postponed until the new year while we prioritise getting people the booster.
‘These are steps that no Health Secretary would wish to take unless they were absolutely necessary, but I am convinced that if we do not prioritise the booster now, the health consequences will be far more grave in the months that lie ahead.’
Speaking to BBC Radio 4’s Today programme, the Health Secretary said NHS appointments for people with symptoms of cancer will be ‘completely unaffected’ by the diversion of NHS resources to booster jabs, though he expects some procedures to be cancelled.
Pictured above is the current pace of the booster programme (green bars) and how it will have to ramp up to hit the million jabs a day target (red bars). NHS bosses warn scaling up the programme will be ‘incredibly difficult’
This graph shows how many vaccination centres were open in April during the first drive, compared to the numbers involved in the booster roll-out. It reveals there are fewer mass vaccination centres now than previously
According to NHS data, many older age groups who have been eligible to get a Covid booster since September still have double digit percentage figures of people who are yet to get a third dose. Yesterday, the NHS online booking system for Covid boosters was opened up to the over 40s. 81 per cent of people aged 40-to-49 have yet to have a booster.
On whether he could give an ‘assurance’ that ‘anyone who has the symptoms of cancer, and specifically in this case breast cancer, will still be able to be seen within two weeks, Mr Javid said: ‘That will be completely unaffected by this new mission.’
He said, however, that planned operations may need to be postponed as the NHS tries to tackle Omicron and turns its attention to boosters.
‘So that might mean, for example, it might mean a knee operation or a hip operation or something… sadly someone has probably been waiting for a long time in any case, but the hospital concerned would have the right to postpone it if it meant they would get a lot more booster jabs done,’ he said.
‘It does mean that, when it comes to primary care, for the next couple of weeks that our GPs will only be focusing on urgent needs and vaccinations.
Raab claims total number of Britons hospitalised with Omicron is 25 times the true toll before back-tracking
A transparency row over No10’s handling of crucial Omicron data deepened today as Dominic Raab claimed 250 Britons infected with the variant were hospitalised — before correcting the figure to just nine.
The Government was heavily criticised yesterday for announcing the first Omicron death without revealing the person’s age, condition, vaccination status or whether Covid was even the primary reason.
Asked how many people were hospitalised with the super strain during a round of interviews this morning, the Justice Secretary Mr Raab told Sky News the figure was ‘in the low hundreds, I think 250 the last time I looked’.
But 15 minutes later, in a separate interview with BBC Breakfast, Mr Raab said: ‘I think we’ve got nine people who are in hospital with it.’
He corrected the figure on the third attempt with ITV, clarifying that there are ’10 in hospital’ with Omicron. Mr Raab claimed he had ‘misheard’ the original Sky question.
The UK Health Security Agency (UKHSA) told MailOnline 10 Omicron-infected people had been admitted to hospital as of yesterday, saying 250 was ‘incorrect’.
But officials have still refused to offer any more details about any of the hospitalised patients, only saying all were aged between 18-85 and the ‘majority had received two doses’ of a vaccine.
Doctors last night warned the Government was causing ‘unnecessary alarm’ with its Omicron statistics.
The fallout follows even more chaotic messaging by the Health Secretary Sajid Javid last night.
Addressing MPs about the threat Omicron poses yesterday, Mr Javid told MPs up to 200,000 Britons were getting infected with Covid every day. His comments sparked immediate confusion as to whether he meant the figure was solely for the variant or the virus overall.
Department of Health sources later told The Telegraph it was just for Omicron — but experts have questioned the source of the figure and officials have yet to respond to MailOnline and clarify the situation.
‘And it also means that non-urgent appointments and elective surgeries may have to be postponed into the new year.’
Asked on Time Radio whether people will suffer because they cannot get the treatment they need on the NHS, he said: ‘Well, that certainly should not be the case at all because, as well as focusing on this, there will be a focus on any urgent need and any, of course, emergency care.’
He added: ‘If we don’t do this, if the NHS doesn’t do this, then more people will suffer.’
The Department of Health has been approached for clarification on whether urgent surgeries will be
But charities have hit out at the policy, asking for greater clarity on what surgeries will be delayed and arguing even if only ‘non-urgent’ appointments are delayed, it will result in patients missing early diagnoses for deadly diseases.
Minesh Patel, Head of Policy at Macmillan Cancer Support, said: ‘While it’s vital everybody receives their Covid-19 booster, using GP capacity to help with this, at a time when access to GP appointments was already under huge pressure, may have unintended consequences for cancer diagnoses.
‘This is concerning when we know there are already nearly 50,000 patients ‘missing’ a cancer diagnosis in the UK and catching cancer early is so vital in ensuring the best possible outcome for patients.
‘It is crucial that people continue to contact their GP if they have any symptoms that could be cancer and that all concerns about cancer are treated as urgently required appointments.’
Shaun Walsh, of Cancer Research UK, said: ‘Sajid Javid has said that cancer services will be protected, and it’s vital that Government stands by its word.
‘NHS leaders must protect cancer services and ensure that everyone gets the diagnosis and treatment they need for the best chance of survival, because cancer won’t wait.’
Meanwhile heart disease charities argued non-emergency care is still time critical and the longer people have to wait for care, the greater their risk of dying.
Dr Sonya Babu-Narayan, associate medical director at the British Heart Foundation (BHF) and consultant cardiologist, said: ‘The NHS is under immense pressure and difficult decisions are now having to be made, including the postponement of routine care.
‘The best way for people to reduce this pressure on the NHS, and to protect themselves and their loved ones from Covid-19, is to get the booster vaccine as soon as they can.
‘Non-emergency care is frequently far from ‘routine’ — cardiac care is time critical. Treatments like heart surgery aren’t a luxury, as the longer people wait, the greater the chance of dying or developing irreversible heart failure before they receive the care they need.
‘The vast backlog of people needing cardiovascular treatment will only keep growing, putting more and more lives at risk.
‘Heart services must be protected and the shortage of heart disease doctors and nurses must be addressed as a priority.
‘Heart patients need to hear how their life saving care will be delivered, both now, throughout the pandemic’s ebbs and flows and in the future.’
And Caroline Abrahams, charity director at Age UK said: ‘If you are an older person who has already been waiting for an operation for some time, the news that non-urgent surgery is being put on hold must be a hammer blow.
‘The NHS must do everything possible to support older people who are having to wait longer as a result.’
Patients Association chief executive Rachel Power added: ‘Patients who are facing delays must have clear information about what is happening, when they will be treated, and how to care for themselves at home while they’re waiting.’
Meanwhile, Professor Martin Marshall, chairman of the Royal College of General Practitioners, said there must be clear messaging to the public on what is defined as an urgent health need while GPs focus on the Covid booster rollout.
He told Good Morning Britain: ‘We need to have very clear public messaging that helps the public to differentiate between what is urgent, what is a necessary condition to look after, and what can wait for a few weeks.
‘That isn’t easy, I don’t think anybody’s pretending that.
‘Let me be clear what kinds of things we’re talking about here which are urgent, which do require general practice to focus on alongside the booster programme
‘So, if somebody potentially has an infection; if they have symptoms that might be cancer; if they have a long-term condition like diabetes that is poorly controlled; if they are young and maybe have a high temperature or if they’re vulnerable, perhaps if they’re elderly; mental health problems as well.
‘If they have conditions like that, they need to come forward.
‘If they have routine problems – a bit of an ache or a pain; a little bit of a rash if you’re known to have eczema; a cough and a cold; if you’ve got high blood pressure that’s well controlled – then that isn’t urgent, in comparison with general practices’ role in the programme.’
And Chris Hopson, the chief executive of NHS Providers, said will face some ‘very difficult decisions’ on how to deploy staff if there is a surge in hospital admissions.
He told the All Party Parliamentary Group on Coronavirus: ‘If we have got significant numbers of secondary care staff helping out on vaccinations, if we see a surge in hospitalisations before that campaign is completed there will be some very difficult decisions to make about whether those staff return on not.
‘This is a very, very live issue. We definitely have now reached a place where we cannot do everything and we are going to have to prioritise.’
‘How is it fair hospital beds are taken by the unvaccinated when my life is hanging by a thread?’: The shocking human stories behind the thousands of operations cancelled by Covid
By JOHN NAISH FOR THE DAILY MAIL
Lara Sargent had high hopes that this year, finally, the pain which has blighted her life for the past decade would come to an end.
At times, the 25-year-old has been in such agony during her periods that she could barely stand.
‘I’d be rolling around the floor in unbearable pain,’ says Lara, who lives in West Sussex.
The problem began when she was 13, and when she was 18 her GP put her on the Pill, but that ‘just made things worse’.
In January this year, after a 13-month wait, Lara was sent for laparoscopic surgery to investigate the cause of her pain.
Lara Wahab, 34, is an advertising account director. She lives in North London with her younger sister, Tanya. Lara says: If I don’t have a kidney and pancreas transplant soon, I’ll have to go on dialysis or I will die’
She was diagnosed with severe endometriosis — where endometrial tissue that forms the lining of the womb develops elsewhere in the body, causing pelvic pain and heavy periods.’
Lara’s gynaecologist referred her to a specialist NHS centre, where another consultant could operate to remove the tissue and end her pain.
In May this year, after being told her surgery would be imminent, she underwent pre-operative tests — yet the operation that should have followed has been cancelled.
My life is hanging by a thread because of lack of ICU beds
Lara Wahab, 34, is an advertising account director. She lives in North London with her younger sister, Tanya. Lara says:
If I don’t have a kidney and pancreas transplant soon, I’ll have to go on dialysis or I will die. My kidney function is way below normal — a reading above 80 is a sign of a good kidney and mine is 10. My symptoms are getting worse and my body is hanging by a thread.
I was diagnosed with type 1 diabetes when I was seven, and in 2019 developed kidney failure, which is a complication of the disease.
As a result my body itches all over, I suffer from nausea, loss of appetite, hair loss, swelling in my ankles and legs, as well as breathlessness and a loss of strength.
In August 2019 I was put on the transplant list for a simultaneous kidney and pancreas transplant, which can ‘cure’ type 1 diabetes. The alternative is living on dialysis, which reduces my life expectancy. Only ten per cent of dialysis patients live for ten years or more.
I was told that it would take 12-15 months to find a donor. But then Covid hit, and when I checked the transplant list status it said ‘Suspended’.
I was so down. I called the Churchill Hospital in Oxford (where I would be having the operation) and a nurse told me this was partly because the NHS couldn’t handle transplants as well as all the Covid cases.
In the winter of 2020 the programme started again, but it wasn’t until April 2021 that I got a call to say organs may be available. It didn’t work out — as often happens for various reasons — and that happened yet again the same month.
Last month, I rang my kidney nurse to ask why I hadn’t had any more calls — when he looked into it, he found that on six occasions organs had been available but I hadn’t been contacted.
He couldn’t tell me all the reasons, but in one instance last month there was a healthy pancreas and kidney available, and I hadn’t received a call.
My nurse said: ‘Are you sure you want to know the reason?’ He then told me I could have received the new organs, but the operation couldn’t go ahead because there were no beds available in the intensive care unit.
It broke my heart. Here was my chance to have new organs and a new life . . . and it had been taken away from me because of the pandemic.
Not only that, but when I looked into it, many beds seem to have been taken up with people who are actively choosing not to be vaccinated against Covid. How is that fair?
I feel really worried about the future — for me and for other patients who desperately need to have surgery.
It’s a situation countless others are going through — but stories such as Lara’s put the real human cost into perspective.
‘I have had to give up my job as a healthcare assistant because I am often bed-bound with the pain during my period,’ Lara says. ‘I have had to start taking prescription pain relief just to cope with each day.
‘I’m now taking antidepressants because, before, there was an end in sight and I could cope. Now there isn’t and I feel hopeless.’
Lara has been calling the hospital, hoping to be told when she can have the operation.
‘But they keep telling me there’s a waiting list, staff shortages due to the pandemic and a huge backlog,’ she says.
‘Now I’ve been referred to another specialist NHS centre, but am back to square one, waiting for a first consultation before I will even be considered for surgery.’
It’s a situation familiar to many. From people needing new knees or urgent care following a heart attack, to those with cancer that requires surgery — there is one thing that unites so many different NHS patients now: they are all just waiting.
Waiting list numbers are spiralling rapidly to such huge figures that it feels almost impossible to imagine the human misery that lies behind them. Last week, the number of patients waiting for consultant-led hospital treatment, including surgery, in England alone reached six million — the highest figure since records began in August 2007.
Meanwhile, many other patients who had been booked in for surgery are seeing their operations cancelled.
The Royal College of Medicine has just published data that showed more than 13,000 elective-care operations were cancelled in the past two months at 40 sites alone — as a comparison, this was around the same number of cancellations for 156 sites in 2019.
It is easy to blame this fast-spiralling crisis on an obvious villain: Covid-19.
The pandemic has forced hospitals to institute rigorous infection-control regimens, screening patients and staff, isolating anyone suspected of being infected by the virus, and deep-cleaning operating theatres and equipment between operations even more meticulously.
Prime Minister Boris Johnson warned on Monday that cancellations and disruptions could be ‘even greater next year’ if more people do not get their booster jabs to stop Omicron — the new Covid variant — running riot.
However, leading experts say Covid is just the ‘heavy straw that’s broken the camel’s back’ after years of mounting crisis.
The very basics of getting patients into hospitals for timely treatment, then out again into community care, are broken. Instead, desperate patients get stuck at every point because the system is collapsing.
And as we can reveal, while ministers talk apologetically of cancellations and waiting lists being about elective surgery — replacing worn hips and knees — misery-making delays that nevertheless can be endured, research shows alarmingly that more than a million operations categorised as ’emergency’ or ‘urgent’ appear to have been cancelled in 2020 alone in England and Wales.
Research published in the British Journal of Anaesthesia in June found that admissions for Class 1 surgery — emergency operations needed within 72 hours for catastrophes such as strokes or heart attacks — dropped by more than 13 per cent between April 2020 and March 2021, with more than 108,000 patients missing out on vital surgery. For Class 2 urgent surgery — operations needed within a month for problems such as tumours of the brain, lungs, bowel and breast — admissions slumped by almost a quarter, with 92,430 procedures called off.
Patients needing less immediate surgery suffered even more, with more than 900,000 fewer admissions for those needing skin cancer, prostate cancer or gall bladder operations — down more than a third on previous years. And routine hip or knee operations plummeted by nearly half-a-million, down 52 per cent on normal levels.
Priya Raj, 25, from Glasgow, works in financial services. She says that had the surgery been done in March 2020, when planned, it would have been a simple operation. Instead, the delay led to her needing emergency surgery and the risk that she won’t be able to have children
What has happened to all these ‘missing’ operations? Might they be explained by patients’ emergency or urgent symptoms being overlooked or ignored during the pandemic, for instance? Or have these patients simply not received urgent and emergency surgery because the Covid-burdened NHS lacks the capacity to do them?
‘We don’t yet have any answers,’ explains Dr Tom Abbott, the researcher in anaesthesia and perioperative medicine at Queen Mary University of London, who co-authored the study and says they are looking at what is happening to emergency patients.
Dr Abbott nevertheless calculates that the overall NHS surgery backlog will increase to 2.4 million cancelled operations by the end of 2021, with millions more patients feeling the impact for years to come.
‘The backlog is likely to take many years to clear, particularly as the speed with which surgical treatments can be delivered is slowed by infection-control procedures,’ he warns.
My kidneys were irreparably damaged by bladder op delay
Neil Bowles, 46, a business executive, is married to broadcast manager Lisa Armstrong, 47. He says that what started off as a bladder condition has, as a result of Covid delays, further damaged his kidneys, which are now failing
Neil Bowles, 46, a business executive, is married to broadcast manager Lisa Armstrong, 47. The couple live with children Erin, 15, and Callum, 12, in Banbridge, Co Down. Neil says:
What started off as a bladder condition has, as a result of Covid delays, further damaged my kidneys, which are now failing.
My health began to deteriorate in 2016. I was in chronic pain, lost more than 4st in eight months and needed to urinate every half-hour, day and night. I was diagnosed with interstitial cystitis, also known as painful bladder syndrome.
Essentially, my bladder was inflamed. On top of that, my ureters (the tubes that connect the kidney to the bladder) were also inflamed, which was blocking the flow of urine.
I was told I’d need an operation to create a new bladder from part of my bowel, or a stoma bag to collect urine for life.
As an interim measure, I had stents inserted to prop open the ureters and help the urine drain from the kidneys to the bladder.
Even at this point, my kidneys were slowly failing. I had a biopsy, and the surgeon said my bladder was the worst he had seen in 30 years — it was so damaged.
I urgently needed surgery, but in May 2020 I was told that no non-emergency procedures were taking place due to the Covid crisis.
My stents should have been replaced every six months to reduce the risk of infection, but I had the first set for 20 months.
And as a result, my ureters have become badly inflamed. In August of last year, I had to have an emergency procedure as a temporary solution. Tubes were inserted into each of my kidneys through the skin on my back and connected to an exterior drainage bag.
I am now at stage three kidney failure and live with chronic pain. If I end up needing dialysis or a transplant, how much will that cost the NHS?
Other research co-authored by Dr Abbott, and published in the British Journal of Anaesthesia in August, shows how essential such infection-control measures remain. It found that while only 1.1 per cent of patients acquired a Covid-19 infection at hospital at the time of their operation, their mortality rate after catching Covid was extremely high, with patients being up to 25 times more likely to die.
However, stringent infection-control precautions do not explain fully the huge drop in operations and the accompanying rise in waiting times, say health service leaders.
As Rory Deighton, the acute network lead for the NHS Confederation, which represents NHS Trusts, says: ‘While we now have six million people waiting, that figure was [already] around 4.5 million when we went into the pandemic. The problems have accumulated over ten years.’
He claims that ‘money meant for developing NHS services and investing in new equipment had instead to be spent on keeping services going’.
The resulting structural problems now run throughout the health-service system, creating blockages at all vital points. Indeed, the same fundamental problems that are stopping patients getting surgical care — lack of beds and staff — are also leaving seriously ill patients stranded in A&E units, and even stuck outside for hours in ambulances, warns Dr Adrian Boyle, vice-president of the Royal College of Emer-gency Medicine.
This shortage leaves A&E doctors competing with surgical doctors for the inadequate beds available, and both miss out.
‘We can’t get our emergency patients admitted, and at the same time operations are being cancelled for people who need beds in wards or intensive care in which to recuperate,’ says Dr Boyle.
‘Operations have been cancelled like this since bed shortages began to mount up in 2015.’
Chronic bed shortages have only been worsened by Covid. Analysis by researchers at the King’s Fund health think-tank this year shows that infection-control precautions and staff absence have shrunk the number of beds by a further 5 per cent, which Dr Boyle fears has pushed services over the edge.
‘We have almost the least number of beds per head of population in Europe,’ he says.
For example, while Germany has 601.5 beds per 100,000 citizens, the UK has only 249.5, according to 2017-18 EU statistics.
‘The pandemic is a heavy straw on the camel’s back,’ says Dr Boyle. But that is not the only thing stopping beds becoming available for desperate patients. Thousands of people are currently stuck in those preciously rare beds because there’s nowhere else they can go.
‘One in ten of the patients in hospital is medically fit to be discharged, but there is not the community support available to take them,’ says Rory Deighton.
For now, waiting lists for routine operations may be significantly addressed by creating a nationwide network of specially dedicated surgery hubs, says Tim Mitchell, vice-president of the Royal College of Surgeons of England.
Surgical hubs are already being pioneered in some areas, such as London and Northumbria, where they perform procedures that range from low-complexity surgery (such as hip and knee replacements) to specialised treatments such as cancer operations.
Such hubs, says Mr Mitchell, may either be dedicated free-standing units or be located independently inside large hospitals.
In Croydon University Hospital, for example, a hub has been set up with ten theatres and 28 beds for surgical patients. The centre has strict infection-control procedures. In a separate part of the hospital, emergency admissions and Covid-positive patients are treated.
‘The idea is gaining traction in the NHS,’ says Mr Mitchell. ‘Croydon has drawn patients from across London, showing that patients are prepared to travel for surgery.’
Mr Mitchell adds that the Government is expected soon to publish its Elective Recovery Plan for tackling the waiting-list crisis. In the immediate term, he wants to see the green light given to a nationwide plan for surgical hubs. In the longer term, he says NHS bed numbers must be almost doubled, from 2.5 to 4.7 per 1,000 people — and the number of hospital doctors (including surgeons) from 2.8 to 3.5 per 1,000 people. While that sounds very ambitious, Mr Mitchell says this would bring the NHS only up to the average numbers seen in other developed nations.
Minesh Patel, head of policy at Macmillan Cancer Support, told Good Health: ‘Our research estimates that more than 47,000 people are missing cancer diagnoses, compared with what the numbers should be. And more than a quarter of people having cancer treatment in August have told us they are worried about their chances of survival being hit by delays.’
Meanwhile, there is no magic wand, warns Rory Deighton: ‘We have to be realistic about how long it will take to resolve the problem.’
Today’s record waiting lists are symptomatic of an emergency that has been years in the making. If we blame only Covid, we will never find an effective answer.
Case studies by Julie Cook, Sheron Boyle and Jill Foster
I ended up needing emergency surgery
Priya Raj, 25, from Glasgow, works in financial services. She says:
Ten days before I was due to have an operation to remove a large cyst from one of my ovaries, I got a phone call to say the surgery had been cancelled because it was not ‘an emergency’. I couldn’t believe it.
I’d already been living with crippling pain in my abdomen for a year. Had the surgery been done in March 2020, when planned, it would have been a simple operation. Instead, the delay led to me needing emergency surgery and the risk I won’t be able to have children.
I developed pain in my abdomen in October 2019 and soon it was waking me at night and I started vomiting. My GP diagnosed irritable bowel syndrome. I managed by taking paracetamol and sleeping when I could, but the pain persisted and by February 2020, it was so bad I couldn’t get out of bed.
I decided to go private and had an ultrasound, which showed I had a large cyst (9cm by 8cm) pressing on my right ovary. I was told I’d need surgery to remove it in case it burst, which could cause sepsis.
The private clinic sent my notes to my NHS doctor, and a couple of weeks later a consultant arranged for me to undergo surgery in March 2020.
I was so very relieved — but then I got the phone call telling me my operation had been delayed indefinitely. I phoned the hospital and begged that it should go ahead, but was told it was ‘elective’ and not urgent.
Yet the pain was getting progress-ively worse, and within a week I couldn’t get up at all as it hurt so much to move and I had to quit my job.
I lived at home and my mum had to help me wash and dress. I spent hours in bed each day as I was so wiped out with pain.
In April, five weeks after the surgery had been cancelled, I was in such a bad way my mum and brother rushed me to A&E. My ovarian cyst had twisted and cut off the blood supply to my fallopian tube and right ovary and I needed emergency surgery.
When I came round, I found out the surgeons had had to remove my fallopian tube and ovary, as well as the cyst, because they were so damaged. As a result, I have lost half of my fertility.
At first I was too stunned to take it in. I was relieved not to be in danger, but I really want children one day — and as the months passed, I became increasingly angry.
I’m now looking into egg freezing just in case I can’t get pregnant. The cancellation of my operation will affect me for ever.