By the end of July, it is expected that all adults in the UK will have been offered their first Covid vaccine dose and by mid-June, all restrictions are expected to come to an end. With this is mind, it is easy to believe the effects of the pandemic will soon be a distant memory.
However, despite the drop in infection rates and hospital admissions, the NHS is facing a crisis. The NHS has spent the last year under the most strain its ever experienced and has had to cancel countless non-emergency appointments. As a result, there is a huge backlog of unmet healthcare needs which will need to be addressed, in many cases, as a matter of urgency.
The British Medical Association (BMA) reported that an estimated three million fewer elective treatments occurred last year than usual, while there have been 22.1 million fewer outpatient attendances. There are a record 4.6 million people waiting for operations, with an estimated 340,000 patients waiting more than 12 months. This compares to just 10,000 in August 2019.
With so many patients waiting for treatment, it is fairly unsurprising that 59% of RCP members believe it will take at least 18 months for the NHS to recover from the pandemic, and 30% believe it will take more than two years.
Which areas have seen the largest backlogs?
Delays in care are particularly acute within certain specialist areas of medicine. Specialists believe that backlogs will take over a year to clear in certain areas, including:
• Dermatology (82%)
• Gastroenterology (75%)
• Rehabilitation medicine (67%)
• Respiratory (59%)
• Oncology (58%)
• Cardiology (52%)
Delays to treatment can cause serious complications. Since so many appointments had to be carried out remotely, such as via telephone, physical examinations could not take place. Clinicians across Europe recently revealed that they are seriously concerned about the effects this could have on cancer patients.
In a survey by SERMO, 74% of clinicians said they are concerned there is likely to be a ‘ticking timebomb’ of cancer patients waiting for diagnosis and treatment, as a result of Covid-19. Delays to treatment are likely to have serious consequences for cancer patients, as more progressed cancers are much harder to treat than they would be in the early stages.
Early detection is advantageous for many diseases, not only medically but also in a social context. An early diagnosis gives families more opportunities to learn about the disease, develop realistic expectations, and plan for the future. This can help reduce feelings of stress and burden later in the disease process.
How will healthcare staff cope with this crisis?
Doctors, nurses and other healthcare professionals across the nation (and the rest of the world) are physically and mentally exhausted from the pandemic. However, their services are still to be high in demand for the coming years while the NHS catches up with the millions of patients requiring medical attention.
This is worrying, considering over half of doctors say their health and wellbeing is worse now than during the first wave of Covid. From the same survey, researchers found that 41% of doctors are suffering from depression, anxiety or another mental health condition that has worsened during the pandemic, and 59% feel their current level of fatigue or exhaustion has been higher than normal.
The survey also found that 26% of doctors are more likely to take a career break or seek early retirement in the next 12 months as a result of the pandemic, while almost a fifth of doctors are considering leaving the NHS altogether.
This is further compounded by RCP’s report, which found that staff wellbeing is suffering, with over two thirds (69%) reporting feeling exhausted and 31% demoralised. Only 57% of doctors say they are getting enough sleep. Two thirds said there had still been no discussion in their organisation about time off to recuperate. Even for the 29% who had had time off, 59% still felt tired afterwards and only 27% refreshed and ready to return.
When asked what impact the pandemic had on teamwork, a third (33%) thought it had a negative impact during the first wave. Two fifths thought it then worsened during the second wave. The top reasons given for that were the pressure they were under (74% in the first wave and 82% in the second) and not enough staff (64% in the first wave and 68% in the second).
What action must be taken?
The NHS is already facing extreme workforce shortages. The prospect of so many healthcare workers leaving or taking a break from their profession poses a real threat to the nation’s health. At the same time, it is neither "sustainable or realistic to expect doctors to take this huge backlog without some respite", say the BMA.
For this reason, the BMA has set out a series of recommendations to UK Governments to ensure that services resume safely for both staff and patients, including:
• All Governments and system leaders across the UK to have an honest conversation with the public about the need for a realistic approach to restoring non-Covid care, and support for systems to tackle the backlog.
• Health, safety, and mental wellbeing of the workforce to remain a top priority.
• Additional resourcing to help tackle the backlog.
• Measures to expand system capacity.
• Measures to expand the workforce and retain existing staff.
The government has recently announced a £7 billion package for health and care services to support the next phase of the NHS response to Covid-19. The Health Secretary, Matt Hancock, announced that the NHS will receive £6.6 billion over the next 6 months to support the hospital discharge programme, infection control measures, long COVID services, and NHS staff support services.
Although this funding is welcomed by the sector, Andrew Goddard, president of the RCP, said it will not solve longer term problems: “While this targeted funding will support clinicians to get by in the next 12 months, many of the pressures they face are caused by workforce shortages. There is no quick fix to this. It will require long term funding commitments, including for a significant expansion of medical school places. The most effective way to reduce NHS backlogs and ease pressure is to increase the workforce that is available to treat patients.”
For this reason, the RCP is calling for a doubling of medical school places to ease the pressure on doctors and ensure the NHS can meet patient demand in future. The Office for National Statistics projects that the number of people aged 85 years and over is set to double from 1.6 million in 2018 to nearly 3 million in 2043. As it takes 10-14 years to train a doctor, the RCP say the number of medical school places should be doubled now so that we have more doctors to manage that increased demand.
"Nearly 1 in 10 patients are waiting longer than a year for routine treatment or operations"
Responding to the latest NHS monthly performance statistics, Nuffield Trust Deputy Director of Research, Sarah Scobie said: “With waiting lists now at the highest number since records began, it is clear that the NHS has been set back years as it faces a battle to clear these major backlogs of postponed care. Returning to the levels of activity seen before March last year will not be enough to meet demand, and we will continue to live with coronavirus for years to come.
“Nearly one in ten patients (8%) are now waiting longer than a year for routine treatment or operations, and these are the highest numbers seen since 2007. We shouldn’t underestimate the strain this is putting on these patients who need this treatment. But with hospitals and staff working under intense pressure amid the second spike in hospitalisations, it is no surprise that elective care had to be pulled back.
“Healthcare staff have made huge sacrifices during this pandemic, but more will be asked of them on the path to recovery. That is concerning when the latest NHS staff survey results in England show that more of them working in Covid-settings have suffered illness from work-related stress. Ensuring the wellbeing of staff must be an integral part of any credible long-term recovery plan.”