The NHS Crisis – a creaking infrastructure that has been decades in the making and that has no quick and easy fix
Every day the news carries stories of the NHS being in the middle of the worst crisis in its history, with senior doctors warning that hospitals are facing intolerable pressures that in turn are costing lives.
The NHS has been under pressure for many years and Covid, flu and recent ongoing strike action by staff have all exacerbated the sense of crisis this winter.
A report by the Health and Social Care Committee in 2022 drew on the latest research from the Nuffield Trust which suggested that NHS England is short of more than 50,000 nurses and midwives as well as some 12,000 hospital doctors.
Jeremy Hunt, the then Chair of the Health and Social Care Committee said “Persistent understaffing in the NHS poses a serious risk to staff and patient safety…We now face the greatest workforce crisis in the NHS and Social Care with still no idea of the numbers of additional doctors, nurses and other professionals that we actually need.”
The situation relating to staffing shortages has been compounded by staff leaving the NHS and employment considerations post-Brexit with around 1 in 10 NHS posts now vacant, leaving the UK with fewer doctors per 1,000 population than many of its Western European counterparts.
This lack of staff puts even more pressure on those left in post and this is regularly evidenced in conversations with nurses, doctors and paramedics, who all state that they no longer enjoy their work as the can not provide the level of care they would like to for their patients. Poor pay and this acute lack of job satisfaction are the main drivers behind the current strike action.
But just having more frontline staff and increasing the NHS budget for day-to-day spending is not going to solve the crisis or make any significant reduction in the waiting lists, as the underlying issue is an acute shortage of beds. Providing the funds for a new ambulance and crew means extra patients can be brought into A & E, but if beds have not been freed up, all that has been achieved is to increase the queue outside A & E.
On paper there are a similar number of beds available in English NHS hospitals as there were in 2019, yet the NHS is treating 12% fewer patients from the waiting lists and admitting 14% fewer, emergency patients than it did in 2019.
Why is this the case?
Quite simply there are still about 2,000 hospital beds in use by patients with severe Covid and more significantly there are almost 14,000 beds occupied by patients who no longer need to be in hospital.
The underinvestment in NHS infrastructure for nearly two decades has brought about this bed crisis.
Reducing the amount of time that people need to spend in hospital and solving the delayed discharge problem is the key issue that must now be addressed.
The crisis in Social Care is closely linked to the overall crisis in the NHS with the problems going back to when the NHS was founded in the landscape of post-war Britain.
The decision was taken to split health (run by the NHS) and Social Care for the elderly (run by local councils). Although now some 70 years on there has been some integration this division still exists, despite regular government promises of a major reform.
What this means is that our health system is free at point of need, but our care system is means tested and has been squeezed even more than the NHS.
The waiting list for care is rising sharply and without space in care homes, coupled with an acute shortage of staff in that sector, or the availability of care in the community, the frail elderly are more likely to end up in hospital and are unable to be released back into the community as there is no one to look after them or provide them with specialist support in terms of OT and other such services. Over half the patients who are ready to leave hospital can’t because of lack of care in the community.
Pressure from the “twindemic” has only added to this crisis. The NHS was battered by the pandemic but now other infections, in particular flu which had been suppressed during the lockdowns, have taken a grip on a population with a significantly reduced immunity. This in turn is putting further strain on the NHS.
The lockdowns have led to people with chronic conditions not always getting the support that they need. A frailer, sicker population is only adding to the pressure when the NHS and its staff are least able to respond. Lesley Powls, Director of Operations at Kings College Hospital notes “We’ve got Covid, flu, seasonal viruses, the impact of the cost-of-living crisis – what we’re seeing now is a patient population that is much, much sicker than they were pre-Covid…we’re seeing an increase in people who just can’t cope with their physical illnesses any more. The other big hike we’re seeing is people who are presenting with mental health as their primary reason for their presentation. They are coming A&E because there’s nowhere else for them to go.”
These are the issues that will need to be addressed at the NHS Recovery Forum between the Government, the NHS and care leaders in an attempt to tackle the immediate crisis and agree a longer-term solution.
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