Door of an emergency ambulance.
England’s healthcare system is facing significant challenges across urgent and emergency services, cancer care, diagnostics and planned care as demand continues to outstrip capacity.
The National Health Service’s latest performance statistics show the country’s elective backlog remains stable but high, while its ambulance response times and emergency room waits are far below target levels.
Although private hospital care is available in England, the vast majority of planned and unplanned care is performed by the NHS, which is publicly funded and offers almost all services free at the point of use.
The NHS’s performance standards had been slipping before the pandemic, with patients waiting for more than 4.4 million elective procedures like hip replacements and cataract surgeries back in February 2020. Statistics published Thursday show that number has been hovering around the 7 million mark since August 2022.
This performance standard, which is published two months in arrears, may well may well be impacted by two major junior doctor’s strikes in March and April: action that’s already seen hundreds of thousands of appointments pushed back.
But Covid-19, which has caused widespread cancellations and delays over the last three years, is a much more significant factor than strikes in the elective backlog. Not only has the pandemic seen the waiting list grow markedly, but it’s contributed to a dramatic increase in the amount of time patients typically wait for care.
Back in February 2020, the median wait time for a non-urgent procedure was 7.5 weeks. This February, that number hit 14.5 weeks.
But hospitals have been able to reduce the number of patients waiting incredibly long periods of time — more than two years or eighteen months, for example — for care. Although a national target to eliminate 78-week waiters was recently missed, there has nonetheless been significant improvement in this area.
This is really important both for patients themselves and the hospitals that will ultimately treat them. For many patients, the longer they wait for care, the worse their condition tends to be when they attend hospitals. This means lots of patients are arriving at hospitals — whether for planned, urgent or other types of care — with more acute and complex needs than they might have had before the pandemic.
Emergency care in crisis, but cancer improving
Other metrics released Thursday show how widespread the NHS’s performance issues have become. For many months, emergency care statistics like ambulance response times and emergency room wait times have been very poor as hospitals have struggled to free up beds for new patients.
Waits of 12 hours or more in emergency rooms have become such a problem that the the NHS has now started sharing how often this is happening. In February, of 1.19 million emergency attendances, 11% waited 12 hours or more after arrival at the ER.
Difficulties discharging patients, hindered by factors like a lack of adequate social care, are a major driver of these ambulance and emergency results, which are consistently causing serious harm to patients around the country.
Diagnostics and cancer care are also struggling to hit several performance targets. But hospitals are managing to perform much more activity in both areas than before the pandemic, and several metrics are improving.
Staff battling ‘moral injury’
Staff wellbeing is a major concern for care providers, with anxiety and depression major drivers of absence.
A recent report by the Health and Safety Investigation Branch found ambulance staff experienced “extreme emotion” when discussing their work, with “moral injury” — where staff feel they are unable to provide adequate care for patients in need — a recurring problem in emergency care.
Experts have long argued the NHS’s now-widespread performance issues reflect a lack of investment in fundamental areas like workforce, hospital equipment and the social care services that can relieve pressure on acute wards. Some of these problems have been exacerbated by the pandemic, two major think tanks concluded in a report published last year. Brexit, which disrupted the flow of specialist doctors from the E.U., may well have made the situation worse.
Other longstanding concerns, like the country’s ageing population and the inadequate condition of many hospital estates, have persisted and even worsened over the same period.
‘Severe and unsustainable pressure’
Reflecting on the NHS’s latest performance metrics, Miriam Deakin, director of policy and strategy at industry body NHS Providers said: “[These] figures show the NHS is under severe and unsustainable pressure.
“Trust leaders and their staff have made remarkable gains bringing down the number of people waiting longest for elective treatment, which is no mean feat given the record-high staff vacancies, recent seasonal challenges and ongoing strikes.
“However, persistent challenges across urgent care are hindering progress on ambulance response times and A&E waits.”
Deakin said the flow of patients “through the entire system, including mental health and community services” was struggling as demand outpaced capacity and waiting lists grew.
National workforce planning and investment is needed to shore up performance, she said, as well as action to help resolve strikes.
“It’s clear the ongoing strikes are compounding pre-existing pressures, impacting patient care and hindering progress on care backlogs amid plunging workforce morale,” she said in a statement encouraging the government to use an intermediary body to facilitate meaningful negotiations.
“We’re at a critical juncture. Both sides of the current pay dispute — the government and unions — need to urgently open talks in good faith.”