Over the last few weeks, and in the months preceding, there’s been a huge amount of media coverage about the NHS’s “looming winter crisis”. “The NHS staffing crisis is killing people – and this winter it will be even worse”, reads one paper, and you can expect fears to increase as we head towards January, when demand for health services normally peaks.
Clearly there are reasons to be worried about what lies ahead, due to multiple pressures on the NHS, which has been put on its level of emergency preparedness due to the Omicron variant. There’s the strain caused by the “twindemic” of flu and Coronavirus, both of which flourish in winter; the fact that millions of non-Covid procedures, including operations, have been scrapped to ensure that GPs and otherwise can focus on urgent needs and vaccinations; and there are staff shortages too. It’s estimated that the NHS has a shortfall of up to 100,000 employees in total, with vacancies for medical practitioners rising 15 per cent in the last year and seven per cent for nurses.
Are we about to head into one of the worst crises on record? When I ask Dr Raghib Ali, Senior Clinical Research Associate at the University of Cambridge and a consultant at Oxford University Hospitals, where we are on a timeline of events, he replies “If you mean [by a crisis] ‘will the NHS not be able to deliver all services, as was the case in both the first and second waves, then that is likely – in fact, it’s already happening to an extent because some elective services are being cancelled in some places.” He explains that “the NHS is under a lot of pressure now because of non-Covid… we’re much, much busier than we were certainly in the first wave and, to an extent, even the second wave.”
Ali believes that there are a number of variables that will influence what January looks like. One is how big the backlog is of a) the people who avoid coming into hospital around Christmas and b) those currently staying away, in their own “voluntary lockdown”.
The crucial factor, though, is how effective vaccines are against hospitalisations for the Omicron variant. In short, the less effective, the more hospital beds will start to fill up. Ali says that we should have the hospitalisation data in around one to two weeks, which will mean SAGE – and the Government – is far more able to predict what kind of winter the NHS is in for, and whether it should take preventative measures.
Should the worst outcome prove true (that hospitalisations increase rapidly as a result of Omicron), expect Keir Starmer to use this to argue that the Government did “too little, too late”, even though he knows Boris Johnson would have an extremely challenging time trying to get any more restrictions through (judging by Tuesday’s vote). Were the Labour leader to be granted a vote on the measures, which he’d probably vote through, he could still take the view that they were introduced too late or not enough, as a means to knock the Prime Minister.
When I ask Liam Fox, also a doctor, about where we are in the “crisis” timeline, he says we have a chronic problem of under capacity. “I think the question we have to ask is why is it that the NHS seems at almost all times of the year now to be in what we used to call a winter crisis, and what does this tell us about the capacity of the system and the way it’s being run?”
Fox cites two major factors that are destabilising the system. One is that “the NHS runs at a bed occupancy rate that is too high” which “leaves it lacking resilience” if demand changes suddenly (e.g. Covid patients increasing).
The other is medical practitioners’ “lack of ability to discharge patients who don’t need to be in hospitals” partly due to the closures of community hospitals and respite care – particularly in the 90s. He says that “we’ve been obsessed with increasing high-tech medicine, without considering convalescence as a concept”, which is – in turn – leading to imbalances in healthcare.
Similarly, Ali believes that part of dealing with NHS pressures means working out how to physically discharge patients (who have been medically discharged), who don’t have support afterwards. He believes that key to solving this is better funding for social care; and that this would be economically wise, too, as the cost of hospital beds being taken up by medically discharged people is probably more than the cost of paying social care workers more (who can look after them).
The Government has made a start on tackling this area. Hotels have been transformed into temporary care facilities, for one, and workers from Spain and Greece have been flown in to take care of patients. It seems ministers are well aware of some of the main ways to relieve the strain on the NHS, but they will come under pressure to create reforms for the long-term.
In conclusion, it’s impossible to predict whether the NHS was justified to move into its highest level of emergency preparedness, mainly due to the unknowns about the Omicron variant, which – in the best case scenario – could be highly transmissible, but less severe than others. There’s also the booster jab programme, whose success could radically change the situation. But the Government does know what structural remedies can help it avoid, as one paper put it, “the worst winter.”