07.04.2022

Seasons of crisis

The huge increase in NHS waiting times is not just a result of the pandemic, James Linney explains

Daffodils have bloomed, bees are again buzzing amongst the flowers and the sun’s rays are thankfully once again offering warmth: spring has arrived.

Not too long ago, for workers in the national health service spring also meant they could breathe a little easier, because they had made it through the annual winter crisis; a time when, inevitably, emergency departments would be overflowing and free hospital beds would be as rare as hens’ teeth. I am not saying that outside of the winter crisis period things used to be all rosy - there has never been a golden age for the NHS, since it has always been grossly underfunded. There was, however, a temporary easing of the most extreme pressures felt during the winter months.

But it seems those days are gone. The new reality is an NHS in perpetual crisis - like an old fir tree being battered by ever more violent storms, it feels, sadly, like only a matter of time before it comes crashing down. As yet another surge of Covid-19 cases have worryingly started manifesting themselves in increasing hospitalisations and deaths, there looks to be no sign of the storm subsiding.

In the past week there has been a 21.6% increase in people being admitted with Covid-19 (13,844 people) and a 17.9% increase in deaths within 28 days of a positive coronavirus test (877) compared to the previous week.¹ On the day of writing there were 50,202 new cases recorded, but this will only be a fraction of the real number, because there are fewer people testing now and the number of tests is soon going to plummet further, because as of April 1 the government will no longer provide free lateral flow or PCR tests in England and many cannot afford the £5.99 for a single test that the likes of Boots are charging.² In terms of a public health strategy, this move is the equivalent of the government switching off all the lights whilst the NHS is still battling to hold off the deadliest pandemic in a generation. Perhaps the Tories hope that the darkness will conceal the ever growing number of dead bodies - 165,570 and still counting - the majority of whom have died as a direct consequence of their gross mismanagement of the pandemic.

The current wave of infections is being driven by the new Omicron BA.2 variant - the most recent in a long line of variants that have dominated UK cases. This comes as yet another warning that Covid-19 is not going away and remains highly unpredictable. There are likely more people infected in the UK now than at any other time - cases have climbed by a million in a week and swab tests suggest at least one in every 16 people is currently infected.³ BA.2 is a sub-variant of the highly transmissible Omicron, which is even more infectious than its predecessor. Thankfully the available vaccines remain effective in reducing the risk of severe complications from the virus, although being fully vaccinated is no guarantee of not being infected - and it is possible to become infected a second time.

The protection provided by the vaccines is also limited temporally and it starts to wane after only a few months.⁴ The fact that the Omicron variants have proven to be less deadly is not due to any natural or guaranteed tendency for Covid-19 virus to become less severe with time or with each mutation: it is largely down to chance. As long as it can successfully spread from one host to another, there is nothing stopping future variants from being more deadly or being able to evade the vaccines.

Highlighting this fact, in the past week a new variant, called XE, was detected and is now spreading in the UK. XE is a mutation of the BA.1 and BA.2 Omicron strains, having probably emerged in someone who was infected by multiple variants of Covid-19. The World Health Organisation estimates that early data indicates a community growth rate advantage of 10%, as compared to BA.2,⁵ and it is not yet clear how severe an infection XE will produce or how effective the vaccines will be in limiting its impact.

These facts are, of course, mere trivial inconveniences for our government, whose ‘Living with Covid’ message equates to ignoring Covid. There will be no attempt to make our schools better ventilated and safer for children, there will be no more support for workers with Covid-19, who are expected to turn up for work, there will be no more attempts at tracking and tracing the virus. Additionally, the React study (which randomly tests about 150,000 people across England each month to see how many are infected with coronavirus), the Zoe Covid study (which tracks symptoms and the spread of the virus), the Siren and Vivaldi studies (which monitor infections in health workers and care homes) and the CoMix social contacts survey are all being defunded or scrapped as of April 1.

The combined effect of all this means that, if a vaccine-avoiding variant does appear, by the time we are able to detect it, it will be too late, and we could end up in a similar position to February 2020.

What next?

Whatever the future consequences of Covid-19, the NHS is going to be in dire trouble: even if there were not another single case, it would take us at least a decade to catch up with the backlog of work the pandemic has already created. That backlog consists of the care that the NHS would normally have delivered, but which was disrupted, as the pandemic impacted service delivery, and includes the ‘known’ backlog - ie, those patients on waiting lists for medical or surgical care - but also a likely significant ‘unknown’ number of people who need care but have not presented to the NHS yet, due to concerns about catching Covid-19 or not wanting to overburden the health service.

Before Covid-19 there were already 4.43 milllion people on a waiting list for care. But, as of January, there was a record 6.1 million people waiting for treatment.⁶ The total waiting longer than the 18 week target is two million, while for no fewer than 312,000 it has been over a year: this is 190 times more than before the pandemic. Cancer waiting times too are at a record high, with half a million having to wait more than the two-week target to see a specialist when cancer is suspected by their GP. Emergency care is just as dire - the average number of people being seen and treated within the four-hour target has fallen from 95.5% (the target being 95%) to currently being as low as 61%, with those having to wait over 12 hours for treatment being once again higher than ever - over 16,000 people as of February 2022. This is despite the fact that there has only been a relatively small increase in the number of attendances to accident and emergency units.

The government’s mantra has predictably been that the current state of the NHS is due solely to Covid-19 - that it was just a bad hand we have been dealt and that the health service will take time to rebuild. Yet, even if we buy into this idea of Covid-19 just simply hitting us like a ‘natural disaster’ (of course, such disasters will always affect the working class more in general, while leaving the poorest communities most devastated), its disastrous consequences for the NHS are directly related to the appalling state it was in just prior to the outbreak of the pandemic; the backlog of work and staff sicknesses have simply been a catalyst for a process that was consciously set in motion by the Tory government over a decade ago. A political strategy of defunding and privatising by stealth meant the NHS had a 93,000 staff deficit, leaving those who remained overworked and disheartened before a single Covid-19 case had been diagnosed.

The fallacy of the ‘natural disaster’ lie can be see most clearly in the contrast with how the private health sector has fared during the pandemic: for it, unlike the NHS, Covid-19 has turned out to be a very good thing indeed. These good times started soon after the pandemic hit, when NHS England block-booked almost the entirety of the private hospital sector’s services, facilities and nearly 20,000 clinical staff. This deal - the cost of which is still secret, but estimated to be between £2 billion and £5 billion - meant that between March 2020 and March 2021, whilst the NHS was shouldering the cost of caring for the severely sick and dying, during the most fatal period of the pandemic, the private sector was making more profit than ever for doing nothing. It turned out that, in total, private hospitals delivered 0.08% of Covid-19 care - the highest number of private hospital beds occupied by Covid patients on any one day was just 78.⁷

But this transfer of NHS funds was just the start: for the Tories the deaths and indescribable suffering of the pandemic was too good an opportunity to miss to undermine the NHS - whilst at the same time making eye-watering profits for their mates, donors or business partners. The ‘VIP Lane’ for purchasing personal protective equipment proved to be one very efficient method for achieving this and 32 billion items of PPE with a value of £14 billion were bought following directly awarded and negotiated contracts. For example, this week we have learnt that the PPE for which the government paid £122 million to Medpro - a company linked to the Tory peer, Michelle Mone - was purchased by Medpro from a Chinese manufacturer for just £46 million.⁸ In an article investigating Tory spending in the first year of the pandemic The New York Times summed up the levels of corruption quite well: we have seen:

one of the greatest spending sprees in Britain’s post-war era … roughly 1,200 central government contracts … have been made public - together worth nearly $22 billion. Of that, about $11 billion went to companies either run by friends or associates of politicians in the Conservative Party.⁹

No sign here of the politics of austerity that have been slowly starving the NHS over the last 10 years.

The current backlog of waiting times crippling the NHS is also a perfect opportunity for private health companies to cherry-pick those patients who can afford to pay for private care or who are too desperate to wait years for their operations - hence the Spire Healthcare company has seen a 47% surge in revenues from self-paying patients, up to a record £130 million. That has lifted its overall revenue by nearly 40% to £558 million.¹⁰ Growing waiting times for elective treatments in the NHS have also seen an acceleration in their outsourcing to private clinics and hospitals - but this too is only a continuation of a trend that the Tory government has been pushing for years: between 2010 and 2018 NHS-funded patient activity in private-sector facilities grew by 156%, compared to a 19% growth in elective activity in NHS hospitals. The opening this month of the Cleveland Clinic London - a new £1 billion private hospital - is another signal that private health companies are smelling blood and want to be ready to cash in on any feeding frenzy resulting from the further decay of the NHS.

In regard to Covid-19, the Tories are trying their best to push their own version of reality - one where they defeated the pandemic through developing vaccinations and by preventing the NHS from becoming ‘overwhelmed’. No doubt these are claims we will hear repeated endlessly, largely unchallenged by the media, until the next general election. And, given the state of the current Labour leadership, there is every chance they will get away with it.