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Covid-19: High rates in hospitals have hampered elective care recovery, says NHS chief

BMJ 2022; 379 doi: https://doi.org/10.1136/bmj.o2909 (Published 01 December 2022) Cite this as: BMJ 2022;379:o2909
  1. Gareth Iacobucci
  1. The BMJ

The NHS in England significantly underestimated the continuing impact of covid-19 on hospital bed capacity this year, its chief executive has said. Amanda Pritchard said that the ongoing high numbers of patients with covid in hospitals had hindered efforts to tackle the backlog of elective care that had built up during the pandemic.

“We’ve been completely wrong on the assumptions about covid,” Pritchard told MPs on the House of Commons Public Accounts Committee on 28 November. “Having made, I think, some ambitious assumptions that the level of covid would be low . . . across the UK, we’ve never had less than 5000 patients in hospitals at any one time this year. Covid has been much higher than expected, and the consequences of that are not just beds with patients in, it’s the impact on sickness of staff.”

Pritchard conceded that the NHS was currently behind trajectory on its commitment to increase elective activity to 129% of pre-covid levels by 2025. “We are still absolutely aiming for 129% at the end of that period of time. What we do recognise is that we are going to need to reprofile the trajectories to get there,” she said.

She added that this reflected the squeeze on capacity this year, with inpatient activity particularly affected. “As a rule of thumb, we have about 10 000 beds in the NHS used for elective care. It has been about 8500 all year, so we’ve lost a significant amount of capacity,” she said.

James Mackey, national director of elective recovery at NHS England, told the committee that patients were being offered remote consultations with doctors elsewhere in the country to try to reduce long waits. “If you are a patient in the south west, it is technically possible to have a consultation with somebody in the north east,” he told MPs. “We are trying to do that, and it is starting to happen around the country.”

Cancer care backlog

During the session Pritchard also admitted that the NHS would not meet its target to ensure that by March 2023 no more than 85% of people waited longer than 62 days to start treatment for cancer after an urgent referral by their GP, as was the case before the pandemic. She said this was largely because the number of referrals to secondary care had risen substantially, by 20%, in the past year. “At the moment, roughly one in four referrals from a GP is for suspected cancer,” she said. “Clearly, that has put very significant pressure on the cancer treatment capacity, because it’s difficult to grow oncology services or specialist cancer services by 20% per year.”

But she emphasised the bigger picture in terms of patients getting an early diagnosis. “This is a classic example where you could meet the target and miss the point,” she said. “You could try and suppress referrals to get the backlog down, but that would be entirely the wrong thing to do because we want to encourage people if they are worried to come forward [and] get diagnosed as quickly as possible.”

Pritchard also sounded a cautious note on whether the NHS was on course to hit its target to clear all 78 week breaches from the waiting list from March 2023. She said, “We are supporting the NHS to try and do this, but within that, there are risks . . . what happens with covid, what happens with flu . . . what happens with the workforce. Realistically, this is a very challenging milestone.”

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