Patients are facing increased delays at almost every stage of their NHS treatment, as the health system struggles to find the resources to deal with demand.
The latest data shows waiting lists across England have surpassed record highs every month for two years running, one of many major challenges currently facing the NHS.
“There is not one area of NHS provision that isn’t really struggling,” Alastair McLellan, the editor of Health Service Journal, told the Guardian in August. “There is literally nowhere where it isn’t bad, and in some cases really bad.”
But what impact does this have on ordinary people trying to access the NHS in 2022?
Through a combination of interviews with health professionals and analysis of official data, the Guardian has plotted the journeys of four fictional patients through their NHS journey and how waiting times have changed at each stage of their treatment and recovery.
We look at how the crisis affects the day-to-day lives of four patients: someone with breast cancer, someone requiring cataract surgery, a patient with heart issues and one with a hip fracture. These case studies have been created in consultation with health experts and represent realistic patient pathways that a person with one of these conditions could expect.
The Head of Policy at Macmillan Cancer Support, Minesh Patel, said that delays existed prior to the pandemic, but Covid “has made these much worse and led to backlogs.”
“Hardworking cancer professionals are doing the best they can to treat people, but vast gaps in the workforce have been growing for years, leaving NHS staff exhausted and burnt out, and too many people left in limbo waiting to be seen.”
Mr Patel warned that “these excruciating waits can significantly affect people’s physical and mental health”.
Daniel Hardiman-McCartney MBE, Clinical Adviser from the College of Optometrists, said that the “rapid increase in the number of [independent NHS-funded] clinics has destabilised traditional eye care provision in some areas and has exacerbated problems related to the shortage of ophthalmologists”.
The lack of eye doctors in NHS trusts has “resulted in longer delays in some areas for people with chronic eye conditions” such as glaucoma or people with comorbidity or complex problems, which can increase the number of people affected by preventable sight loss.
For Mr Hardiman-McCartney, eye care could be improved by better supporting local ophthalmologists’ departments with optometrists. While there are some areas in England with successful examples, this “frustratingly remains a post code lottery, with the main barrier being local systems’ reluctance to fully utilise the optometric workforce.”
Professor Antony Johansen, consultant orthogeriatrician in Cardiff and clinical lead at the National Hip Fracture Database, told the Guardian: “Hip fracture care is losing the momentum that was so successfully maintained during the pandemic, and a patient’s chance of next-day surgery has fallen lower than we’ve seen for a decade.
“This may reflect poorer population health, as well as strain on ambulance services, emergency departments, hospital beds and operating theatres. Delayed surgery will worsen these pressures by increasing patients’ risk of complications and prolonging their time in hospital.”
Professor Ioakim Spyridopoulos, an honorary Consultant Interventional Cardiologist at Newcastle’s Freeman Hospital, told The Guardian that while the NHS response to acute life-threatening conditions is “still excellent”, urgent or elective care such as valve replacements “lags behind other leading European nations.”
For patients who require urgent treatment for a heart condition, “the cause for delays for urgent patients is mainly due to hospital staffing issues and bed capacity.
“As a consequence [of longer waiting times], these patients have a higher risk of dying while waiting for treatment, and even the general outcome is much worse when treated too late.”
In a statement released to coincide with the release of several of the metrics covered here, NHS England said the service was contending with its busiest October ever, including for the most serious ambulance callouts.
NHS medical director, Prof Sir Stephen Powis said there was “no doubt October has been a challenging month for staff who are now facing a tripledemic of Covid, flu and record pressure on emergency services”.
“Pressure on emergency services remains high as a result of more than 13,000 beds taken up each day by people who no longer need to be in hospital. But staff have kept their foot on the accelerator to get the backlog down with 18-month waiters down by three-fifths on last year.”
The service said that recent NHS analysis found that the service was diagnosing more patients with cancer at an earlier stage than ever before.
Notes
While patient pathways vary depending on geography, the patient and the severity of the case, each scenario has been verified by a health professional as a reasonable care pathway someone could expect. The majority of the data used in this piece was from the NHS England and NHS Digital, however some data was also sourced from the Royal College of Physicians, the Royal College of Ophthalmologists and the British Heart Foundation. MacMillan, the Health Foundation, the Royal College of Nursing, the College of Optometrists and Heart Research UK were consulted in the development of accurate patient journeys. Our cataract operation scenario refers to Leicester City CCG as equivalent national figures were not available.
