Data Journalism, Journalism

NHS Staff at breaking point, beds running out, backlogs, delays, and Brexit.

What does the future hold for the NHS?

Urgent and emergency care situation reports show how the NHS almost ran out of critical care beds during the second wave of the pandemic. Hospitals in London reached 95% of their capacity by January 2021, closely followed by the South East and the East of England.

The situation was perilously close to being an unmitigated disaster as the second national lockdown began across the UK. Yet many of the pressures faced by the NHS were predicted in advance.

Five Coronavirus spikes piercing the NHS

In early 2020, a study by the Health Foundation predicted five distinct areas of impact linked to the pandemic.

Severe illness & Death

The authors considered how the direct impact of Covid-19, measured in terms of severe illness, hospitalisations, and deaths, would almost break the NHS. The latest data back up their grim forecast.

Dr Alex Stockdale, NIHR Academic Clinical Lecturer in Clinical Infection, Microbiology & Immunology at the University of Liverpool, who worked on Covid wards during the first wave, said:

“Everybody was really afraid. Non-infection specialists particularly, because they hadn’t really dealt with infectious diseases. All of us had quite profound insomnia, lying awake at night worrying ‘is it going to be me next’?”

Existing socioeconomic inequalities were also exacerbated by the pandemic, with black and minority ethnic communities disproportionately affected

Acute system shake up

Acute care was also expected to suffer from decreased capacity, caused by the massive surge in demand of Covid-19. This transpired as thousands of people were discharged to free up beds for Covid patients, staff were redeployed en masse, enormous numbers of operations were cancelled, and GP appointments increasingly took place remotely.

Non-covid related hospitalisations fell dramatically during the first lockdown, with accident and emergency admissions dropping by 31.4% overall compared to 2019, according to a recent data release by NHS Digital. Around 45% fewer Children aged 0-4, and 21-27% fewer young adults aged 18-25 were admitted to hospitals than the previous year.

Non-acute care and GP clinics

Non-urgent, routine healthcare normally dealt with by GPs was also dramatically impacted by the pandemic. Cancer Research repeatedly raised concerns about the relative lack of early cancer diagnoses, which is likely to lead to adverse outcomes.

Dr Stockdale echoed their concerns: 

“What we’re seeing now is lots of late diagnoses of cancer. That’s going to be the biggest shadow: Cancer related death over the next 24 months.”  

Cancer surgery has also dropped since the first lockdown, meaning that many urgent referrals received alternative treatments like radiotherapy.

Remote GP appointments increased significantly during the pandemic. According to NHS data, between May and July 2020 almost 50% of all appointments were conducted by telephone, exceeding the number of face to face appointments. Previously, from October 2019 until March 2020, in-person appointments accounted for 80% of the total.

A GP from Kent, who spoke on condition of anonymity, said: 

Remote appointments can actually take longer than seeing someone face to face, because…you can’t pick up…non-verbal cues and use your intuition.”

“There is…technology to ask patients to send images…for example of a rash. Sometimes this can be a real time saver, but other times…you have to [see them] face to face…to get a clear view.”

They also worried about elderly, deprived, and vulnerable patients “missing out on access because of digital exclusion.”

A report by Health Watch concurred that “many people [were] struggling to access care”, and found the lack of clear communication about changes to the appointments system “frustrating” and “confusing”.

Delays and failures


Research by the British Medical Journal showed a “record high of 4.46 million” patients were awaiting planned treatment in November 2020, and “2.3 million people” were still “waiting for surgical care” earlier this year.

Repurposed wards, operating theatres and outpatient clinics, staff redeployment, absence due to sickness or self-isolation, protective protocols slowing down hospital treatment, and “delays or failures in patient testing”, were all cited as possible contributing factors to increased waiting times.

A decimated & demoralised workforce 

A report by the Health Foundation examined how perennial staff shortages hampered the NHS’ pandemic response. Despite a recruitment drive there were over 80000 staff vacancies in June 2020. Almost 50% of these were nursing jobs, keeping the UK below the OECD average for nurses per capita.

Evidence also suggests that NHS staff have increased levels of anxiety, depression, stress, and PTSD. Female nurses and ethnic minority workers were particularly affected, with the latter having “50% greater risk” of “high PTSD symptoms”, and being significantly more worried about getting Covid-19 than their white counterparts.

The NHS Staff survey 2020 provided a parallel perspective. Overall, 44% of staff reported “feeling unwell” due to “work related stress” during the pandemic, an increase of 10% from 2019.

Post-pandemic recovery in the shadow of Brexit

A report by the Nuffield Trust outlined the complexity of Brexit for the NHS. From the prospect of investor-state dispute clauses in the controversial Trans-Pacific trade deal allowing private companies to challenge public health regulation, to rising medicine prices, changes in the mutual recognition of qualifications affecting NHS recruitment, UK immigration rules ensuring that social care applicants cannot pass minimum “salary or skills thresholds” for visas, foreign nurses finding it harder to accept jobs, data sharing disruption, and the burgeoning crisis in Northern Ireland, the future looks fraught with problems.

Alongside issues related to Brexit, the NHS is on the verge of integrated care systems reshaping the current model of healthcare. New partnerships between NHS providers and local government are set to be fully operational by April 2022. The proposed changes have been met with scepticism.

What next for the NHS? 

Coronavirus shows no sign of disappearing in the near future. A “chronically underfunded” and understaffed NHS and social care system looks likely, at the very least, to have to maintain a delicate balance between:  

And much more besides. 

As the pandemic ebbs and flows these challenges represent the tip of an increasingly unfathomable iceberg. The question is whether the British government, healthcare providers, and key stakeholders can work together to steer the NHS Titanic through the tumultuous, storm-tossed waves threatening to sink the ship before any lifeboats can be released. 


Photo by Markus Spiske from Pexels

Journalism, Opinion

Remain is Dead: The 5th stage of Brexit Grief

*Links are highlighted*

Less than 12 months have passed since that stunning BBC exit poll dashed the naive dreams of Britain’s Remain tribe, and burst the buoyant bubbles of idealistic enthusiasm stoked up by Labour’s radical Corbynite manifesto. A barrage of cut-throat commentary on social and mainstream media alike failed to dim the hopes of many echo-chamber dwellers who dared to contemplate the highly improbable scenario that Boris might fail to win a majority, and Brexit could yet be reversed.

To use a comic book analogy, when the unstoppable force of optimism collides with the immovable object of realism, explosive sparks are bound to fly. In this case the electorate proved to be unwilling to budge from their scepticism about Jeremy Corbyn, or their apparent belief that they must simply allow Boris to “get Brexit done”. Workington man was not to be moved by the unlikely inertia of democratic socialism. Instead, he stood his ground and the so called “red wall” fell into the abyss of populism and resurgent English nationalism.[1]

Dissent drowned in a tsunami of dystopian disinformation throughout the election campaign. The prime minister’s tub-thumping majority was clearly not affected by his track record on having a less than intimate relationship with the truth. Nor were Labour’s hopes of winning over the British public brought in out of the cold by Boris’ decision to hide in a fridge rather than face Piers Morgan. Any prospect of the PM consenting to being drawn over the hot coals of political scrutiny by Andrew Neil prior to retaking office also remained firmly on ice. One could surmise that the Johnsonian mandate to govern genuinely did have a “chilling” effect on democratic debate.

Denial

Since the 2016 referendum, many UK citizens have been coming to terms with nothing less than a full blown identity crisis. The anxiety induced by such epoch-shifting events can manifest itself in something akin to grief, characterised as it often is by five distinct stages of denial, anger, bargaining, depression, and finally acceptance.

For several years now, Remainers had hoped that their denial would turn out to be a fresh form of the classic British stiff upper lip syndrome; endure the worst of the polarisation and uncertainty long enough to persuade the overwhelmingly leave-voting general public with facts and well-rehearsed, reasoned arguments, and they might change their collective mind. All they had to do was persist and resist any temptation to complain or be too condescending. Eventually, with enough resolve they could see eye to eye with enough leave voters to swing the electoral map back in favour of the EU. It now turns out that this was a grave mistake; Remain have been in denial for over four years.

Anger

The emperor of a second referendum had no clothes. The Remain dream has long since breathed its last. Brexit is now “done” and dusted. Yet No Deal, far from being off the table, remains a genuine possibility before the end of 2020. Boris Johnson has won. Power, privilege, and populism hold sway, and any socialist notions of levelling the playing field in the UK between the have and the have-nots has vanished in a sea of black X’s next to Tory candidates. Any misplaced notion that Britain could become a nation which works “for the many, rather than the few”, has finally been laid to rest for at least another generation. For some, anger is an entirely understandable response to this scenario, and all that Boris Johnson’s government entails. But it is too late for anger to bear any real fruit in the immediate short term. Playing the blame game won’t fix anything. Vitriol may feel good, and even have a cathartic quality at times, but it won’t change the UK’s current circumstances.

Bargaining

The general public could have wrought great change at last year’s election. They could have given themselves a second opportunity to consider the wisdom of Brexit; to vote for a bold new vision of equality and reform. Many Remain voters attempted bargaining with committed leavers, to convince and persuade them to change course. To rage against the injustice of ruling class privilege. To opt for a man of principle and side with social justice over against reinforcing the status quo.

Instead, the people have opted for the latter and given another old Etonian, of Bullingdon club pedigree, unfettered permission to take the UK out of the EU and rule the country as he and his party see fit for at least the next five years. In all likelihood this will stretch to ten, and beyond. By 2030, the UK will look radically different. EU membership will be a distant memory. Further bargaining might feel necessary, urgent even. Yet this too would be mistaken.

Depression

Depression, despondency and/or abject apathy may well be a natural response to the finality of the present political situation in the UK. Anyone who has ever experienced depression will be able to tell you that recovery is not a simple case of clicking one’s fingers and attempting to “snap out of it”. The good old British phrase “chin up”, or hollow platitudes about looking on the bright side, are useless and insensitive to anybody wrestling with poor mental health. So it is with the emotional fallout generated for so many by the Brexit process.

For many remain voters Brexit has hurt. It has dragged them down and dampened their spirits. It will undoubtedly take time to heal if this is the stage you find yourself in. There are no easy answers here, and until you are ready, moving on to the final stage is not easy. Be patient with yourself. Know that you’re not alone. If possible reach out for help and support. Staying in this stage of Brexit grief is not sustainable. As a committed Christian, I am thankful that I have been able to take solace from my hope in Jesus Christ and the peaceful security the gospel of hope brings. Yet even this can be easier said than done in the nitty gritty of day to day life.

Acceptance

When you are ready for it, maybe the time has come to move past denial, relinquish any anger, cease attempts to bargain a way out of this, and do your best to deal with the depression of losing “Europe” once and for all. Acceptance is the only realistic, and healthy way to ultimately move forward. Fighting to change a nation’s mind is a fool’s errand in the current political climate. It would also be undemocratic. Like it or not, the people have spoken.

To accept this reality is to be empowered to prepare for potential next steps, whatever they may be. For each person who decides to take the path away from denial, anger, bargaining, and manages to get through the depression, the unthinkable yet necessary task of accepting the death of the UK that existed before Brexit awaits. It it surely better to embrace this reality, warts and all, than to persist in a futile fight for a forgotten ideal.

The Remain Funeral is booked

Remain is dead. Realignment is imminent. Rather than mourning the loss of freedom of movement, or a sense of European identity, a smarter move now might be to spend the coming months and years planning an escape route into the EU, and leave the UK behind. Either that, or remain and face the music of Boris’ Brexiteer symphony, conducted to imperfection by Dominic Cummings & Co.

Grief is an entirely normal response to loss. Just be aware that to remain in that state too long is extremely unhealthy and destructive. For those who decide, or have no choice but to remain in the UK, the sooner you can let go of being a part of the EU and all that it represented, the better. For those who are able to leave the UK for the EU or elsewhere, the clock has always been ticking. Life is painfully short. Wasting it will only lead you to miss the gift of life that precedes the moment when there is no more of it, and the coffin lid is finally nailed shut. Seize the day before it ends for the last time.

Change has come. Brexit is now the unstoppable force that will shape the future of these islands for generations, for better or worse. Brace yourselves for it, or remove yourselves from it. Such is the path ahead. For me, this will involve sustained prayer and reflection before making any bold moves. Should any opportunities arise to take a leap of faith elsewhere, I suspect that jumping at such a chance is now almost as inevitable as the UK’s EU membership funeral service due on January 1st 2021.

Whatever the future may hold, I can only be eternally grateful that I also have the hope of resurrection and new life springing forth from any form of death; as much during this life as in the next. I pray that by some miracle you would all be blessed with the same.

Godspeed.

M

End Notes

1. See Fintan O’Toole’s Heroic Failure: Brexit and the Politics of Pain, for an incisive analysis of this. Also a recent article in the Washington Post for a snapshot.