Covid-19: NHS is struggling to treat more patients than before pandemic despite more staff and funding, finds analysis

  1. Matthew Limb
  1. London

Covid-19 may have dealt a “lasting adverse hit” to NHS performance rather than a short lived one-off shock, leading economists have said.

The Institute for Fiscal Studies said its analysis showed that the NHS was struggling to treat more patients than it was before the pandemic despite having more staff and more funding, a seeming fall in performance and output that it described as a “puzzle.”1

In its report the institute said that there were signs that patients were generally sicker than before the pandemic and in need of more complex treatment but also other contributing and interacting factors that would need further data to unravel.

There were fewer hospital beds available for patients without covid-19 than before the pandemic and a continuing struggle to discharge patients into the community or social care, further clogging up the system and acting as a drain on staff resources, it said. “More generally, there are worrying signs that rather than imposing a one-off, time-limited shock to the healthcare system, covid-19 has dealt a lasting adverse hit to NHS performance,” said the report.

Max Warner, a senior economist at the institute who co-wrote the report with colleague Ben Zaranko, a senior research economist, said, “Going forward, we need to grapple with the possibility that the health service is just able to treat fewer patients with the same level of resources.”

The report examined how the funding, staffing, and hospital beds available to the NHS had changed since 2019 and how the number of patients treated in eight different areas compared with 2019 levels.

The NHS was carrying out more first cancer appointments and GP appointments—even though GP numbers had fallen—than before the pandemic. But it was managing lower treatment volumes for many other types of care, despite large staffing increases over the past three years. Even after numbers were adjusted for higher rates of staff sickness absence, the NHS had 8% more nurses, 9% more consultants, and 15% more junior doctors than before the pandemic. After recent top-ups, the NHS budget by 2024-25 will be 2.9% higher than under pre-pandemic plans, but challenges and cost pressures are also considerably greater than were anticipated.

The additional cash announced in the chancellor’s recent autumn statement has been “sufficient to offset only around half of the real terms hit from higher inflation,” said the report.

Although the total number of hospital beds has risen to 1% above pre-pandemic levels, the number of beds available for non-covid patients was still lower in the third quarter of 2022 than pre-pandemic levels.

The think tank said that the latest month of data showed that the NHS carried out 14% fewer emergency admissions, 14% fewer outpatient appointments, and 11% fewer elective and maternity admissions than it did in the same month in 2019.

It has become harder to discharge medically fit patients because of problems with community care, and there are more “long stayers” in hospital, it said.

The institute’s director, Paul Johnson, told the BBC on 14 December that it seemed many factors were playing a role in reducing the amount of care the NHS was able to deliver within the resources available. “GPs are doing more than they were, and that seems to reflect perhaps the most worrying trend of all, which is we seem as a nation to have got significantly unhealthier over the last three or four years, whatever data you look at—whether it’s people claiming benefits or people self-reporting as sick or the number of people dying—it just does look like we are a significantly less healthy nation than we were three years ago,” he said.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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