The NHS has more funding and more staff than it had pre-pandemic.
At the same time, across most types of care, the NHS is treating
fewer patients than it was before COVID-19. This is a puzzle,
with no single or simple explanation.
Perhaps the most convincing partial explanation is that although
the total number of NHS hospital beds has returned to
pre-pandemic levels, the number of beds available for
non-COVID activity in the third quarter of 2022 was still lower
than pre-pandemic. Furthermore, there are clear signs
that the NHS is struggling to discharge hospital patients when
medically appropriate. And a broader worsening
of population health, evident in the rising number of disability
benefit claimants, is likely increasing the number of patients
requiring complex, resource-intensive treatment.
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. It could be that, going forward, the NHS is
able to treat fewer patients from a given level of resources than
it was in the past – and those resources are being squeezed in
the short-term by higher inflation.
These are among the findings of new IFS analysis of NHS funding,
resources and treatment volumes. Other key findings include:
-
The additional cash allocated to the NHS at the recent
Autumn Statement is sufficient to offset only around half of
the real-terms hit from higher inflation. Looking
across the five-year parliament as a whole, the original
intention was to increase the NHS budget by 3.4% per year in
real-terms between 2019–20 and 2024–25. Even after recent
top-ups, spending is now set to rise by an average 2.9% per
year over the five years.
-
Even after adjusting for higher rates of staff sickness
absences, the NHS has 8% more nurses, 9% more
consultants and 15% more junior doctors than
pre-pandemic. For context, the number of nurses
increased by just 3% between 2010 and 2019.
- The health service is carrying out more GP appointments and
first cancer appointments, and is obviously treating more COVID
patients, but for many other types of care it is treating fewer
patients than it was pre-pandemic. In the latest month of
data, 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. The number of incidents recorded by ambulance
services was 9% lower in the latest month of data, despite 4%
more 999 calls.
-
With almost 3,000 patients in hospital primarily
because of COVID-19 on an average day in the third quarter of
2022, there were 1% fewer beds available for non-COVID activity
than pre-pandemic. There were, in addition, around
5,500 patients a day in hospital with COVID-19, but who were in
hospital primarily for other reasons. Adjusting for all
patients in hospital with COVID-19, there were 5% fewer beds
available for non-COVID patients than was the case
pre-pandemic.
-
The number of beds occupied by patients who have been
in hospital for more than 7 days is 14% higher than at this
point last year, and the number occupied by patients who have
been in for more than 21 days is 24% higher. Both of
these figures are already above the highest level hit in any of
the past five winters.
-
Official data suggest that in the first week of
December, around 40% of those in hospital for more than 21 days
were ready for discharge, compared with 34% at the
same point in 2021.
Max Warner, Research Economist at the IFS and an author
of the report, said:
“The NHS is showing clear signs of strain heading into the
winter, and is treating fewer patients than it was pre-pandemic
across many types of care. The real risk, almost three years on
from the start of the pandemic, is that the COVID hit to NHS
performance is not time-limited. 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.”
ENDS
Notes to Editor
'NHS funding, resources and treatment volumes' is an IFS
report by Max Warner and Ben Zaranko.
