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Massive cancellations of routine operations in England are inevitable this fall and winter despite an NHS edict that hospitals must not again interrupt normal care, medical leaders said.
Organizations representing frontline physicians, including the British Medical Association (BMA), also criticized England’s NHS for ordering hospitals to provide “near normal” levels of non-Covid-related care in the second wave of the pandemic, and demanded fines for not meeting targets will be scrapped.
His intervention came as the University of Nottingham hospitals became the fourth trust in England to postpone non-urgent surgery after an influx of Covid-19 patients.
On Friday, sources said Rotherham, Doncaster and Barnsley hospitals were also canceling “small amounts” of elective operations and non-urgent outpatient appointments. “Things are very, very difficult at the moment, very challenging,” said a South Yorkshire NHS official. “It feels like a juggling act every day.
“The problem is both the growing number of patients entering the hospital with Covid and the number of staff that we have sick due to Covid, either because they themselves are sick or because someone in their home has symptoms, so they are isolating themselves “, the official said.
National NHS leaders have decreed that normal care must continue amid mounting evidence that the widespread suspension of screening services, diagnostic tests and treatment in the spring left hundreds of thousands of patients without access to care for cancer, heart disease, and other serious illnesses. Knee and hip replacements, cataract surgery and other operations were canceled.
As a result, some experts have estimated that tens of thousands of people could die prematurely from cancer alone. In June, the NHS waiting list was projected to reach 10 million by the end of the year.
Three years ago, without a pandemic but faced with a winter health crisis that included severe flu and bad weather, non-urgent surgery was postponed across the country.
Over the past week, the coronavirus has led to the hospitalization of nearly 1,000 people per day on average across the UK. The number of Covid patients treated at the Liverpool hospital exceeded the peak of the first wave.
The BMA, which accounts for around 70% of Britain’s 240,000 doctors, says hospitals have too few beds and staff to maintain surgery and diagnostic tests for non-Covid-associated diseases while the second wave unfolds.
“While trusts did their best to reintroduce elective care after this first wave, many have now been forced to return to limited services to stay afloat as we work through the second, even more demanding peak of cases,” he said Dr. Rob Harwood, Chairman of the BMA Hospital Advisory Committee.
“As winter approaches, many trusts will likely have no choice but to continue to restrict their elective care services, which is incredibly concerning to staff and patients alike as delays and conditions increase. health can get worse ”.
He added: “We always knew that Covid was going to disrupt healthcare, but years of underfunding meant that we started on the back foot at the start of the pandemic and in some places it has been impossible to meet the NHS plan to resume care. elective. as the figures recovered again. There just aren’t enough staff or resources. “
Addressing the NHS’s plans to fine hospitals if they fail to perform at least 90% of the planned operations they did in October last year this month, Harwood added: “It is clear that with Covid cases increasing rapidly across the country, this approach is unrealistic and should be scrapped. Hospitals should not be penalized for having to make difficult decisions about canceling elective procedures where they urgently need to divert resources to ensure that Covid patients receive the care they need. “
Dr. Nick Scriven, immediate past president of the Society for Acute Medicine, said: “I think this [trusts cancelling operations] It will be unavoidable in large areas of the health service, as the pandemic and winter coincide. We know that the number of beds is low compared to other countries and with the necessary infection control processes, the “functioning” of what we have slows down in all areas.
“In a ‘normal’ winter, the NHS plans less elective work, especially at Christmas and New Years, and this is not normal at all. If you add the increasing difficulty of maintaining ‘green’ areas [of hospitals] outside of Covid, having enough staff to cover the front door, as well as elective areas and ICU capacity issues, it will be extremely difficult to keep elective surgery running anywhere above an emergency procedures only model / low emergency “.
Scriven added: “I think it is unrealistic to expect trusts across the country to meet the elective targets set in the current climate, especially in those areas that have already been hit hardest in the North West of England, where even today we see hospitals with more Covid patients than in the spring. I hope the financial consequences of not meeting elective goals this fall and winter will be eliminated. “
The impact of Covid-19 on one of Northern Ireland’s largest hospitals led to warnings that trauma surgery might have to be rationed. Ronan McKeown, a Craigavon-area hospital consultant who treats patients with injuries from road collisions and home accidents, told the BBC: “As the capacity of the hospital decreases, that will influence what we can do. and the services we can offer to the public. . “
Tracy Taylor, CEO of the Nottingham Trust, said she had made the difficult decision to postpone some surgeries and non-urgent appointments until November 2 following a dramatic increase in the number of Covid-19 patients.
The trust has had this week more than 200 hospitalized patients in treatment for coronavirus. “This increase is now at similar levels to April and is combined with our normal emergency pressures in winter. This is not a decision that we have made lightly, but we must ensure that we have beds and staff available to care for people with urgent needs during this increase in Covid-19, “added Taylor.
The Bradford Teaching Hospitals Trust on Tuesday suspended some non-urgent surgeries and outpatient consultant appointments for two weeks to help it cope with an influx of Covid patients that brought its case total to 100.
Professor Mel Pickup, executive director of the trust, said: “The increase is now at levels similar to the peak of the first wave in May. That [delaying surgery] It is not a decision we have made lightly, but we must create so much bed capacity and free up clinical staff within our hospitals to help us manage this increase in Covid-19 patients. “
The trust is sending some patients who need surgery and research to private hospitals in Yorkshire to help ensure that at least some of them are treated.
NHS England was contacted for comment.
