The bad news just keeps on coming this week for patients in the UK - and that means all of us Britons, whether we're currently healthy or not.
First we heard that cuts in social care could have been responsible for up to 30,000 deaths in the UK last year.
Next came the news that the NHS has cut 15,000 beds in the last eight years alone - the equivalent of closing 24 hospitals.
Now we hear that may not be the end of it - under new proposals by NHS bosses, nearly two thirds of hospitals could see their services cut. The theory is that this will free up money for more GP services including seven-day access, more specialist clinics in the community and centralised 'super hospitals' to provide high-quality care for life-threatening emergencies.
But before we take these grand plans from the government at face value, let's see how the latest headlines stack up.
Beds per head
According to a report by the British Medical Association, the average number of hospital beds in England has dropped from 3.8 per 1000 people in 2000 to 2.4 per 1000 people by 2015. That's the second lowest level of hospital bed provision in Europe. It's important to remember that the number of hospital beds needed has been falling across the whole developed world for the last 30 years. Advances in treatment have allowed many patients to be safely discharged from hospital sooner, or to be treated as day cases for procedures that would have needed several days in hospital in the past.
But we also need to remember that the patients who go into hospital are, on average, older, frailer and less healthy than they were three decades ago. Long gone are the days where people lived with little disability until their 50s, then dropped dead of a heart attack. Average life expectancy is 10 years longer than it was in the 1960s, and people are being kept alive with lots of life-limiting health conditions.
That means many patients need more support when they go home - and often social and nursing care support simply isn't there. They also need much more careful monitoring and medical follow up - and hospital beds have been axed without the community medical services to take their place. GPs are doing their best - they see 15% more patients, have 63% more phone consultations and process more than twice as many blood test results than they did 5 years ago. But the strain is showing and if you thought it was hard to get an appointment with your GP today, just you wait for a couple more years of cuts.
Bottoms in beds
Almost three quarters of hospitals had a bed occupancy rate above 95% at some point in January. Does that mean they have 5% to play with? Of course not. First, there's the welcome move away from mixed sex wards, with all the indignity that can bring at a vulnerable and distressing time. That means a hospital might have 10% of free beds in a man's ward but be vastly oversubscribed for women. Second, patients don't get sick to order - 10% of beds might be free at 5pm, with enough patients to fill 15% of the hospital's beds (if only they were available) before morning.
Bye bye baby
Mental health patients - among the most vulnerable in our society - have a special Hell all for themselves in this grim scenario. The number of hospital beds for patients with mental health problems has dropped by 44% since 2000/1. It doesn't take a genius to work out that patients who should, in an ideal world, be admitted for intensive treatment are being turned away. And of those who are admitted, an average of 726 mental health patients are sent each month to hospitals outside their own area, sometimes hundreds of miles from the family support they so desperately need.
Blue lights flashing
Over-occupancy of beds has a knock-on effect at A&E. Before Christmas, almost one in seven patients in A&Es across England waited more than four hours for a bed to become available. We've all seen the pictures of desperate patients on trolleys lining the corridors of A&E departments - and this scene is becoming almost the norm.
With A&Es full to overflowing, ambulances are left standing outside A&Es waiting for a resuscitation or treatment room to become available. Every ambulance in a hospital car park is an ambulance that isn't on its way to answer an urgent medical call in the community, meaning longer emergency response times. The domino effect sends ripples through every part of our service.
I hate the term 'bed-blocking' with a vengeance - it suggests it's the patient's fault. What it actually means, of course, is that patients who are fit enough to leave hospital but too frail to live independently are stuck in limbo because there's no halfway house for them to be discharged to. The vast majority of older people, like the rest of us, would far rather be in their own homes than in an unfamiliar institution. And caring for people at home is actually far more cost effective than moving them to a care home.
But social care cuts are real, and they're doing more than just add to delays at A&E - it looks very much as if they may be killing people. A review of previous studies published by the Royal Society of Medicine found that there were 30,000 more deaths than expected in 2015 - death rates higher than any year since 2008. The researchers set about considering possible causes:
- Were the data simply wrong? No
- Was there an 'environmental shock' such as war or natural disaster? No
- Was there a single illness, such as a major 'flu epidemic, to blame? No
After ruling these out, they searched for clues that might explain the increase, and they pinpointed it in NHS and social care performance data. They found clear evidence of higher need and lower provision among vulnerable elderly people:
- Excess deaths were largely driven by higher than expected mortality among the over-60s, and particularly the over-85s
- A&E attendances were not significantly up on the previous year's figures, but A&E waiting times and ambulance call-out times were
- A peak in delays in discharging patients from hospital coincided with an increase in waits for assessment in and admission from A&E
- 650 patients waited more than 12 hours to be admitted from A&E, compared to a maximum of 90 at any time since 2010
- More staff vacancies were left unfilled
- The number of over 85s increased by 9% since 2009 but social care spending on the elderly dropped by 17% over the same period
- In May 2016, the NHS reported its largest ever deficit at £2.45 billion.
Their conclusion was clear - something has caused an extra 30,000 deaths among elderly vulnerable patients, and Health and Social Care cuts are the only logical culprit. From what I've seen, the outlook in the short term is anything but rosy.
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