Dear SCH Reader,

May I take this opportunity in thanking you for your now two-year allegiance to my monthly Health News blog, as we enter into a new year! Trusting that you’ve gotten those almost inevitable post World Cup blues out of your system, integrating back into the domestic leagues, and that the recent minus 5-10 degrees cold snap didn’t cause you too many problems, which seems like a proverbially ‘walk in the park’ when compared to current Northern America & Canada quite horrific minus 30-50 degrees ‘bomb cyclone’ Artic weather conditions, which no doubt will have some aftereffects on us at some point here on this side of ‘the pond’. As always spoilt for article choice, here is my top six for this month for your consideration – 

6^th The Times: Millions of patients turned away from NHS GP appointments

5.2 million patients were unable to book a GP appointment when they tried to make one in October, analysis has suggested. Problems with access to family doctors will drive patients to accident & emergency and exacerbate pressure on hospitals, campaigners said yesterday.

Another two million people faced a wait of more than a month to see their doctor, the highest number since records began, in 2017, and 4.3 million waited for more than a fortnight. The figures, which highlight the creaking state of the health service, are based upon analysis of the GP patient survey and surgery appointment data from NHS Digital.  

According to the GP Patient Survey this year, 13.8 per cent of patients, about one in seven, did not get a GP appointment the last time they tried to book one, excluding those who got other help from the practise. The comparable figure for last year was 8.1 per cent. Among the most common reasons were practises not allowing patients to book ahead and a lack of appointments.  

8^th ITV NEWS: NHS at ‘breaking point’ with waiting list in England hitting new high of 7.2 million people

Chetna has waited two years for endometriosis surgery, and has been unable to leave the house during this time, convinced that her scheduled surgery in January will be cancelled – “You’re a prisoner” she told ITV News. “You’re stuck in a body that doesn’t function. The pain is debilitating. It takes everything away. It literally destroys the soul.”

GPs have described the NHS performance figures as “shameful” because they expose a health service “at breaking point” with England’s record-high hospital waiting list totalling more than Denmark’s entire population of around 5.8 million. New figures from NHS England show 7.2 million people were waiting to start routine treatment at the end of October, up from 7.1 million in September and the highest number since records began in August 2007.

Meanwhile, in emergency departments, just 68.9% of patients in England were seen within four hours last month, down from 69.3% in October and the worst performance on record. The target is for at least 95% of patients attending A&E to be admitted, transferred, or discharged within four hours, but this has not been met nationally since 2015.

Dr. Anita Raja, a Birmingham-based GP says – “These numbers are shameful and tell us the real state of the NHS due to continuous mismanagement and poor decision-making, with general waits to see a neurologist being around 18 months, a rheumatologist also 18 months, whilst hip and knee replacements can take up to two years. The healthcare system in this country is at breaking point.” 

Also revealed in NHS England’s new data was that an estimated 410,983 people in England had been waiting more than 52 weeks to start hospital treatment at the end of October. This is up from 404,851 at the end of September and is the equivalent of around one in 18 people on the entire waiting list.

The NHS in England also has a record high number of vacancies, with patient safety being threatened as there were more than 133,000 full-time posts unfilled at the end of September.

9^th inews: ‘I’m afraid A&E will collapse’: The NHS winter crisis erupts after years of warnings

How bad could the NHS winter crisis really become in the next few months? For one paramedic, who asked not to be named, already used to waiting for hours with patients in ambulance queues outside hospitals in the London area, the answer is almost too worrying to say out loud. “I’m afraid the service will collapse” he says. What would that mean for emergency responses? “I’m just waiting for the day where they just have to say to people, ‘I’m sorry, unless you’re in cardiac arrest, we can’t come in.’ It feels like we’re on the verge of that because I don’t know what else they can do.”

Let’s take a moment to absorb five reasons why frontline staff throughout the UK’s devolved health services are so concerned. You might want to take a deep breath.

Firstly, Wards are full. At the end of last month, the number of beds in England occupied by patients who had been in hospital for more than three weeks had already surpassed the highest level in any of the past five winters – that’s even before entering December. Many of these people were so ill they could not leave, although 40 per cent were medically well enough to be discharged but lacked social care allowing them to go home safely, meaning 19 of every 20 beds in England are full. ‘Bed blocking’ in Scotland is also at a record high.

Secondly, Nearly three in every 10 ambulance patients are getting stuck in queues outside hospitals too busy to receive them. This is around double the pre-pandemic rate and the worst performance recorded in early winter. In Wales, ambulance crews wasted 28,143 hours in queues in October, also a record.

Third, 7.2 million people are waiting for NHS treatment in England, 60 per cent more than before the pandemic. One in seven people in Scotland are on a waiting list; the number in Wales is an all-time peak.

Fourth, Vacancies in the English NHS are at a five year high, equivalent to 133,446 full-time staff missing from the health service. Scotland has a record shortage of nurses, and in Wales nursing vacancies have almost doubled since last year. 

Worst of all, More than 200 deaths in England in the final week of November are thought to have been partly caused by problems in urgent and emergency care, according to the president of the Royal College of Emergency Medicine. “Excess deaths” happen every winter, but could this year be worse? If we’re in this situation now, what will things be like in January?

No wonder Dr. Layla McCay, Policy Director at the NHS Confederation which supports and speaks for the whole healthcare system in England, Wales, and Northern Ireland, tells i that members fear “this is potentially going to be the worst winter on record” – sentiments echoed in Scotland. Sir Chris Whitty, England’s chief Medical Officer, has even said medics may have to break “established rules to care for people” to cope.

Charting the decline

NHS medics and officials acknowledge that winter has always had seasonal impacts on the NHS. There is more ice for people to slip on and break bones. It’s darker, meaning a higher risk of road accidents. Cold homes harm those with weaker bodies, and the greater spread of viruses not only makes the public ill but also keeps medics out of work. Mental health cases can also rise at a lonely and isolating time of year, with spill-over effects on emergency services. 

As long ago as 1999, the British Medical Journal ran a paper titled: “What caused the winter crisis in the NHS?” It summed up the problems that “brought the NHS to its knees” for one week in January that year: “Low uptake of influenza vaccine, a shortage of nurses, unrealistic expectations of patients, an already high occupancy rate for beds, and the unfortunate timing of outbreaks of both influenza and meningitis over the new year holiday.” That summary makes the situation sound like a short-term pinch on an imperfect system, rather than today’s severe, long-term, structural problems.

One writer in the journal suggested the problems back then amounted to “a mountain of bad publicity” hyped up by the media rather than a genuine emergency. He concluded wearily: “In Britain if it’s January it’s winter health crisis time.” For years, however, it became a phrase we barely heard. Research by fullfact.org shows how mentions of “winter crisis” began in newspapers in the 90s and spiked in 2000 during a flu outbreak, but then declined to minimal levels as NHS funding increases under the Labour governments of Tony Blair and Gordon Brown took effect. Only in 2013 did it become common parlance again – hitting a new peak in 2017. 

16^th London Evening Standard: Covid-19 infections rising again across most of UK

Covid-19 infections are rising in most parts of the UK but are still well below levels reached earlier this year, figures suggest. In England, infections are estimated to have climbed above one million for the first time since the end of October, while Scotland and Wales have both seen an increase. The trend in Northern Ireland is uncertain and there is a mixed picture among different regions and age groups. 

The total number of people in private households in the UK testing positive for coronavirus stood at an estimated 1.3 million in the week to December 5, according to the Office for National Statistics (ONS). This is up 16% from 1.1 million in the previous week, equivalent to one in 50 people, up from 941,700, or one in 60, in the week to November 26. During the main waves of coronavirus earlier in 2022, the total peaked at nearly four million in July and just under five million in March.

In Scotland, 100,700 people were estimated to have Covid-19 in the latest week, or one in 50, up from 88,500 or one in 60. Wales has also seen an increase, with 55,900 infections in the week to December 5, or one in 55 people, up from 43,400 or one in 70. In Northern Ireland, the number of people testing positive for Covid-19 stands at 38,700, or one in 45, compared with 36,700 in the previous survey, or one in 50.

20^th Reuters UK: China races to bolster health system as COVID surge sparks global concern

Cities across China scrambled to install hospital beds and build fever screening clinics on Tuesday as authorities reported five more deaths and international concern grew about Beijing’s surprise decision to let the virus run free. China this month began dismantling its stringent “zero-COVID” regime of lockdowns and testing after protests against curbs that had kept the virus at bay for three years but at a big cost to society and the world’s second-largest economy. 

Now, as the virus sweeps through a country of 1.4 billion people who lack natural immunity having been shielded for so long, there is growing concern about possible deaths, virus mutations and the impact on the economy and trade. “Every new epidemic wave in another country brings the risk of new variants, and this risk is higher the bigger the outbreak, and the current wave in China is shaping up to be big,” said Alex Cook, Vice-Dean for Research at the National University of Singapore’s Saw Swee Hock School of Public Health. 

“However, inevitably China has to go through a large wave of COVID-19 if it is to reach an endemic state, in a future without lockdowns and the economic and political damage that results.” U.S. State Department spokesman Ned Price said on Monday the potential for the virus to mutate as it spreads in China was “a threat for people everywhere.” Xu Wenbo, an official with the Chinese Center for Disease Control and Prevention, told reporters new mutations would occur but played down concerns.

Beijing reported five COVID-related deaths on Tuesday, following two on Monday, which were the first fatalities reported in weeks. In total, China has reported 5,242 COVID deaths since the pandemic emerged in the city of Wuhan in late 2019, a very low toll by global standards. But there are rising doubts that the statistics are reflecting the true impact of a disease ripping through cities after China dropped curbs including most mandatory testing on Dec. 7.

Since then, some hospitals have become inundated, pharmacies emptied of medicines, while many people have gone into self-imposed lockdowns, straining delivery services. Some health experts estimate 60% of people in China – equivalent to 10% of the world’s population – could be infected over coming months, and that more than 2 million could die. In the capital, Beijing, security guards patrolled the entrance of a designated COVID crematorium where Reuters journalists on Saturday saw a long line of hearses and workers in hazmat suits carrying the dead inside. Reuters could not establish if the deaths were due to COVID.

Speaking at the same news conference as Xu, the Head of Peking University First Hospital’s infectious disease department Wang Guiqiang said only deaths caused by pneumonia and respiratory failure after contracting COVID would be classified as COVID deaths. Heart attacks or cardiovascular disease causing death of infected people will not get that classification. 

In the past week, major cities including Beijing, Shanghai, Chengdu, and Wenzhou announced they had added hundreds of fever clinics, some in converted sports facilities. The virus is also hammering China’s economy, expected to grow 3% this year, its worst performance in nearly half a century. Workers falling ill are slowing down production and disrupting logistics, economists say.

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Trusting that you found a few minutes during this holiday period in order to catch-up on these latest health headlines as hereby summarised, which as always, these days makes for a quite sobering read – Just as we start to consider the virus to be getting more or less under control here in the UK, its origin country looking like being on the verge of exploding with infection. Here in the UK as a cocktail of viral infections combines with likely minus degrees colder weather again, please be proactive – Diet, exercise, wrapping up and adequate sleep – It really isn’t ‘rocket science’!

Take care,

Kind regards,
Daniel Donoghue,

MD, Surrey Circle Health

Whole of Market Specialist PMI Brokers