In a major new analysis of the state of the health and care system in England in the run up to the Covid-19 pandemic, the think tank IPPR reveals the extent of the crisis that was facing medics and carers even before the crisis hit. The paper – ‘Resilient Health and Care: Learning the lessons of Covid-19’ - argues that a decade of austerity had ‘ripped the resilience out of the heath and care service’ leaving it in a ‘dire state’ just as it faced its greatest challenge since its founding.
The IPPR analysis of NHS and international data found that just before the crisis hit:
• Four in five hospitals had bed occupancy levels above the acceptable safe limit (85%) and in three out of five hospitals, bed occupancy exceeded 90%.
• England had just 700 open and unoccupied ICU beds at the end of 2019 and the South West had access to the least - just 51.
• The health service is severely understaffed, causing increased strain on healthcare professionals. For the UK to meet top international standards the UK would need 49,600 more long-term care workers, 70,000 more doctors and 220,000 more nurses.
• The UK is very short of CT and MRI scanners compared to similar advanced countries. Our adoption of new treatments is also markedly slower.
• While smoking rates were below the international average, the UK has higher levels of excess weight and alcohol consumption. These were either linked to vulnerability to Covid-19 or cause underlying health conditions that increased individuals’ risk. The pandemic also exposed the vast health inequalities in the UK.
• The UK currently spends £27.7 billion less on health annually, relative to the size of its economy than the G7 average.
The IPPR report says that while the NHS in England was not overrun by Covid-19, the lack of capacity in the health system forced government to make harmful policy choices. This included two million cancelled ‘non-urgent’ or ‘routine’ treatments; the delayed screening, treatment or diagnosis of cancer for 2.4 million people; and a mass discharge of thousands of patients. The latter often put strain on social care and, at times, meant Covid-19 positive patients were sent to care homes.
While the report does not criticise the overall strategy of moving care into social, community and home settings, it does highlight that it was a historic failing for so many of them to have been in hospital beds in the first place. The report points to the chronic shortage of beds in care homes and the crisis in social care as a primary cause.
Building long-term resilience
IPPR argues that had just a fraction of the Westminster government’s covid-19 economic response been invested in the health and care service before the pandemic, there could have been a considerably better health outcome.
For example, had the £1.3 billion given to support discharge during the coronavirus crisis been invested in early 2019 it could have paid for a combined 3,600 hospital beds, 7,000 nursing home beds, 8,500 care home beds, 10.8 million hours of community care and two million occupational therapy sessions in that year.
This investment would have significantly eased pressure not only during normal times, but also helped build the resilience needed to handle health crisis such as Covid-19, according to IPPR.
The think tank therefore calls for a long-term approach for the health and care service in England, to build resilience for any future crisis and to ensure the system isn’t always ‘running hot’ during normal times. It recommends:
• Capacity: Bring hospital spare bed numbers to safe levels and add significant capacity to social and community care, by investing £8 billion in extra ‘catch-up’ funding to the community sector between now and the end of the parliament.
• Staffing: Expand the NHS People Plan by recruiting 400,000 more NHS workers and 250,000 more social care workers by 2030; and guarantee open immigration routes for healthcare workers for as long as we have shortages.
• Modernisation: Upgrade adoption of healthcare technology and treatment to at least match the top international standards.
• Public health: Set out a prevention white paper to reach higher standards on excess weight, alcohol consumption, long-term condition management and vaccination levels.
• Health inequality: Establish a new health inequality committee - modelled on the National Security Council and chaired by the PM - to deliver progress on tackling health inequality.
• Funding: Increase NHS funding to at least £183 billion by 2030. The capital component of the Department of Health budget should also rise to £13 billion by 2025 to tackle the growing backlog of maintenance issues, including fire hazards and sewage leaks, on the NHS estate.
Chris Thomas, IPPR Senior Research Fellow and lead author of the study, says:
“For more than a decade, health and care has been ruled by a brutal austerity logic – championed by people who said it would make the UK more efficient. Covid-19 has shown they were wrong.
“Far from making public services more efficient, austerity stripped resilience out of the health and care service - taking away beds, devastating social care, pushing staff out of the sector, and ignoring public health.
“Covid-19 is one of the most devastating disasters in history. After an earthquake, you’d build earthquake-proof structures. After Covid-19, we need crisis-proof healthcare.”
