The latest NHS guidance for hospitals has increased the expectation for recovering services, stating that they should aim to deliver at least 95% of the services they delivered before the Covid-19 pandemic measured against the value of services delivered in the same month in 2019/20. However, the pandemic has caused huge disruption to services that were already under considerable pressure, so how realistic is this target?
At the start of the pandemic, planned care (including hospital appointments and admissions) was scaled back due to the number of Covid-19 patients requiring treatment. The number of people attending A&E and GP appointments also fell, which may have been due to fear of catching Covid-19 or concerns about increasing the burden on the NHS. This fall in hospital activity was more pronounced for elective care (treatment that is planned in advance) than in emergency services. In April 2020, GP referrals were 75% lower than before the pandemic, while unplanned admissions fell by a third.
Since then, activity levels have fluctuated but been maintained at higher levels than during the first wave of the pandemic. In recent months, emergency activity has reached pre-pandemic levels, while elective activity remains lower. Last month, the number of A&E attendances reached the highest level for any June since records began and trusts are reporting considerable pressure on urgent care services.
The sharp fall and slow recovery of GP referrals suggests there may be people who need care but are not yet known to health services. Despite GP practices being under strain, referrals in May this year were around 15% lower than pre-pandemic levels. Combined with the increasing pressure on emergency care, this raises concerns that patients are unable to access elective care and are presenting in an emergency when their condition has worsened.
While staff have worked hard to recover activity levels, measures required to prevent the spread of Covid-19, such as social distancing and staff self-isolation, put further constraints on NHS capacity. Alongside increasing numbers of patients attending emergency departments and the drive to clear the elective care backlog, rising numbers of patients with Covid-19 requiring hospitalisation are putting further pressure on hospitals. Some trusts have had to cancel elective operations, threatening ambitions to return services to pre-pandemic levels.