Mick Hartley

As was predicted, the hidden cost of our single-minded obsession with the coronavirus is now becoming clear. Christina Lamb in the Sunday Times:

Since the start of the crisis, NHS hospitals have treated more than 100,000 patients with the virus, but that has come at a huge cost. Fearing hospitals would be overwhelmed, as they were in northern Italy, thousands of hospital beds were freed up by the simple expedient of stopping almost all routine, non-urgent surgery, outpatient appointments and referrals from mid-March through April, May and most of June. Only now, as hospitals prepare for a possible second wave, is the true extent of the collateral damage starting to emerge.

Many of the delayed treatments were for patients with cancer or other life-altering conditions. The number of prostate cancer referrals between April and June was the lowest for a decade, and almost half the number for the same time last year. Prostate Cancer UK estimates that as many as 3,500 men with undiagnosed higher-risk prostate cancer have missed checks.

Even those who had been given a diagnosis experienced delays in treatment that may have worsened their prognosis. Chris Romney, 64, a former RAF fighter controller, was settling into retirement in the Peak District with his wife, Laura, and looking forward to time with their grandchildren when a biopsy at the Royal Derby hospital in late January uncovered aggressive prostate cancer.

Surgery was scheduled for March 30, pitching Romney onto what he describes as “a complete emotional rollercoaster”. Lockdown began a week before his operation was due and his surgeon phoned to tell him all urology operations had been suspended. “In order to ramp up their capabilities to deal with the suspected flood of Covid patients, the trust had mothballed the theatre and turned it into a three-bed ward,” he said. “The equipment that was needed to do the operation was put into storage.”

With months to wait before he could be seen, Romney sought to pay for treatment but found private hospitals had been seconded to help the NHS — though in the event, many were not used. “You’re literally left just sitting there, with no options,” he says. “It was like a black hole.”

Eventually Romney was put on hormone therapy and finally had the operation on June 18, nearly three months late. “I was incensed by the fact that throughout this [the health secretary] Matt Hancock and the NHS people were maintaining it was business as usual,” he says. “It was a lie, just a simple lie.”

After recounting his experience on local radio, Romney says many people contacted him to say their radiotherapy or chemotherapy had been stopped or surgery delayed.

It’s a similar picture with bowel cancer, which is the UK’s fourth most common cancer and the second biggest cancer killer, but treatable and curable if caught early. “Bowel cancer services were already stretched at the start of the year, with too many people not being seen for urgent investigations, even before the coronavirus,” says Genevieve Edwards, the chief executive of the Bowel Cancer UK charity. “Screening and diagnostic services were paused across the four nations in March and are only now restarting in some areas. This has created a huge backlog that needs to be dealt with, and quickly.”

Though other countries experienced similar problems, the long-term effect in Britain has been worse because the NHS already had long waiting lists and was overstretched after years of cuts.

“We went into this crisis with the NHS already struggling to meet demand,” says Nigel Edwards, the chief executive of the Nuffield Trust, an independent healthcare think tank. “We think of ourselves as an affluent country but we have fewer beds, fewer CT scanners and fewer doctors than most of Europe. I know of a 400-bed hospital in Macclesfield with just one scanner. It’s quite extraordinary.”

The UK has 2½ hospital beds per 1,000 people, compared with eight in Germany, and about three doctors per 1,000 people compared with just over five in Portugal. The NHS in England started the year with more than half a million people on the waiting list for trauma and orthopaedic surgery, such as hip and knee replacements. An average of 35,000-43,000 patients are added each week.

There was another unforeseen consequence of the pandemic. So effective was the government’s message to “stay home, save lives, protect the NHS” that even people with life-threatening conditions such as heart attacks avoided A&E and thousands died unnecessarily.

At the John Radcliffe hospital in Oxford, heart surgeons were puzzled by the drop in cases — a 60% fall, starting in late February. “We were waiting, all kitted up, and patients just stopped coming,” said Professor Robin Choudhury, a consultant cardiologist.

“We were baffled. We thought, ‘Is it because people are not going out? Or the pollution is going down?’ But in fact they just stopped coming. It was an unintended side effect. We had not thought it was our job to make sure patients kept coming.”

The tragedy was brought home when a close friend of Choudhury’s died. “He was an educated man and father in his mid-fifties who spoke to his GP and convinced himself he had Covid, so rather than coming to hospital, he self-isolated for 10 days. In fact it was a heart attack. It was tragic. Treating heart attacks is something we do extraordinarily well in this country and he lived walking distance from the hospital.”

Professor Barbara Casadei, the president of the European Society of Cardiology, estimates that 5,000 patients in England had heart attacks in March and April and did not go to hospital. “It’s extremely upsetting. I would never have believed that people would have a heart attack and stay at home.” She contacted colleagues in Europe and America and found the same thing happening there, so started a campaign with the British Heart Foundation to encourage people with chest pains to seek help. Admission rates for heart patients are now almost back to normal.

With infection rates rising again, there is no doubt that winter will be tough. Though hospitals have been told by NHS England to return to 90% of capacity by the autumn, few surgeons we spoke to thought this was possible. Enhanced protective measures, such as socially distanced wards and waiting rooms, and the need to constantly change cumbersome PPE — personal protective equipment — have reduced capacity. New Covid-safe procedures such as having to spend 20 minutes disinfecting a scanning machine between patients mean longer delays.

Even before the coronavirus, NHS England had a shortage of 36,000 nurses. The stress of dealing with the pandemic means many staff are off work and some nurses are returning to their home countries. GP services are restricted and, judging by letters to newspapers, people are finding it hard to access them to get referrals.Those who do reach hospital talk of deserted waiting rooms and doctors twiddling their thumbs.

A man in Hampshire complained of driving for four hours for a 10-minute consultation with an oral surgeon only to be told the unit would not restart surgery until next year. Yet the hospital, he said, was empty, “with staff in scrubs standing about doing nothing”.

The government stands condemned either way.

If you believe that the lockdown has been fully justified, get outraged at any mention of how well the Swedes have done, and mutter angrily at anyone in a shop not wearing a mask, then for you the government was culpable for not introducing lockdown weeks earlier – never mind all the other fiascos like track and trace or the shortage of tests.

If on the other hand, like me, you think that while the virus is clearly nasty and understand why the lockdown was initially introduced in the face of dire predictions which turned out to be nonsense about the NHS being overwhelmed, it's still not nasty enough to justify setting the economy back some twenty five years and side-lining every other form of illness – plus the mental health issues, and the unprecedented assault on our social liberties.

It's all very grim.