The Economist - USA (2021-07-10)

TheEconomistJuly10th 2021 53

Britain

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54 JohnBull’sauthoritarianstreak

55 Bagehot:A nationbondsoverfootball

Hospitalqueues

The mystery at the heartoftheNHS

I

t is midday in Milton Keynes, and a

young woman is coming round after sur-

gery on her vocal cords. Her breathing was

controlled during the operation, so she is

woken carefully, surrounded by blue-

scrubbed medics. A chronic smoker, she is-

sues a series of hacking coughs, attempt-

ing to clear built-up phlegm—and the

medics are once more exposed to any ill-

nesses she may be carrying.

Throat surgery is known by a newly

popular acronym: it is an agp, or Aerosol-

Generating Procedure. The entire point of

ear, nose and throat surgery, says Hamid

Manji, Milton Keynes University Hospital’s

clinical director for surgery, is to “mess

around with that airway mucosa, be it pha-

ryngeal, be it nasal or in this case vocal”.

That releases viruses, which is a problem

during a pandemic.

Lots of this sort of surgery stopped last

year. Now theatres are deep-cleaned be-

tween procedures, and patients must iso-

late and take a covid-19 test before arriving.

The result is an enormous backlog. Across

England, and in all specialisms, more than

5.1m operations are waiting to be carried

out,thelongestlistsincerecordsbegan.

And the waitsare increasingly lengthy:

nearly400,000oftheseoperationshave

beenplannedformorethana year,upfrom

1,500-oddbeforethepandemic.

Thesenumberstellonlypartofthesto-

ry. Some 4.6m fewer people completed

electivetreatmentin 2020 thanintheyear

before,aspatients avoidedtheirgeneral

practitionersandhospitalsshuttoallbut

themostunwell.Thetrendhasnotabated

thisyear(seechart).Nobodyknowswhen,

orinwhatconditionandnumbers,these

missingpatientswilleventuallyshowup.

Buta yearwithouttreatmentiscertainto

havetakena toll.

Allthisismakingpoliticiansnervous.

“Thepublictotallyunderstandthecause

nowis covid,” says a senior Tory. “The

hardestthingtoexplainisthat[waiting

lists]willkeepgoingup.”SajidJavid,the

newsecretaryofstateforhealthandsocial

care, has started preparing the ground,

warninginanarticlefortheMailonSunday

thatthebacklogis“goingtogetfarworse

beforeitgetsbetter”.Thelasttimequeues

weresolong,under TonyBlair’sLabour

government,pollingfoundthatnoissue

botheredvotersmore.

Intheearly2000sMrBlairsoughttocut

waitinglistsbyraisinginflation-adjusted

spendingonthehealthservicebyatleast

6%a year.BorisJohnson’sgovernmenthas

sofarpromised£1.2bn($1.7bn)extra,less

than1%ofthehealthservice’s pre-pan-

demicbudget.Moreisexpectedinthenext

spendingreview,duelaterintheyear.By

then,thetruelengthofthequeueshould

beclearer.So,too,shouldthehealthserv-

ice’sabilitytogetthroughit.“Weneedto

identifyhowfastwecan go,”saysChris

Hopson,thechiefexecutiveofnhsProvid-

ers,whichrepresentshospitals.

Onerequirementwillbetoincreaseca-

pacity.Englandhasfewerctormriscan-

nersperpersonthananyotherEuropean

MILTON KEYNES

Millions of patients were not seen duringthepandemic.Whenwilltheyturnup,

and in what condition?

Patient patients

England, completed elective NHS treatments, m

Sources: NHS England; Health Foundation

1.6

1.4

1.2

1.0

0.8

0.6

0.4

DNOSAJJMAMFJ

2021 2020

2019

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