The Economist November 20th 2021 27
BritainEmergencycareThe dead of winter
H
ow muchis the local Amazon ware
house paying? Raina Summerson used
to ask that question a couple of times a
year. Now her firm checks most weeks,
such is the competition for workers. In
parts of the country she has raised pay at
Agincare, the care provider she runs, to £11
($15) an hour from around £9.50 before co
vid19 struck. Even so carers are scarce:
“We are turning away work every day in ev
ery one of our locations.”
That is bad for business—and for the
health service, the source of much of that
work. With hospitals unable to free beds
because of a lack of carers, patients ready
for discharge are piling up, crowding out
new admissions. In October, across Eng
land, nearly 120,000 people spent more
than four hours waiting to be admitted.
Even in the worst winters, waits have never
been so long (see chart on next page).
Outside the wards are ambulances try
ing to discharge patients and unable to
pick up fresh ones. The average wait for a
“category two” incident (concerning a serious condition such as a stroke, chest pain
or burn) is 54 minutes, up from an average
of 25 last year and missing a target of 18. Re
search shows longer waits are associated
with more deaths. The West Midlands am
bulance service has warned delays are put
ting patients at risk of “catastrophic” harm.
Pressure is ratcheting up almost every
where, says Chris Hopson of nhsProvid
ers, which represents hospitals. After near
ly two years in which people have tried to
stay away from healthcare facilities, pa
tient demand is now higher than it was be
fore the pandemic. More primarycare ap
pointments are by phone, which tends to
mean more referrals. Patients presenting
for acute care, meanwhile, are sicker, sug
gesting that the wait for treatment has tak
en a toll on their health.
Fewerthan9,000peopleareinhospitalwith covid, down from more than 34,000
in January. But that is still a lot, and infec
tion controls further reduce the number of
beds available. “We’ve stopped using areas
that were unsuitable even before the pan
demic,” says an emergency doctor. Accord
ing to Mr Hopson, the combination of co
vid, antiinfection measures and the diffi
culty of discharging patients has cut the
number of beds available by a third.
What particularly worries hospital
bosses is how early in the year this crunch
has come. The normal pattern is for pro
blems to mount until January, and some
times longer. Having declined for three
weeks, covid cases are now ticking back
up, meaning those with the disease will
continue to take up space. And anticovid
measures are making recruitment more
difficult. Ms Summerson lost 20 of her
1,100 carehome workers because of a na
tional vaccine mandate which came into
effect on November 11th.
Winter is tough in healthcare systems
everywhere. That the taxpayerfunded nhs
falls into a “crisis” every year—and is suf
fering so early in this one—reflects how lit
tle slack it has. It runs on relatively low
numbers of doctors and nurses. In Europe,
only Sweden has fewer beds per person
than Britain does. Other rich countries
with small numbers of beds also tend to
have more “stepdown” care, so people do
not linger in hospital.
Policymakers have long sought to divertHospitals are in a dire state—and temperatures are only just starting to drop→Alsointhissection
28 Cricket’sracismreckoning
30 British-Indianswingvoters
30 Thefizzylabourmarket
32 What’sina surname?
34 Freeportsarenofreelunch
35 Bagehot: Britain’s divided
establishmentCorrection: Last week, in a chart accompanying a
piece on nuclear power, we said Britain produced
235 gigatonnes of carbon dioxide per kilowatt-hour
of electricity generated. That should have been 235
grams. We apologise for the rather large error.