6th April 2020
Here is a section from the Health Service Journal (HSJ) in the UK, discussing the current fears of NHSE (NHS England). The article is behind a paywall.
NHS England is an executive non-departmental public body of the Department of Health and Social Care. NHS England oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the NHS in England as set out in the Health and Social Care Act 2012>/p>
Exclusive: NHSE to act over fears covid-19 focus could ‘do more harm than virus’
‘NHS England analysts have been tasked with the challenging task of identifying patients who may not have the virus but may be at risk of significant harm or death because they are missing vital appointments or not attending emergency departments, with both the service and public so focused on covid-19.
A senior NHS source familiar with the programme told HSJ: “There could be some very serious unintended consequences [to all the resource going into fighting coronavirus]. While there will be a lot of covid-19 fatalities, we could end up losing more ‘years of life’ because of fatalities relating to non-covid-19 health complications.
“What we don’t want to do is take our eye off the ball in terms of all the core business and all the other healthcare issues the NHS normally attends to.
“People will be developing symptoms of serious but treatable diseases, babies will be born which need immunising, and people will be developing breast lumps and need mammograms.”…
Nuffield Trust deputy director of research Sarah Scobie said it was “a considerable worry that people are keeping away from routine and urgent health services, and also from emergency departments”.
She added: “The PHE (public health England) data suggests there could be significant problems already developing for heart disease related conditions patients, for example. Attendances relating to myocardial infarction at emergency departments have dropped right down, whereas ambulance calls in relation to chest pain have gone right [up].’
I suppose my first response would not be one of great surprise. In fact, it confirms what I have been saying for some time. When the great Swine Flu epidemic (that killed hardly anyone) created the last pandemic crisis in the UK, exactly the same thing happened. If, whatever you were suffering from, wasn’t Swine Flu, it didn’t seem to matter.
In my small part of the world a small but significant number of people were diagnosed with Swine Flu. This was done over the phone, by poorly trained operatives. These people were then prescribed the (almost entirely useless Tamiflu), they then died. It turned out that they had other conditions that could, and would, have been properly treated had we not been overcome by a massive over-reaction to Swine Flu. They died because of swine flu.
Last week, in Intermediate Care, we sent two patients into the local hospital who were seriously ill. They were both sent back almost immediately. They both died. Yes, they were ill, and may have died anyway. But I believe they should both have been admitted, and treated, and they could both still be alive. They died because of COVID.
Ambulance crews are under very heavy pressure not to admit anyone unless absolutely necessary. Some of those, not admitted, will die.
These people, all these people, are dying ‘because of’ COVID. Because of the fact that almost the entire focus of the NHS is now on COVID – to the virtual exclusion of anything else.
Our local hospital now has more empty beds than at any time in history. Elective surgery has stopped, to free up resources. There is enormous managerial pressure to clear more and more people out of hospital, out of Intermediate Care beds, back home with little support available. Some of them will die because of this.
My last blog focussed on the economic costs of the reaction to COVID. My argument was that economics, and health, do not exist in isolate bubbles. Harm to the economy will result in harm to health and vice-versa.
Equally, if you spend all your healthcare resources trying to treat one thing, everything else will suffer, because resources are not infinite. At present we have virtually shut down the NHS to deal with COVID.
I saw several patients yesterday while I was working in “out of hours”, who were not critically ill, but they were ill. Two of them, I felt, really needed to be followed up. A girl with weight loss over the last three months, a man with clear signs in his chest that could have been malignant.
They will not be followed up any time soon. If at all.
At present there is a lot of discussion about how we are categorising deaths from COVID. Anyone who dies, having been diagnosed with COVID, is considered to have died of COVID. Even if they died of something else. The died with COVID, not of COVID.
There is, I believe, an even greater immediate problem here. Which is those who are dying because of COVID. This is not just me saying this, this is NHS England:
“While there will be a lot of covid-19 fatalities, we could end up losing more ‘years of life’ because of fatalities relating to non-covid-19 health complications.”
For many years, there has been an old medical joke. It will not make you laugh out loud, but it goes like this.
‘The operation was a success, unfortunately the patient died.’