Defunding Frontline Healthcare Services During a Pandemic: an Unrecoverable Moral Debt

Defunding Frontline Healthcare Services During a PandemicAn Unrecoverable Moral Debt

Daniel Goyal observes that unlike other nations, the UK’s healthcare capacity remains 4% lower than pre-COVID level, and this means more unnecessary deaths

Access to healthcare during a pandemic is crucial for life and the economy. Even before breakthrough treatments such as steroids were available, access to healthcare was known to affect the chances of survival.  It also, of course, dictates how tolerant a society is to community levels of SARS-CoV-2. Each lockdown has come on the back of an NHS reaching its maximum capacity.  Those places with more hospital capacity have been able to remain ‘open’ longer.

It is then, a relatively easy equation to solve.  A new disease will bring new, additional patients, so providing space to treat them is a necessary step – should you be seeking a mortality mitigating and economically viable solution.  

Most nations did.  Singapore rapidly expanded basic healthcare capacity, converting public buildings, setting up field hospitals, and fully opening its dedicated infectious disease hospital.  More impressive still was the community clinical response. Subsequently, lockdowns have been short and timely and their economic growth has continued almost unaffected by the pandemic.  

Many others followed suit.  China schooled the rest of the world on test and trace, field hospitals, and mitigation strategies.  Kerala, Ghana, Russia, even Germany and Spain stepped forward to tame the SARS-CoV-2 beast through field hospitals, military hospitals, repurposing gyms, hotels and barracks to provide the necessary increase in basic healthcare capacity. 

It is the intelligent approach. COVID-19 pneumonia is quite demure in the early stages – easily monitored by non-clinical staff and treated simply with basic interventions.  It becomes increasingly more challenging and demanding to manage if the disease is allowed to progress before intervening.  Astute and economically savvy leadership took advantage of this weakness of SARS-CoV-2 and provided the additional resources needed to manage COVID-19 patients.

The UK didn’t.  For reasons known perhaps to only the inner circle, the UK government shrunk hospital bed capacity by 8% at the start of this pandemic.  Bed capacity remains, to this day, 4% lower than pre-COVID levels.  The equation suddenly looks broken or missing some other unknown variable.  Why reduce bed capacity when more patients are expected?

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To some, a 4% reduction in capacity may seem negligible. Just as some may consider the current bed occupancy level of 94.5% as a sustainable position, with a further “6,000 available beds”. A more informed position would necessitate a different sentiment, somewhere between panic and terror.  

Once inpatient bed occupancy levels reach 85% the risks to the public significantly increase.  Not, as one may expect, due to being unable to respond to sudden surges in activity or a major incident. When hospitals start to reach capacity the danger relates to the necessary change in behaviour from healthcare professionals to keep the doors open.

Decisions become increasingly more uncomfortable and risky, as we must determine who is the ‘most’ unwell and who should get the remaining beds.  When the remaining capacity is less than 15%, the normal healthcare rationing we must endure becomes more severe and damaging.  

Over the last few years (pre-covid) there has been growing concern over the NHS’s ability to respond to winter pressures. Bed capacity has shrunk dramatically over the last ten years and it is not uncommon for us to approach the winter with a bed occupancy of around 85%. This year bed occupancy is at 94.5%, and winter has yet to arrive.  

Concurrently, and quite consistently over the last year, COVID-19 has taken up between 6 to 8% of inpatient bed capacity. Combined with the ongoing reduction of bed capacity by 4%, it is quite apparent why we are 10% over our usual bed occupancy as winter begins. 

The Chancellor’s additional £6billion in funding does nothing to address the current crisis.  It is unlikely to even resolve the growing waiting-list crisis it has been targeted to address.  Over half of it has been earmarked for diagnostic machines and ‘development’ of new technologies to shorten waiting list times when we don’t have the space or personnel for either.

A lack of investment into the NHS for staff and toward increasing capacity suggests strongly that these diagnostic tests will only be of use to private companies contracted in to ‘pick up the slack’. The proposal is reminiscent of the Test and Trace debacle, where public funds seemed to prop up “commercial partners”, and where the purpose of providing care for the public is merely a distant afterthought.

It is then, the lack of engagement in the reality facing the British population that is most concerning. Boris Johnson’s desire for ‘business as usual’ seems to only make sense from a rather obscured vantage point.  On the ground, people are dying and will continue to die unnecessarily due to the failure to provide additional capacity to manage the ongoing pandemic.