Close to half the beds in some English hospitals are lying empty in a sign that people may be failing to seek help for other life-threatening conditions during the coronavirus pandemic.
The National Health Service in England moved aggressively last month to release more than 30,000 beds in anticipation of a flood of patients infected by Covid-19, halting all non-emergency surgery from mid-April and discharging anyone medically fit into the community.
However, people familiar with the situation say that the speed and scale of the drop in demand for other services has surprised health leaders, fuelling concerns that people are failing to seek help even for conditions as serious as suspected heart attacks.
As the UK government considers how and when to lift the lockdown, ministers are also concerned about the knock-on health impact on citizens who are staying away from hospitals and not receiving treatment for other ailments.
The NHS was failing performance targets by record margins before the pandemic began, and the prospect of demand being suppressed points to the challenge the service will face in returning to normal once the crisis is over.
NHS England said that across the country, about 60 per cent of beds in acute hospitals were currently occupied. A year ago the equivalent figure was a little over 90 per cent.
A similar phenomenon has been seen in Scotland, where the health system — aside from the parts dealing with coronavirus — was described as “eerily quiet” by Scottish interim chief medical officer Gregor Smith on Wednesday.
His comments came as new data suggested a sharp rise in overall deaths in Scotland that is not fully explained by the numbers succumbing to Covid-19.
National Records of Scotland data showed that a provisional total of 1,741 deaths from all causes were registered in Scotland in the week to April 5, 643 higher than the average of 1,098 deaths registered in the same week of the previous five years. Coronavirus was mentioned on the death certificate registration for 282 of the deaths.
Dr Smith stressed that patients should seek urgent attention if they had symptoms such as chest pains or unexplained weakness in the limbs. “The system feels eerily quiet in relation to people presenting with illness which isn’t Covid-19 just now,” he said. “That, as a clinician, is immediately disconcerting because that illness hasn’t gone away somewhere.”
Data analysed by the Financial Times show a dramatic change in the way Britons are using their taxpayer-funded health service since the pandemic began to reshape many aspects of daily life. For years, England’s emergency departments have borne the brunt of rising demand for care; before the coronavirus crisis struck, record numbers of patients waited for hours on trolleys for a hospital bed after a decision had been taken to admit them.
Last month, however, A&E attendance overall fell almost 30 per cent compared with the same time last year, to 1.5m visits. The figure represents the lowest level of attendance ever reported by NHS England.
Attendances at larger “type 1″ A&Es were 26.3 per cent lower than a year ago, while type 2 departments — consultant-led facilities for single specialities, such as eye conditions or dental problems — saw falls of more than 35 per cent.
In type 3 departments — which treat minor injuries and illnesses, such as stomach aches, cuts and bruises — attendances fell 34.7 per cent.
Most striking of all is evidence of a precipitate fall in the number seeking help for cardiac symptoms.
Stephen Powis, national medical director at NHS England, used the platform of the daily Downing Street news conference on Wednesday to appeal to people to continue to seek emergency help if they needed it.
The NHS had “worked night and day to surge capacity to manage coronavirus but it is also there for you if you have symptoms of stroke, symptoms of a heart attack,” he pointedly noted.
The precise reason for the sharp drop-off in demand remains unclear, but experts believe it reflects a combination of reluctance to add to the burdens on the NHS amid a public health emergency, and fear of exposure to infection.
Siva Anandaciva, chief policy analyst at the King’s Fund think-tank, said the fall in bed occupancy was “breathtaking” and at one level represented “a fantastic achievement” in freeing up space for coronavirus patients. But he highlighted a potentially ominous fall in the number of people attending emergency departments with chest pain. “You hope there is not some unmet need,” he added.
Civic and NHS leaders across England told the same story of systems facing far lower demand than normal for emergency treatment, apart from the coronavirus.
Richard Leese, deputy mayor of Greater Manchester, said the city’s hospital beds were only 57 per cent full, compared with 94 per cent normally. “999 calls for heart attacks and strokes are significantly less than normal. There may well be people who really ought to be going to hospital [but] are fearful that they could get coronavirus,” he said.
Professor John Howarth, strategic incident commander for Covid-19 at North Cumbria Integrated Care NHS Foundation Trust, noted significantly lower than normal numbers being referred with suspected cancer, heart problems and strokes. “I am really worried that people are not seeking the help they need for important conditions other than Covid-19,” he said.
In England’s Midlands, meanwhile, University Hospitals Birmingham NHS Foundation Trust said its four hospitals were 70 per cent full — they usually run above 90 per cent — and visits to emergency departments had halved. “We do not know where those patients have gone,” a spokesperson said.
Martin Marshall, who chairs the Royal College of General Practitioners, said the dilemma for doctors on the frontline was “differentiating between people who have real medical needs that need to be dealt with immediately, and making sure they get that, and people who are inconvenienced but don’t require urgent care”.
“In terms of getting back to routine care, that’s going to have to happen very cautiously. We’re going to see an NHS that’s functioning below its normal capacity for some months to come,” he added.
Additional reporting by Sebastian Payne
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