Lara Sargent was hopeful that Lara’s pain, which she has suffered for the last ten years, would finally end in this year.
The 25-year old was sometimes so ill during her period that she couldn’t stand up at times.
‘I’d be rolling around the floor in unbearable pain,’ says Lara, who lives in West Sussex.
The problem began when she was 13, and when she was 18 her GP put her on the Pill, but that ‘just made things worse’.
After a wait of 13 months, Lara received laparoscopic surgery in January to examine the root cause of her pain.
Lara Wahab is 34 and a director of advertising accounts. With her sister Tanya, she lives in North London. Lara says: If I don’t have a kidney and pancreas transplant soon, I’ll have to go on dialysis or I will die’
She was diagnosed with severe endometriosis — where endometrial tissue that forms the lining of the womb develops elsewhere in the body, causing pelvic pain and heavy periods.’
Lara’s gynaecologist referred her to a specialist NHS centre, where another consultant could operate to remove the tissue and end her pain.
In May this year, after being told her surgery would be imminent, she underwent pre-operative tests — yet the operation that should have followed has been cancelled.
It’s a situation countless others are going through — but stories such as Lara’s put the real human cost into perspective.
‘I have had to give up my job as a healthcare assistant because I am often bed-bound with the pain during my period,’ Lara says. ‘I have had to start taking prescription pain relief just to cope with each day.
‘I’m now taking antidepressants because, before, there was an end in sight and I could cope. Now there isn’t and I feel hopeless.’
Lara called the hospital hoping that she would be informed when the surgery could take place.
‘But they keep telling me there’s a waiting list, staff shortages due to the pandemic and a huge backlog,’ she says.
‘Now I’ve been referred to another specialist NHS centre, but am back to square one, waiting for a first consultation before I will even be considered for surgery.’
It’s a situation familiar to many. From people needing new knees or urgent care following a heart attack, to those with cancer that requires surgery — there is one thing that unites so many different NHS patients now: they are all just waiting.
The waiting list is growing rapidly and it’s almost difficult to see the suffering that they are causing. Last week, the number of patients waiting for consultant-led hospital treatment, including surgery, in England alone reached six million — the highest figure since records began in August 2007.
Meanwhile, other patients booked in for surgery have their bookings cancelled.
The Royal College of Medicine has just published data that showed more than 13,000 elective-care operations were cancelled in the past two months at 40 sites alone — as a comparison, this was around the same number of cancellations for 156 sites in 2019.
It’s easy to put this spiraling crisis on Covid-19.
Hospitals were forced to establish strict infection-control protocols. They screen patients and staff for the disease, isolate anyone who is suspected, and clean up operating theatres between procedures.
Prime Minister Boris Johnson warned on Monday that cancellations and disruptions could be ‘even greater next year’ if more people do not get their booster jabs to stop Omicron — the new Covid variant — running riot.
However, leading experts say Covid is just the ‘heavy straw that’s broken the camel’s back’ after years of mounting crisis.
There are no simple ways to transport patients from their homes into hospital for quick treatment. Then, they need to be taken back into local care. The system is crumbling and desperate patients are stuck in every step.
And as we can reveal, while ministers talk apologetically of cancellations and waiting lists being about elective surgery — replacing worn hips and knees — misery-making delays that nevertheless can be endured, research shows alarmingly that more than a million operations categorised as ‘emergency’ or ‘urgent’ appear to have been cancelled in 2020 alone in England and Wales.
Research published in the British Journal of Anaesthesia in June found that admissions for Class 1 surgery — emergency operations needed within 72 hours for catastrophes such as strokes or heart attacks — dropped by more than 13 per cent between April 2020 and March 2021, with more than 108,000 patients missing out on vital surgery. For Class 2 urgent surgery — operations needed within a month for problems such as tumours of the brain, lungs, bowel and breast — admissions slumped by almost a quarter, with 92,430 procedures called off.
Patients needing less immediate surgery suffered even more, with more than 900,000 fewer admissions for those needing skin cancer, prostate cancer or gall bladder operations — down more than a third on previous years. Routine hip and knee surgeries fell by almost half a million, which is 52 percent less than normal.
What has happened to all these ‘missing’ operations? Might they be explained by patients’ emergency or urgent symptoms being overlooked or ignored during the pandemic, for instance? Could it be that these patients did not receive urgent and emergency treatment because the Covid-burdened NHS was unable to perform them?
‘We don’t yet have any answers,’ explains Dr Tom Abbott, the researcher in anaesthesia and perioperative medicine at Queen Mary University of London, who co-authored the study and says they are looking at what is happening to emergency patients.
Dr Abbott still believes that by 2021 the NHS will have 2.4million more cancelled surgeries, and millions of people could be affected for the rest of their lives.
‘The backlog is likely to take many years to clear, particularly as the speed with which surgical treatments can be delivered is slowed by infection-control procedures,’ he warns.
Additional research, coauthored by Dr Abbott and published in British Journal of Anaesthesia’s August issue, shows the importance of such infection control measures. The study found that although only 1.1% of patients contracted a Covid-19-related infection in hospital, the mortality rate for patients who have caught it was up to 25% higher.
According to health care leaders, strict infection control precautions are not sufficient to explain the dramatic drop in operations, and associated rise in wait times.
As Rory Deighton, the acute network lead for the NHS Confederation, which represents NHS Trusts, says: ‘While we now have six million people waiting, that figure was [already]Around 4.5million when the pandemic began. The problems have accumulated over ten years.’
He claims that ‘money meant for developing NHS services and investing in new equipment had instead to be spent on keeping services going’.
These structural issues are now affecting every part of the health-services system and causing blockages. Indeed, the same fundamental problems that are stopping patients getting surgical care — lack of beds and staff — are also leaving seriously ill patients stranded in A&E units, and even stuck outside for hours in ambulances, warns Dr Adrian Boyle, vice-president of the Royal College of Emer-gency Medicine.
This shortage leaves A&E doctors competing with surgical doctors for the inadequate beds available, and both miss out.
‘We can’t get our emergency patients admitted, and at the same time operations are being cancelled for people who need beds in wards or intensive care in which to recuperate,’ says Dr Boyle.
‘Operations have been cancelled like this since bed shortages began to mount up in 2015.’
Covid’s inability to provide beds has made bed shortages even worse. Analysis by researchers at the King’s Fund health think-tank this year shows that infection-control precautions and staff absence have shrunk the number of beds by a further 5 per cent, which Dr Boyle fears has pushed services over the edge.
‘We have almost the least number of beds per head of population in Europe,’ he says.
According to the 2017-18 EU statistics, Germany boasts 601.5 beds for every 100,000 people, but the UK only has 249.5.
‘The pandemic is a heavy straw on the camel’s back,’ says Dr Boyle. Beds are not always available to desperate patients, but that’s just one reason. Thousands of people are currently stuck in those preciously rare beds because there’s nowhere else they can go.
‘One in ten of the patients in hospital is medically fit to be discharged, but there is not the community support available to take them,’ says Rory Deighton.
Tim Mitchell, vice president of the Royal College of Surgeons of England, suggests that waiting lists for routine surgeries could be reduced by setting up a network of special surgery hubs across the country.
Some areas such as London or Northumbria have already established surgical hubs. They perform everything from simple procedures (such as knee and hip replacements) to more complex treatments like cancer surgery.
Mitchell says such hubs could be free-standing units, or they can be found in large hospitals.
Croydon University Hospital is an example of a hospital hub that has 10 operating theatres as well as 28 beds for patients undergoing surgery. It follows rigorous infection-control protocols. The hospital also has a section for emergency cases and Covid positive patients.
‘The idea is gaining traction in the NHS,’ says Mr Mitchell. ‘Croydon has drawn patients from across London, showing that patients are prepared to travel for surgery.’
Mitchell says that Mitchell expects the Government to soon release its Elective Recovery Plan in order to tackle the crisis of the waiting list. He wants the government to approve a national plan to establish surgical hubs. In the longer term, he says NHS bed numbers must be almost doubled, from 2.5 to 4.7 per 1,000 people — and the number of hospital doctors (including surgeons) from 2.8 to 3.5 per 1,000 people. Although this sounds ambitious, Mitchell claims that it would only bring the NHS up to comparable numbers in developed countries.
Minesh Patel, head of policy at Macmillan Cancer Support, told Good Health: ‘Our research estimates that more than 47,000 people are missing cancer diagnoses, compared with what the numbers should be. And more than a quarter of people having cancer treatment in August have told us they are worried about their chances of survival being hit by delays.’
Meanwhile, there is no magic wand, warns Rory Deighton: ‘We have to be realistic about how long it will take to resolve the problem.’
Today’s record waiting lists are symptomatic of an emergency that has been years in the making. Covid is all we can blame for the ineffectiveness of our current situation.
Julie Cook, Sheron Bole, and Jill Foster present case studies