The hidden impact of visiting restrictions

The hidden impact of COVID-19 on
patient care in the NHS in England
July 2020

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The COVID-19 outbreak has had a huge impact on core NHS services. In order to free up enough
capacity to deal with the initial peak of the pandemic, the NHS was forced to shut down or
significantly reduce many areas of non-COVID care during April, May and June 2020.i This, combined
with fewer patients seeking care during lockdown, means that there has been a significant drop in
elective procedures, urgent cancer referrals, first cancer treatments and outpatient appointments.
The full impact of this drastic reduction in routine NHS care in England is only now emerging. Millions
of patients living with health problems (including life-threatening conditions such as cancer) have
been affected, with their treatment postponed or cancelled. And millions of patients will have missed
vital opportunities to receive initial assessment and diagnosis for health problems in the first place.
This is the hidden impact of the COVID crisis – patient safety is being severely compromised not just
by the virus itself, but by the knock-on effects of an unprecedented disruption to NHS services.
The BMA estimates that in April, May and June 2020 in England there were:
– between 1.32 and 1.50 million fewer elective admissions than would usually be expected
– between 2.47 million and 2.60 million fewer first outpatient attendances
– between 274,000 and 286,000 fewer urgent cancer referrals
– between 20,800 and 25,900 fewer patients starting first cancer treatments following a
decision to treat
– between 12,000 and 15,000 fewer patients starting first cancer treatments following an
urgent GP referral.
This outcome was avoidable. Although a pandemic on the scale of COVID-19 was always likely to
cause major disruption to health services, the drastic extent to which the NHS had to shut down
routine care is a consequence of over a decade of underinvestment and (in the case of public health
and social care) cuts to services. As a result, NHS capacity has lagged behind many other EU
countries, including in terms of bed numbers, critical care facilities, workforce numbers (with 10,000
medical vacancies in the NHS in England in 2019) and resources in primary and community care. The
NHS was already in crisis before the pandemic hit, as the BMA consistently warned.
As the NHS begins the vital task of reopening non-COVID services, it now faces a huge backlog of
unmet patient need, with patients now facing long waits for treatment. The commitment made by
the Chancellor of the Exchequer in March to give the NHS ‘whatever it needs’ to tackle the pandemic
must not end as the initial peak of the virus recedes. The NHS needs:
– honesty and clarity from government about the size of the backlog and how it is going to be
managed – in real practical terms
– assurances that there is a credible plan in place to the NHS through this incredibly difficult
period, including increasing funding for the coming years above previous spending plans
– a package of support for NHS staff, who have consistently gone ‘above and beyond’ so far
during the crisis.
The BMA has set out more detailed recommendations on restarting non-COVID care here.

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Background
The COVID-19 pandemic led to an extensive shift in the package of care provided by the NHS as
hospitals had to prepare for a large surge in patients requiring intensive care. With services already
under severe strain and functioning at maximum capacity in early 2020, unprecedented steps were
needed to ensure COVID-19 care was not rationed and the NHS did not become overwhelmed.
Sir Simon Stevens wrote to NHS bodies on 17 March to notify them that significant amounts of
capacity would have to immediately be created by cancelling planned operations, large numbers of
patients being discharged back into the community, and non-COVID-19 patients and staff conducting
GP consultations remotely.1
Whilst these changes meant that intensive care did not have to be rationed to COVID-19 patients,
data indicates that the shutdown of most non-COVID services, combined with drastic changes in
patient behaviour, mean the NHS is now facing a large backlog of non-COVID-19 care, storing up
greater problems for the future. This paper investigates the extent to which non-COVID care has
been disrupted over April, May and June 2020, and the likely impact this will have in the longer term.
BMA analysis
We used NHS England data to estimate the gap between NHS care provided during the pandemic
and the pre-COVID ‘norm’. To understand what level of activity would usually (pre-COVID) be
expected, we looked at data from the same period in 2018 and 2019.
We chose to focus on how many urgent GP cancer referrals, elective general & acute admissions,
first cancer treatments, and first general & acute outpatient attendances have not taken place during
the epidemic that we would usually have expected. Data is currently available for the months of April
and May 2020 – we therefore compared the activity recorded during these months in 2020 to the
average recorded during the same months in 2018 and 2019. We estimated ‘worst’ and ‘best’ case
scenarios for what activity may have been like in June based on the level activity was at in April and
May, a statement from Sir Simon Stevens, and our own surveys of BMA members (see Table 1).
1 https://www.england.nhs.uk/coronavirus/publication/next-steps-on-nhs-response-to-COVID-19-letter-from-
simon-stevens-and-amanda-pritchard/