Data from the Office for National Statistics shows that there were nine percent more excess deaths in the UK in 2022 than there were in 2019 – but what is the cause?
The report shows that more than 650,000 deaths were registered in the UK in 2022, a figure nine percent higher than that in 2019, and representing the largest ‘excess death’ level (that is, the number of deaths more than the average per year) for 50 years, outsie the years of the Covid-19 pandemic.
While the excess death level is below that during the pandemic, where the underlying cause was obvious, the question is why there are still so many excess deaths now that the worst of the pandemic is over.
Certainly Covid has not gone away, and is still responsible for some deaths, though not as many as at the height of the pandemic. The ONS figures show that around 38,000 deaths in 2022 involved Covid, compared with more than 95,000 in 2020.
But there are clearly other factors at work in 2022, and the ONS data suggests that the organisational effects of the pandemic on the NHS and other health services may be to blame.
The president of the Royal College of Emergency Medicine, Dr Adrian Boyle, says that waiting times for hospital admission of Christmas were the worst ever seen, with more than a dozen NHS trusts and ambulance services declaring critical incidents over the festive period.
Another problem is the waiting period for treatment after diagnosis of serious conditions such as cancer. NHS figures for a 12-month period ending in October 2022 showed 18,679 patients who had an urgent referral for suspected cancer waited at least 104 days for treatment. In comparison, the figure was 8,820 in the 12 months that ended in October 2019.
The crisis in the NHS was entirely predictable, as winter conditions always lead to an increase in visits to A&E. With recovered patients blocking beds because there are no social care facilities to discharge them to, death rates which were looking at the start of 2022 as if they were returning to pre-pandemic levels, began to shoot up again in June.
On 1st January 2023, the President of the Royal College of Emergency Medicine suggested that the crisis in urgent care could be causing “300-500 deaths a week”, a figure calculated by multiplying the number of people waiting long periods in A&E with the extra risk of dying estimated to come with those long waits (of between five and 12 hours).
In November, for example, it took 48 minutes on average for an ambulance in England to respond to a suspected heart attack or stroke, compared to a target of 18 minutes.
While ‘long Covid’, the after-effects of a coronavirus infection, may be a contributory factor in excess deaths, increasing the problems of heart attacks and strokes, delays in diagnosis, hospital admission and treatment are now much more likely to be the cause of excess deaths. The largest jump in excess deaths was recorded in men aged 50-64, most commonly caused by heart problems.
The situation will no doubt be made worse by a planned series of strikes by NHS staff. Members of the Royal College of Nursing are striking on 18th and 19th January 2023, members of the GMB and UNISON (ambulance staff) are striking on 11th January 2023 and members of UNISON (ambulance staff) are striking on 23rd January 2023.
NHS England has created a national planning framework and set out a checklist of preparations for trusts in advance of strikes, offering additional support where needed. Detailed preparations are made at a local, individual trust level with NHS England regional teams supporting trusts in their planning and identifying where mutual aid between trusts can be provided.
NHS England has also held discussions nationally with unions on what services will continue – services that are ‘derogated’ from industrial action – across the country. As a result of these talks, the Royal College of Nursing (RCN) has agreed that chemotherapy, dialysis, critical care units (such as intensive care and high dependency), neonatal, paediatric intensive care and paediatric A&Es will be exempt from strike action.
A message from the NHS to patients reads:
“Nobody should put off seeking emergency care. Key life-saving services are set to continue.
Patients whose conditions are not life-threatening are likely to experience delays in accessing urgent care in affected trusts and during ambulance strikes.
Patients should attend as normal during strike days. Some planned care appointments may be rescheduled. Hospitals will contact patients directly if their appointments need to be rescheduled due to industrial action.
As always, anyone who needs less urgent care can also use NHS 111 online for advice.
Primary care is not affected by the current planned strikes, so people should continue to attend their GP or dental appointments.”