‘How is it fair hospital beds are taken by the unvaccinated when my life is hanging by a thread?’: The shocking human stories behind the thousands of operations cancelled by Covid
Lara Sargent had high hopes that this year, finally, the pain which has blighted her life for the past decade would come to an end.
At times, the 25-year-old has been in such agony during her periods that she could barely stand.
‘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’.
In January this year, after a 13-month wait, Lara was sent for laparoscopic surgery to investigate the cause of her pain.
Lara Wahab, 34, is an advertising account director. She lives in North London with her younger sister, Tanya. 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 has been calling the hospital, hoping to be told when she can have the operation.
‘But they keep telling me there’s a waiting list, staff shortages due to the pandemic and a huge backlog,’ she says.
Neil Bowles, 46, a business executive, is married to broadcast manager Lisa Armstrong, 47. He says that what started off as a bladder condition has, as a result of Covid delays, further damaged his kidneys, which are now failing
‘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.
Waiting list numbers are spiralling rapidly to such huge figures that it feels almost impossible to imagine the human misery that lies behind them. 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, many other patients who had been booked in for surgery are seeing their operations 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 is easy to blame this fast-spiralling crisis on an obvious villain: Covid-19.
The pandemic has forced hospitals to institute rigorous infection-control regimens, screening patients and staff, isolating anyone suspected of being infected by the virus, and deep-cleaning operating theatres and equipment between operations even more meticulously.
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.
The very basics of getting patients into hospitals for timely treatment, then out again into community care, are broken. Instead, desperate patients get stuck at every point because the system is collapsing.
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. And routine hip or knee operations plummeted by nearly half-a-million, down 52 per cent on normal levels.
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? Or have these patients simply not received urgent and emergency surgery because the Covid-burdened NHS lacks the capacity to do 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 nevertheless calculates that the overall NHS surgery backlog will increase to 2.4 million cancelled operations by the end of 2021, with millions more patients feeling the impact for years to come.
‘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.
Other research co-authored by Dr Abbott, and published in the British Journal of Anaesthesia in August, shows how essential such infection-control measures remain. It found that while only 1.1 per cent of patients acquired a Covid-19 infection at hospital at the time of their operation, their mortality rate after catching Covid was extremely high, with patients being up to 25 times more likely to die.
However, stringent infection-control precautions do not explain fully the huge drop in operations and the accompanying rise in waiting times, say health service leaders.
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 4.5 million when we went into the pandemic. 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’.
The resulting structural problems now run throughout the health-service system, creating blockages at all vital points. 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.’
Chronic bed shortages have only been worsened by Covid. 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.
For example, while Germany has 601.5 beds per 100,000 citizens, the UK has only 249.5, according to 2017-18 EU statistics.
‘The pandemic is a heavy straw on the camel’s back,’ says Dr Boyle. But that is not the only thing stopping beds becoming available for desperate patients. Thousands of people are currently stuck in those preciously rare beds because there’s nowhere else they can go.
Priya Raj, 25, from Glasgow, works in financial services. She says that had the surgery been done in March 2020, when planned, it would have been a simple operation. Instead, the delay led to her needing emergency surgery and the risk that she won’t be able to have children
‘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.
For now, waiting lists for routine operations may be significantly addressed by creating a nationwide network of specially dedicated surgery hubs, says Tim Mitchell, vice-president of the Royal College of Surgeons of England.
Surgical hubs are already being pioneered in some areas, such as London and Northumbria, where they perform procedures that range from low-complexity surgery (such as hip and knee replacements) to specialised treatments such as cancer operations.
Such hubs, says Mr Mitchell, may either be dedicated free-standing units or be located independently inside large hospitals.
In Croydon University Hospital, for example, a hub has been set up with ten theatres and 28 beds for surgical patients. The centre has strict infection-control procedures. In a separate part of the hospital, emergency admissions and Covid-positive patients are treated.
‘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.’
Mr Mitchell adds that the Government is expected soon to publish its Elective Recovery Plan for tackling the waiting-list crisis. In the immediate term, he wants to see the green light given to a nationwide plan for 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. While that sounds very ambitious, Mr Mitchell says this would bring the NHS only up to the average numbers seen in other developed nations.
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. If we blame only Covid, we will never find an effective answer.
Case studies by Julie Cook, Sheron Boyle and Jill Foster
My life is hanging by a thread because of lack of ICU beds
Lara Wahab, 34, is an advertising account director. She lives in North London with her younger sister, Tanya. Lara says:
If I don’t have a kidney and pancreas transplant soon, I’ll have to go on dialysis or I will die. My kidney function is way below normal — a reading above 80 is a sign of a good kidney and mine is 10. My symptoms are getting worse and my body is hanging by a thread.
I was diagnosed with type 1 diabetes when I was seven, and in 2019 developed kidney failure, which is a complication of the disease.
As a result my body itches all over, I suffer from nausea, loss of appetite, hair loss, swelling in my ankles and legs, as well as breathlessness and a loss of strength.
In August 2019 I was put on the transplant list for a simultaneous kidney and pancreas transplant, which can ‘cure’ type 1 diabetes. The alternative is living on dialysis, which reduces my life expectancy. Only ten per cent of dialysis patients live for ten years or more.
I was told that it would take 12-15 months to find a donor. But then Covid hit, and when I checked the transplant list status it said ‘Suspended’.
I was so down. I called the Churchill Hospital in Oxford (where I would be having the operation) and a nurse told me this was partly because the NHS couldn’t handle transplants as well as all the Covid cases.
In the winter of 2020 the programme started again, but it wasn’t until April 2021 that I got a call to say organs may be available. It didn’t work out — as often happens for various reasons — and that happened yet again the same month.
Last month, I rang my kidney nurse to ask why I hadn’t had any more calls — when he looked into it, he found that on six occasions organs had been available but I hadn’t been contacted.
He couldn’t tell me all the reasons, but in one instance last month there was a healthy pancreas and kidney available, and I hadn’t received a call.
My nurse said: ‘Are you sure you want to know the reason?’ He then told me I could have received the new organs, but the operation couldn’t go ahead because there were no beds available in the intensive care unit.
It broke my heart. Here was my chance to have new organs and a new life . . . and it had been taken away from me because of the pandemic.
Not only that, but when I looked into it, many beds seem to have been taken up with people who are actively choosing not to be vaccinated against Covid. How is that fair?
I feel really worried about the future — for me and for other patients who desperately need to have surgery.
My kidneys were irreparably damaged by bladder op delay
Neil Bowles, 46, a business executive, is married to broadcast manager Lisa Armstrong, 47. The couple live with children Erin, 15, and Callum, 12, in Banbridge, Co Down. Neil says:
What started off as a bladder condition has, as a result of Covid delays, further damaged my kidneys, which are now failing.
My health began to deteriorate in 2016. I was in chronic pain, lost more than 4st in eight months and needed to urinate every half-hour, day and night. I was diagnosed with interstitial cystitis, also known as painful bladder syndrome.
Essentially, my bladder was inflamed. On top of that, my ureters (the tubes that connect the kidney to the bladder) were also inflamed, which was blocking the flow of urine.
I was told I’d need an operation to create a new bladder from part of my bowel, or a stoma bag to collect urine for life.
As an interim measure, I had stents inserted to prop open the ureters and help the urine drain from the kidneys to the bladder.
Even at this point, my kidneys were slowly failing. I had a biopsy, and the surgeon said my bladder was the worst he had seen in 30 years — it was so damaged.
I urgently needed surgery, but in May 2020 I was told that no non-emergency procedures were taking place due to the Covid crisis.
My stents should have been replaced every six months to reduce the risk of infection, but I had the first set for 20 months.
And as a result, my ureters have become badly inflamed. In August of last year, I had to have an emergency procedure as a temporary solution. Tubes were inserted into each of my kidneys through the skin on my back and connected to an exterior drainage bag.
I am now at stage three kidney failure and live with chronic pain. If I end up needing dialysis or a transplant, how much will that cost the NHS?
I ended up needing emergency surgery
Priya Raj, 25, from Glasgow, works in financial services. She says:
Ten days before I was due to have an operation to remove a large cyst from one of my ovaries, I got a phone call to say the surgery had been cancelled because it was not ‘an emergency’. I couldn’t believe it.
I’d already been living with crippling pain in my abdomen for a year. Had the surgery been done in March 2020, when planned, it would have been a simple operation. Instead, the delay led to me needing emergency surgery and the risk I won’t be able to have children.
I developed pain in my abdomen in October 2019 and soon it was waking me at night and I started vomiting. My GP diagnosed irritable bowel syndrome. I managed by taking paracetamol and sleeping when I could, but the pain persisted and by February 2020, it was so bad I couldn’t get out of bed.
I decided to go private and had an ultrasound, which showed I had a large cyst (9cm by 8cm) pressing on my right ovary. I was told I’d need surgery to remove it in case it burst, which could cause sepsis.
The private clinic sent my notes to my NHS doctor, and a couple of weeks later a consultant arranged for me to undergo surgery in March 2020.
I was so very relieved — but then I got the phone call telling me my operation had been delayed indefinitely. I phoned the hospital and begged that it should go ahead, but was told it was ‘elective’ and not urgent.
Yet the pain was getting progress-ively worse, and within a week I couldn’t get up at all as it hurt so much to move and I had to quit my job.
I lived at home and my mum had to help me wash and dress. I spent hours in bed each day as I was so wiped out with pain.
In April, five weeks after the surgery had been cancelled, I was in such a bad way my mum and brother rushed me to A&E. My ovarian cyst had twisted and cut off the blood supply to my fallopian tube and right ovary and I needed emergency surgery.
When I came round, I found out the surgeons had had to remove my fallopian tube and ovary, as well as the cyst, because they were so damaged. As a result, I have lost half of my fertility.
At first I was too stunned to take it in. I was relieved not to be in danger, but I really want children one day — and as the months passed, I became increasingly angry.
I’m now looking into egg freezing just in case I can’t get pregnant. The cancellation of my operation will affect me for ever.
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