In a health system in crisis, UK heart care is suffering

COLCHESTER, England, Feb 2 (Reuters) – In April 2021, Gary Cogan felt a slow, burning pain steadily rise through his right arm. It was the start of a massive heart attack that doctors warned could cost him decades of life without timely triple-bypass surgery.

Almost two years later Kogan is still waiting for an operation from Britain’s overwhelmed health service, one of millions suffering from the burden of an aging population, lack of investment and the weight of the COVID-19 pandemic.

“It’s made me feel very uncomfortable with myself, very tentative about what I can and can’t do,” said the 62-year-old warehouse worker from Colchester, southeast England, who has cut his working week to three days. Trigger another attack.

He is one of a record 7.2 million people waiting for treatment in Britain’s National Health Service, or NHS, which was created after World War II to provide care for everyone, free at the point of use from cradle to grave.

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Long a source of national pride, its collapse now dominates headlines in Britain and videos on social media show people being treated in corridors and waiting hours on trolleys, while ambulances queue outside, unable to secure beds in full emergency wards.

UK cardiology departments are a microcosm of the problems spreading through the system. Staff shortages and years of stagnant investment are straining wards to their limits, with life-threatening consequences for patients.

Sonya Babu-Narayan, a consultant cardiologist practicing in London, described a “heart disease crisis” in the UK, with excess deaths from heart disease remaining high since the pandemic, while deaths from cancer and other conditions have started to return to average trends.

The British Heart Foundation charity says full treatment should start within 18 weeks of a heart attack but currently a third of patients are not seen within that period. In November, about 8,000 people like Kogan were waiting more than a year for heart treatment, up from two dozen pre-pandemic.

Since the start of the pandemic, the combination of Covid-19 and disruptions in care has meant that on average 230 more people a week have died from heart disease than expected, the charity said, and rates have remained high. The number of deaths due to covid infection is decreasing.

There are signs that the after-effects of the pandemic are disrupting routine care and operations.

For example, one particular heart condition, cardiomyopathy, is being diagnosed in four times more people on hospital admissions than before the pandemic, the charity Cardiomyopathy UK has found, with routine checks not detecting the disease.

When a heart attack occurs, cardiologists say the patient should be taken to an ambulance within 18 minutes. At the time of Kogan’s heart attack, the average wait time was 20 minutes. In December, the average ambulance waiting time for such patients was 93 minutes, NHS data shows.

In response to questions from Reuters about excess death data and care delays, NHS England said heart patients were among people waiting the longest for treatment, but the number of patients waiting 18 months or more had fallen. In November, the number waiting 18 months was 44% lower than the same month in 2021, NHS data showed.

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Teams were still trying to restore cardiac services to pre-pandemic levels, NHS England said.

“Covid has inevitably had an impact with fewer people coming forward for care,” a spokesperson said.

Babu-Narayan said the epidemic has caused patients to stay away from hospitals and family doctors, make fewer appointments and receive less preventive care. Epidemic barriers to diagnosis and treatment, in addition to delays in emergency care, had a major impact on cardiology care, she said.

A reduction in capital investment before the pandemic, when the government began a nine-year program of fiscal austerity, meant that very few beds were available, she said. A cycle of staffing shortages increased the workload of doctors and nurses, driving more to leave the service.

“We know what to do. We know how to help, but the hospital is full and we don’t have enough,” she said, describing a deeply painful situation in person.

In its defense, the government is pumping record investment into health care – accounting for 40% of daily government spending.

Prime Minister Rishi Sunak has made fixing NHS England one of his priorities, and has described recent waiting times as unacceptable, outlining a two-year recovery plan for emergency care this week.

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Heart surgery was cancelled

Admitted to Basildon Hospital, 40 miles (64 km) from home, after his heart attack, Cogan was diagnosed with severe left-sided coronary disease. Doctors told her that bypassing three blocked arteries would add 25 years to her life and that the operation could be performed within six months.

The operation never materialized. More vague timelines came and went when he was finally given a date for January, 2023, 21 months after the original event. Then, with just four days to go, the hospital told him it was canceled, citing staff and bed shortages.

At one point, Kogan even considered trying to make himself sick, going for a run so he could “kill over” and have immediate surgery, he said.

He now has a new date for his surgery on February 9, but he remains vigilant and needs to ask if a hospital bed is available the morning of the surgery: “It’s a call you really don’t want to make.”

Kogan, waiting for his surgery, was much better off seeing nurses or doctors – who were lovingly depicted at the opening ceremony of the 2012 Olympics in London and applauded in the streets during the pandemic -. But he said that the service was running erratically.

Even in his condition, he struggled to see his local family doctor or take his medication. On one visit to his local Colchester hospital, staff could not find a working ECG machine to read his heart’s electrical activity when he felt a shock. The two hospitals disagreed on his priority level.

Neil Moloney, deputy chief executive of the NHS Foundation Trust in charge of Colchester Hospital, said the hospital apologized to Kogan in 2021 for his experience and had since “reviewed our processes and made improvements.”

Mid and South Essex NHS Foundation Trust, which runs Basildon Hospital, said it treated Cogan on a clinical priority basis and that he would have surgery on February 9.

In keeping with the national picture, where people come to the hospital with a lot of things wrong with them, or in more serious cases, Kogan also developed a hernia, which cannot be operated on until he has heart surgery.

Beds, staff and cash

In 2022 England and Wales recorded 45,000 more deaths than the 2015-2019 average, making it the deadliest year outside of the COVID-19 pandemic since 1951 by this metric.

Around 2.5 million people are also out of work due to chronic illness, with the lowest paid being the worst affected, according to the Office for National Statistics (ONS).

The Bank of England cited poor health as one of the reasons for the fall in the number of workers.

It is too early to know what impact long COVID and large waiting lists will have on the workforce, the ONS said, but the government is investigating any link between chronic illness and people leaving work.

Healthcare was struggling a lot before the pandemic.

Growth in health spending under the previous Labor government has contributed to the longest period of sustained real spending growth in the NHS’s history, the Institute for Fiscal Studies said.

And after the Conservatives came to power in 2010, health spending did not fall sharply, it plateaued, and IFS economist Ben Zaranko said Britain’s aging population would put further pressure on NHS budgets.

“Even before the pandemic the NHS was slowly deteriorating in terms of its performance,” he told Reuters.

According to the Organization for Economic Co-operation and Development, UK health spending as a share of economic output averaged less than 10% in the years leading up to the pandemic, compared to a rate of close to 12% in Germany, which is 60% higher. More doctors per capita than in the UK.

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Between 2014 and 2019, the number of British public hospital beds fell by 7% – the sharpest fall in the Group of Seven advanced economies – and the Health Foundation, a charity, estimates the NHS will need an extra 103,000 staff to meet demand.

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That’s the pressure nurses are on strike this year for the first time in their union’s 106-year history.

Analysts say the latest extra funding, which could help pay staff more, is not enough to transform the NHS, or prepare it for a future with an aging population.

The Nuffield Trust think-tank also found that registrations of doctors from the European Union have slowed since the UK’s 2016 Brexit decision, possibly exacerbating staff shortages.

Siva Anandasiva, chief analyst at the King’s Fund, a charity working to improve health outcomes, said a combination of structural problems and the pressures of Covid could take a decade for the NHS to reach its targets again.

“There is no short-term solution here,” he told Reuters.

Additional reporting by Andy Bruce and Natalie Thomas; Edited by Kate Holton and Frank Jack Daniels

Our Standards: Thomson Reuters Trust Principles.

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