Responding to an emergency bleep during yet another hectic night shift last month, Jade Walker, an anaesthetist, arrived at a patient’s bedside to find his heart had stopped.
“He had been in the waiting room for eight hours before collapsing. If the waiting time had been less, and he’d been seen a few hours sooner, he’d probably have survived. I’ve been worried someone would die in A&E for months.”
Walker, 34, is one of many NHS staff up and down the country who are seeing the reality of a winter crisis worse than any that has come before. “I feel like the NHS is collapsing and the government is ignoring it,” she said. “People are dying because of delays. It’s not acceptable. I’m scared that it’ll be one of my relatives stuck waiting for an ambulance and unable to get the help they need.”
For many families across the UK that disaster scenario is exactly what is playing out and senior doctors have warned that hundreds of patients could be dying every week because of delays.
Compared with other European countries, who are all recovering from the pandemic at a similar pace, the UK is still experiencing among the highest levels of excess mortality, analysis by The Sunday Times has found.
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Of 20 European countries, the UK recorded the fourth-highest weekly average for excess deaths per 100,000 population since October. Excess deaths are a measure that compares weekly deaths with the average of the same week in the previous five years.
When Covid deaths are deducted, the UK’s rank then climbs to third, behind Germany and Austria. In other countries, excess deaths are returning to, or below, the pre-pandemic norm.
The most recent data for Belgium showed deaths 1 per cent lower than before the pandemic on November 20, while in Poland it was down 8 per cent on November 27 and in France it was 9 per cent below the norm on November 13. These rates can change between countries because of their different demographics, such as an ageing population.
Excess deaths reflect that some health systems appear to be recovering well after the pandemic, while some, including Britain, remain under significant strain.
Sir David Spiegelhalter, emeritus professor of statistics at Cambridge University, said the recent spike in weekly excess deaths was “extraordinary”, adding: “I gasped when I saw that.”
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He said: “It seems to me that deaths registered that week came from a real sort of triple whammy of really cold weather, an early flu season and hospital disruption. We will know more over the next few weeks of warmer weather.”
Spiegelhalter said he felt “pretty convinced” the disruption to NHS services and delays in care was “a big part of the explanation”, adding: “It might not be part of the explanation elsewhere in Europe with what’s happening in the Netherlands or Germany, but I think that here it is.”
Understanding the scale of avoidable deaths attributable to poor NHS care is not easy, but there are some clues that point to a worsening picture.
The UK is experiencing a significant spike in excess deaths, and these are not solely down to Covid-19 and flu. Something else is going on.
Stuart McDonald, an actuary and partner at LCP Health Analytics, which advises the NHS and the Department of Health and Social Care, said: “I’m absolutely convinced that the NHS crisis, the healthcare failure if you like, is an absolutely pivotal part of the UK story. I think that is what marks us out as different. Successive governments for decades have always run the NHS quite ‘hot’ with high bed occupancy rates and shortages of staff.
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“Even in normal times, the NHS struggles to cope with winter and catches up in the summer. That’s been a pattern that we’ve become familiar with. There’s no spare capacity in the system.”
He used published evidence on deaths as a result of long waits in A&E departments to calculate the recently publicised figure of 500 extra avoidable deaths a week.
It is almost certainly an underestimate, McDonald said. “It only applies to waits over 12 hours but we know the harm starts kicking in at four hours.”
Almost 2,500 excess deaths — a measure that compares weekly deaths with the average of the same week in the previous five years — were recorded in the week ending December 23 — which is 21 per cent above the “normal” number of deaths expected for this period.
This is roughly 1,500 more deaths than in the same weeks in 2021 and 2022 during the height of the pandemic, according to the latest available data for England and Wales, published by the Office for National Statistics (ONS).
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Unusually high excess deaths can reflect anomalies in the general health, and healthcare, of a nation. The current flu season and cold weather will have played a part, as will Covid-19.
Yet three years on from the start of the pandemic, most of these deaths were not caused directly by Covid-19. Fatalities linked to the coronavirus accounted for 429 deaths in that week before Christmas, 17 per cent of the total excess deaths.
One aspect highlighted by Spiegelhalter was the sharp increase in people dying at home. “This has increased by 20-30 per cent since March 2020 and carried on right through the pandemic. This is a major change in where people are dying that hasn’t been studied sufficiently.”
Desperate stories by NHS staff of patient deaths at home and in A&E departments have been shared online. Paramedics on an internal staff group for the London Ambulance Service posted numerous examples last week.
One said: “Yesterday we went to a nine-hour old category two [999 call]. Alone, fallen over, can’t get up. When we finally get dispatched and gained access, the poor patient was deceased and had been for some hours. The delay has clearly led to patient harm. How awful it must be, being alone, calling for help and nobody comes until it’s too late.”
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Another said their week had been “absolutely horrendous”, adding: “It is not normal holding category two calls [for urgent conditions such as suspected heart attacks or strokes] for 12 hours. Please can we not normalise this situation.”
One worker said: “I have just got home after spending 11 hours holding a patient [in an ambulance] and actually handed him over to another crew to carry on holding him. When is this madness going to stop? I can’t carry on doing this much longer.”
In response to the staff testimony, London Ambulance Service chief executive Daniel Elkeles said he was “deeply sorry” to the patients and acknowledged the distress it was causing. The service has implemented a new time limit of 45 minutes to hand over patients to hospitals to try and speed up response times.
But the capital’s ambulance service is not alone. Waits of 30 hours outside some A&E departments have been reported elsewhere in the country. Since 2021, ambulance trusts across England and Wales have been reporting about 4,000 cases of severe harm to patients because of delays. A significant number of these will include avoidable deaths.
Sarah Scobie, deputy director of research at the Nuffield Trust think tank, said: “In the UK, growing pressure on NHS services, backlogs and demand of a more complex and challenging nature have been suggested as factors behind increased mortality, but we should not discount other causes too including increased risk of serious conditions such as strokes and heart attacks following infection from Covid-19.”
The ONS has published weekly death figures since the 1960s. Sarah Caul, its head of mortality analysis, said the ONS could not immediately attribute the cause of excess deaths to the NHS and she cautioned that comparisons between countries can be problematic because they can report data differently.
Across the country last week, hospitals continued to declare critical incidents with reports of hospitals opening up “surge” wards for flu patients. In Nottingham, the hospital had 300 flu and Covid patients on Friday, the equivalent of 10 full wards.
Oxygen supply problems have continued with Liverpool University Hospitals having to close corridors and move patients on Wednesday night because of concerns for the supply to some patients.
Away from hospitals, GPs are feeling the strain as well with many having to provide a level of care for patients who have been waiting for treatment for months.
Amanda Head, 56, a GP partner at Oak Street Surgery, in Cwmbran, Wales, said: “I have never known such a crisis. Many colleagues have driven people to hospital themselves, as they suspect a heart attack and want to get the patient in for time-sensitive treatment.”
She said elderly patients with fractures after a fall had been refused ambulances while patients with breathing difficulties were left waiting in her surgery. “We were hoping the oxygen canister wouldn’t run out.”
McDonald said actuaries are already taking a pessimistic view of the projected life expectancy for people in the UK. “There is debate about the extent to which projected life expectancy will be affected, but there is no debate about the direction of travel.”
