London Eye: Fourth wave blues

Midway through June and the estimates from the ground in London of when the fourth wave will hit the capital vary from September to “a lot sooner than that”.

In the meantime, hospital managers told London Eye that some emergency departments were seeing record-breaking levels of (non-covid) attendances.

While this always spikes in the summer (with admissions lower than in winter), this will be the first time the urgent care system has had to face it with an exhausted staff and that imminently expected fourth wave.

The vaccination drive should mean fewer covid attendances have to go to intensive care units but could still fill general wards.

In this case, the heroic efforts to restart other work and get it back above 80 per cent of normal activity will have to halt again.

The effect on morale is said to be significant, with some staff assuming the vaccinations meant they could look forward to it all being over.

The accident and emergency pressure has continued to build since last month and the issues then — a perceived lack of access to primary care — remain.

There are also the more acute patients who worsened in the periods when people were too scared to access services.

One new type of patient identified was what one medic called a “Boxing Day” attendance, which comes after relatives see an older family member, perhaps for the first time in a while, and realise they have deteriorated and need care.

Managers report these different cohorts, plus sunburn, hayfever and the usual summer injury attendances, make for departments in which social distancing is impossible.

If the fourth wave hits a system struggling with demand, it will be an open question as to whether covid measures, like centralising paediatric emergency services for north central London from three sites (University College London Hospitals, Royal Free and Whittington) to one (Whittington) are reinstated.

Pressure from local interest groups already forced a return to the pre-covid configuration, despite a desire in the service to keep the changes.

Paediatrics could be particularly pressured if the fourth wave combines with an increase in other respiratory problems, partly triggered by the disruption covid caused to the normal circulation of those illnesses.

The quadrupling of NCL’s year-plus waiters

It’s worth noting the achievement of the Royal Free London Foundation Trust in returning to reporting its elective waiting times after two years of not doing so — but the data itself paints a grim picture.

Restarting the public reporting last month (with the position in March) showed 15,000 people waiting more than a year for treatment. This is nearly one in five of the north London giant’s total waiting list, and three-quarters of the north central London total.

These long waiters, in common with most trusts, comprised large numbers of orthopaedic and ear, nose and throat plus “other”. Plastic surgery was most challenged though, with 45 per cent of the 2,700 patients waiting more than a year.

The lack of reporting makes it impossible to know the effect of covid cancellations and what was a problem beforehand.

The trust has been carrying out harm reviews during the years when it tried to validate its waiting lists and has not reported “severe harm” or death caused by delays in treatment. When St George’s went through a similar thing a few years ago, there was “severe harm” reported to patients, so the differences could be instructive.

How did RFL get to this position?

One senior manager in the capital said the issue had been “years in the making”, citing poor processes and complacency and suggesting the acquisition of Barnet and Chase Farm hospitals could have been a factor.

Certainly, when Barts Health Trust was created from the merger of three smaller trusts, it too had to suspend reporting for two years to reconcile its elective waiting times data.