It’s not just the NHS: health services are imploding all over Europe – The Telegraph – 08.01.23
Waiting times are surging, staff are leaving and patients are dying across the continent. By Matt Oliver and Eir Nolsøe.
Sick patients flood in at the university hospital, filling up already overcrowded wards.
With doctors and nurses overwhelmed – and many struck down by illness themselves – planned surgeries have been cancelled to help cope with the influx of winter admissions.
“There is a perfect storm going on right now – and we lack staff,” one health leader complains on television.
To British ears, this will all sound familiar. Yet these scenes are unfolding in Sweden, where a winter crisis not dissimilar to our own is also wreaking havoc with the health service.
“The spread of respiratory viruses is at a high level and the burden on the healthcare system is great,” the Swedish Public Health Agency warned on Thursday.
“Staying home when sick is especially important.”
Swedish and UK hospitals are far from alone. Across most of Europe, healthcare systems – ravaged for three years by the pandemic – are struggling with huge backlogs while they simultaneously battle a “triple epidemic” of Covid, seasonal flu and the respiratory syncytial virus (RSV) this winter.
In Italy, medics have warned emergency departments are being “pushed to their limit” after flu cases hit their highest level for 15 years, while Spanish doctors have gone on strike over claims they are being chronically overworked. Authorities in France, meanwhile, have recommended people wear masks indoors again because of the rising number of infections.
As with Britain’s NHS, the crises are the result of short-term damage wrought by the coronavirus and long-term problems that have been stewing in the background for years.
After sidelining all but the most essential care during the pandemic, governments are now scrambling to reduce waiting lists. But they are juggling this priority with demands for greater funding to cope with older and sicker patients, while inflation eats away at their budgets.
The UK appears to have been hit harder by many of these challenges but their causes – from ageing populations to staff shortages – are common throughout the developed world.
But in interviews with the Telegraph, experts warned there are no easy or quick fixes for many of these issues. In the coming years, they will prompt searching questions about the provision of healthcare and how it should be managed without bankrupting the West.
“We get richer as a society in order to be able to invest and spend on innovations which allow us to live longer and enjoy more rewarding lives,” says Anita Charlesworth of the Health Foundation.
“What is challenging, when you fund the system through taxation, is that actually more and more of our taxes are going on the welfare state services that we value in our old age in particular.
“If we want these things over the medium to longer term, and it makes sense to provide them collectively, then the implications of that are that taxes as a share of GDP have to rise.
“Ensuring that's seen as fair, and that the public are happy to do that, is a challenge that all high-income countries are facing now.”
On the brink
There were already signs that healthcare systems in the European Union were under strain before the pandemic, although performance across the bloc varied significantly.
In many countries this came after governments sought to repair their balance sheets in the wake of the financial crisis, trimming health spending or slowing increases.
According to data from the Organisation for Economic Co-operation and Development (OECD), this resulted in a fall in health spending as a proportion of GDP in the UK, France, Italy, Denmark, Ireland and Greece from 2009 to 2019.
Germany, Spain, the Netherlands, Norway, Austria and Finland managed to keep budgets flat or raise them slightly.
At the same time, EU populations continued to age, putting more pressure on health services. In the bloc’s 27 countries, the proportion of people aged 65 and above has risen from 17.5pc to 20.4pc.
Obesity surged as well, to about 60pc of the population in the European region – second only to the Americas – according to the World Health Organisation.
The rise of more complex health needs and flat or falling funding coincided with growing waiting times in many cases. They have climbed in Ireland, Portugal, Spain and the Netherlands in the decade following the financial crisis.
In 2018, the average waiting time for a knee replacement came in at 98 days in the UK, 152 days in Norway and 253 days in Poland, to give some examples.
Luigi Siciliani, a waiting times expert and professor of economics at the University of York, says this meant “health systems were already under stress pre-Covid”.
In Ireland, the government had been battling unsuccessfully to bring down waiting lists for years, with doctors’ associations blaming the problem on a lack of beds and trained staff.
The number of patients waiting for some form of hospital treatment stood at about 553,000 at the end of 2019 – well over target. But the pandemic has caused the figure to balloon even further to 897,300, almost one fifth of the population.
Likewise, the NHS waiting list in the UK stood at 2.3 million in 2009 but by early 2020 had increased to 4.3 million. Today, the figure is about 7 million – equivalent to more than a tenth of the population.
The coronavirus pandemic then dealt a devastating blow to all health services, as it forced them to prioritise urgent care for the huge influx of Covid patients and put off non-emergency procedures as they grappled with the crisis. Later efforts to ensure populations were vaccinated also sucked up time and resources.
During that period, many people avoided visits to the doctor or missed appointments, for fear of becoming infected or contributing to strain on the system.
According to the OECD, the true impact of these delays to care may not come to light for years. Those who missed cancer screenings could now be diagnosed at a later stage, for example, requiring more substantial and costlier treatment. Mental health problems that may have built up during lockdowns are also expected to have a lasting effect, adding to demand.
Overall, survey company Eurofound reported that more than one in five people in EU countries had foregone medical care, including examinations and treatments, during the first year of the pandemic – with a similar number reporting they still had unmet needs in spring 2022.
“We know that we've almost certainly missed a lot of serious illness during the pandemic,” says Anita Charlesworth, director of research at the Health Foundation and a former top civil servant.
“And being able to have a timely diagnosis is really important. Early diagnosis tends to be associated with better outcomes and it tends to mean that you need less complex healthcare intervention, which is more costly in the end.
“So early detection and diagnosis is in the patient's interest and it's also in the taxpayer’s interests.”
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(Clockwise from left) Swedish Covid field hospital, 2020; Ambulances queue in London, 2022; Emergency staff work 24 hour shifts in Palermo, 2022; Covid testing station in Lisbson, 2022 Credit: IBL/Shutterstock; Leon Neal/Getty Images; Francesco Militello Mirto/NurPhoto via Getty Images; Jorge Castellanos/SOPA Images/LightRocket via Getty Images