COVID and the NHS

It’s impossible to ignore current demands to go out and clap for the NHS. It’s often been noted for some years that the NHS is the UK’s replacement for religion, and this conspicuous NHS worship certainly suggests so. Some of us find this worship mis-targeted at best. The NHS as a huge organisation is not the same as the dedicated staff looking after COVID patients. Its unpreparedness to cope with the pandemic has been the main reason the government has enforced lockdown, to ‘flatten the curve’, to ‘protect the NHS’. Given the magnitude of damage resulting from that, I did some googling to find some stats that question whether the NHS is really a world-leading health service full of heroes risking their lives to save us all.

The death rate in the UK under the NHS is far higher than most countries

The UK death rate so far, estimated at 29,000 deaths out of 66M population, is 440 per million

(https://www.telegraph.co.uk/news/2020/04/27/uk-coronavirus-death-toll-january/),

compared to 37 deaths per million in the rest of the world (https://www.ft.com/content/6bd88b7d-3386-4543-b2e9-0d5c6fac846c).

The UK is seeing 12 times more deaths per capita than the rest of the world!

There are very many factors that cause this terrible UK result. High population density is one, London being a global business hub may arguably be another, but lethargic and incompetent government led by poor advisers, and badly administered, relying on an poorly managed, poorly prepared NHS must account for much of the difference.

In this blog, I have done some data diving on some stats, lengthy because appropriate figures are often very hard to find.

NHS deaths are actually lower than average

The UK media frequently emphasises the number of NHS deaths but surprisingly the death rate for NHS staff is lower than for the population as a whole:

The latest figures I can find show that 106 NHS staff have died from COVID (not counting retired workers). That’s a rate of 1 in 17,452.

This compares to 20,626 out of 64.2M in the rest of the population, and adding in the estimated 40% more who have died in care homes, that’s 7.86 times higher than that for NHS workers.

However, most of those deaths are old people (86% of COVID deaths are people over 65). A like-for-like comparison should include only those of working age and exclude the ‘extra’ 40% extra older people dying in care homes.

If only deaths of working age people are included, the non-NHS death rate stands at 1 in 13,000, still a third higher than that for NHS workers.

NHS workers’ death rate is only 75% of that for the normal working age population. I offer no hypothesis to explain why you’re 25% less likely to die from COVID if you work for the NHS.

NHS staff numbers – how many are the heroes?

I have my own good reasons for being critical of the NHS, but I am far from alone in finding the current NHS worship annoying. The NHS is very bloated, badly managed, inefficient and ineffective. Many people gladly cheer the doctors and nurses but not for the useless managers.

According to

https://fullfact.org/health/how-many-nhs-employees-are-there/

1,850,000 work for the NHS, not counting dentists and opticians. That’s 4.5% of the UK working age population!

You may have seen lower figures. Some work part time, and the 1,400,000 NHS workers you often read about are the full-time equivalents. That’s probably why.

Around 900,000 of these are medical and medical support staff such as doctors, nurses, radiographers, hospital physicists, pathology staff and so on. The rest aren’t. Over the last 20 years, as a response to criticism of its near half million managers and administrators, the NHS has gone to some lengths to reduce the numbers of its staff it officially classifies as ‘managers’, managing to get the estimate down to a laughable 3.5%.

It is extremely hard to find how many ‘front line’ workers there are dealing with COVID patients. However, it is estimated that if fully operational, the 4000 bed Nightingale hospital would require 16,000 staff in ‘clinical and ancillary roles’, so that’s a neat 4 staff per bed.

25,000 beds are required for COVID patients according to https://www.independent.co.uk/news/health/coronavirus-nhs-england-intensive-care-beds-lockdown-uk-a9462276.html

If they were are all in use and needed 4 staff each, i.e. Nightingale staff levels, that would mean around 100,000 staff, 5.4% of the NHS. In practice, up to half of beds are unoccupied, and many don’t need so many staff, so that suggests that as few as 2.5% of NHS staff may be realistically considered to be on the COVID front line. 2.5%-5%. In the absence of accurate up to date figures, let’s call it a few percent.

I definitely applaud the few percent of the NHS who are working long and stressful hours doing their very best to keep COVID patients alive, taking personal risks while doing so. I am very happy to agree that they are heroes.

However, I refuse to conflate that few percent with the NHS as an organisation and thus treat as heroes the many percent of NHS managers whose negligent planning and incompetent administration got us into this mess. They deserve strong criticism and once it’s safe to do so, government should look hard at why the NHS wasn’t ready to cope with this long-predicted pandemic, roll some heads and design a new health service that is fit for purpose.