IFS - Elective hospital admissions dropped by a third last year, while outpatient appointments and non-COVID emergency admissions each fell by a fifth

13 May 2021 10:10 AM

New analysis by the Institute for Fiscal Studies, Harvard University and Imperial College London shows there were 2.9 million fewer planned admissions, 1.2 million fewer non-COVID-19 emergency inpatient admissions and 17.1 million fewer outpatient appointments between March and December 2020 compared with the same period in 2019.

Drawing on new data from administrative NHS hospital records, researchers have also examined how patterns of hospital use during the first 10 months of the pandemic varied across geographic region, clinical specialty, age, sex, local area deprivation and ethnicity.

The new research is published ahead of NHS England’s monthly performance figures, released at 09:30 today, figures which are expected to show continued big increases in waiting times. The research shows who has been most affected by loss of care over the last year. It will be a vital input into future planning of NHS resources.

Main findings of the report, funded by the Economic and Social Research Council (ESRC) as part of UK Research and Innovation’s rapid response to COVID-19, include:

• There were 2.9 million (34.4%) fewer elective (planned) inpatient admissions, 1.2 million (21.4%) fewer non-COVID-19 emergency inpatient admissions and 17.1 million (21.8%) fewer outpatient appointments between March and December 2020.
• The North and Midlands experienced bigger reductions in hospital activity than the South and East of England. Elective admissions fell by nearly 40% in Yorkshire. London suffered the biggest fall in emergency admissions, a fall of a quarter. By contrast, there was a fall of ‘just’ 16% in emergency admissions in the South West.
• Reductions in volumes of care varied across clinical specialties. There were 57% (332,000) fewer trauma and orthopaedics elective admissions compared with a reduction of only 7% (46,000) for nephrology (treatment for kidney diseases, including dialysis).
• Paediatrics saw the largest reduction in emergency admissions, 41% (242,000) compared with the same period the year before. More generally, across all specialties, patients under the age of 18 saw a decline of 38.5% in emergency inpatient admissions. Some of this fall will likely reflect a genuinely reduced need for emergency care but still raises concerns that not all children have received the appropriate treatment during the pandemic.
• There were huge falls in the big outpatient specialties. There were 45% (1.9 million) fewer physiotherapy outpatient appointments and 31% (1.2 million) fewer diagnostic imaging appointments.
• There was some difference in the changing patterns of emergency care across more and less deprived areas: the most deprived fifth of local areas had 23% fewer emergency admissions in March to December compared with a 20% reduction in the least deprived fifth of areas. However, there was very little difference in the percentage falls for elective admissions and outpatient appointments between more and less deprived areas.
• As more frequent users of hospitals, older patients were the most affected in per-capita terms. For every 1,000 people aged 80+ in England, there were 122.5 fewer elective admissions, 82.4 fewer emergency admissions and a massive 835.7 fewer outpatient appointments.
• There are substantial differences by ethnicity. White individuals had a 37% reduction in elective admissions, compared with 36% for Asian individuals and 24% for black individuals. For emergency admissions, white individuals saw a 21% decline, compared with 32% for Asian individuals and 28% for black individuals.

Max Warner, an IFS Research Economist and an author of the report, said:

“The COVID-19 pandemic forced the English NHS to reduce much of its normal hospital activity, while the number of emergency patients attending hospital has also fallen drastically. This has affected millions of people, and will cost the government billions of pounds to catch up on missed treatment.

There are striking differences by ethnicity in the use of emergency care, with black and Asian individuals seeing much larger reductions than white individuals. This risks exacerbating both health inequalities that existed before the pandemic and ethnic disparities in the impact of COVID-19. Large reductions in the use of emergency care in particular groups, on top of a larger impact of COVID-19, are therefore alarming.

Ultimately what matters is how the loss of care has affected health and well-being. Some of the missed care will have little consequence for future health but some of it will be very important. It is therefore essential to learn more about how these changes in hospital use have affected patient outcomes during this period and which groups need particular support.”

What happened to English NHS hospital activity during the COVID-19 pandemic?