Fears for the seriously ill after A & E visits drop to record low
Patients should not put their health at risk for fear of being a burden to NHS, warn medical leaders
THE gravely ill are staying away from hospital because of coronavirus, with a lower number of A&E visits last month than at any time since current records began.
Medical leaders are appealing for patients with serious conditions to continue using the NHS, after the first official data since the lockdown began revealed a 29 per cent year-on-year drop in use, including a 50 per cent drop in heart attack attendances.
A total of 1.53million people went to an A & E department in England in March, compared with 2.17million the year before.
Emergency admissions also showed a sharp fall, down 23 per cent to 427,921.
NHS England said the fall was “likely to be as a result of the Covid-19 response”. It follows the publication of figures from Scotland this week that suggested patients were dying because they were avoiding going to hospital.
Hospital services have been dramatically altered to prepare for the expected peak of patients with Covid-19, forecast to be at least seven days away. It includes cancellation of most outpatient appointments, and discharge of as many inpatients as possible.
Services for non-covid-19 patients with urgent and acute needs remain open. But medical leaders fear many are staying away because they do not want to burden the NHS, or fear contracting the virus in hospital.
Prof Stephen Powis, the medical director for NHS England, has implored people to go to A & E “just as you always have done” if they have symptoms of a stroke or heart attack.
The British Heart Foundation (BHF) said last night it believed as many as 5,000 people a month who would normally have gone to hospital with symptoms of a heart attack are putting their lives at risk by staying at home.
Public Health England figures show the number attending emergency departments with symptoms of a possible heart attack dropped from an average of about 300 per day at the beginning of March to around 150 per day recorded by the end.
Dr Sonya Babu-narayan, consultant cardiologist and associate medical director at the BHF, said: “People might feel apprehensive about having to go to hospital or putting unnecessary strain on the NHS, but heart attacks don’t stop for a global pandemic.
“Don’t delay because you think hospitals are too busy – the NHS has systems in place to treat people for heart attacks and they are still a top priority.”
The picture in hospitals across the UK varies dramatically this week.
Some trusts in London – where the outbreak is most widespread – are reportedly struggling to cope with the influx of Covid-19 patients, although NHS bosses insist there was enough critical care capacity even before the NHS Nightingale temporary hospital opened in the city’s docklands.
By contrast, many provincial hospitals have cleared out all but the most ill non-coronavirus patients, but are still waiting for the surge of those with Covid-19. A source said Addenbrooke’s Hospital in Cambridge had more than 400 empty beds this week, roughly a third of its total.
Nigel Edwards, chief executive of the Nuffield Trust think tank, said the drop of a fifth in A & E attendances could be down to “responsible decisions” by many patients. “However … senior clinicians are seriously worried that some patients who really need urgent treatment may also have been deterred from attending, which could result in delayed diagnoses and poorer outcomes over time,” he added.
Dr Katherine Henderson, president of the Royal College of Emergency Medicine, said despite the fall in A&E attendance, there were more admissions as a proportion of attendances.
“We are concerned that this drop in attendance may mean people with serious health problems are avoiding going to their emergency department for fear of getting coronavirus,” she said.
While the number of people visiting A&E has dropped, the volume of calls
to NHS 111 has surged. “This suggests many of those who might have attended A&E previously could be seeking clinical advice elsewhere, and that 111 is playing a critical role,” said Tim Gardiner, from the Health Foundation.
“On the face of it, this may indicate people are following the official advice to try to avoid going straight to A&E.”