The NHS has more funding and more staff than it had pre-pandemic. At the same time, across most types of care, the NHS is treating fewer patients than it was before COVID-19. This is a puzzle, with no single or simple explanation.

Perhaps the most convincing partial explanation is that although the total number of NHS hospital beds has returned to pre-pandemic levels, the number of beds available for non-COVID activity in the third quarter of 2022 was still lower than pre-pandemic. Furthermore, there are clear signs that the NHS is struggling to discharge hospital patients when medically appropriate. And a broader worsening of population health, evident in the rising number of disability benefit claimants, is likely increasing the number of patients requiring complex, resource-intensive treatment.

More generally, there are worrying signs that rather than imposing a one-off, time-limited shock to the healthcare system, COVID-19 has dealt a lasting adverse hit to NHS performance. It could be that, going forward, the NHS is able to treat fewer patients from a given level of resources than it was in the past – and those resources are being squeezed in the short-term by higher inflation.

These are among the findings of new IFS analysis of NHS funding, resources and treatment volumes. Other key findings include:

  • The additional cash allocated to the NHS at the recent Autumn Statement is sufficient to offset only around half of the real-terms hit from higher inflation. Looking across the five-year parliament as a whole, the original intention was to increase the NHS budget by 3.4% per year in real-terms between 2019–20 and 2024–25. Even after recent top-ups, spending is now set to rise by an average 2.9% per year over the five years.
  • Even after adjusting for higher rates of staff sickness absences,the NHS has 8% more nurses, 9% more consultants and 15% more junior doctors than pre-pandemic. For context, the number of nurses increased by just 3% between 2010 and 2019.
  • The health service is carrying out more GP appointments and first cancer appointments, and is obviously treating more COVID patients, but for many other types of care it is treating fewer patients than it was pre-pandemic. In the latest month of data, the NHS carried out 14% fewer emergency admissions, 14% fewer outpatient appointments and 11% fewer elective and maternity admissions than it did in the same month in 2019. The number of incidents recorded by ambulance services was 9% lower in the latest month of data, despite 4% more 999 calls.
  • With almost 3,000 patients in hospital primarily because of COVID-19 on an average day in the third quarter of 2022, there were 1% fewer beds available for non-COVID activity than pre-pandemic. There were, in addition, around 5,500 patients a day in hospital with COVID-19, but who were in hospital primarily for other reasons. Adjusting for all patients in hospital with COVID-19, there were 5% fewer beds available for non-COVID patients than was the case pre-pandemic.
  • The number of beds occupied by patients who have been in hospital for more than 7 days is 14% higher than at this point last year, and the number occupied by patients who have been in for more than 21 days is 24% higher. Both of these figures are already above the highest level hit in any of the past five winters.
  • Official data suggest that in the first week of December, around 40% of those in hospital for more than 21 days were ready for discharge, compared with 34% at the same point in 2021.

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

“The NHS is showing clear signs of strain heading into the winter, and is treating fewer patients than it was pre-pandemic across many types of care. The real risk, almost three years on from the start of the pandemic, is that the COVID hit to NHS performance is not time-limited. Going forward, we need to grapple with the possibility that the health service is just able to treat fewer patients with the same level of resources.”