How Covid has dealt the NHS a lasting blow
NHS in England has more funding and staff than before the pandemic - but in many types of care, it is treating fewer patients. Why? A leading think tank has tried to come up with some answers.
Institute for Fiscal Studies (IFS) says this is a puzzle with no simple explanation - but the pandemic has dealt a lasting blow to the NHS and it could be costing more to treat patients, on average, than before.
Despite higher staff sickness rates, compared with pre-pandemic levels, the NHS has available to work:
But - not counting those filled by patients who have tested positive for Covid, even though they may be there mainly for something else -  there were 5% fewer beds available in the third quarter of this year than in 2019, the IFS says. The impact of the virus has lasted longer than expected. 
It is also harder to discharge medically fit patients because of problems with community care.  
And evidence, such as rising numbers of disability-benefit claimants, suggests there are more ill patients needing complex care.
monthly data shows 4% more GP appointments in England than in the same month in 2019, which is "particularly striking" as the number of fully qualified general practitioners has fallen, the IFS says.
re were also more first cancer hospital outpatient appointments - but fewer overall and the number of patients treated from the waiting list, currently 7.2 million in England, was down 11%.
f NHS finances has been well documented and the report says the real value of the current spending plans has been reduced by inflation.
IFS research economist Max Warner says: "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."
A Department of Health spokesperson said: "As the IFS report acknowledges, Covid had a significant impact on the NHS, and we are focused on delivering the biggest catch-up programme in health history".
NHS had reduced waits of 18 months by 60% in a year and "virtually eliminated" waits of more than two years.
"We're allocating an extra £500 million to speed up hospital discharge, getting ambulances back on the road more quickly, and increasing the number of NHS call handlers."
f a series of IFS reports. 
first found the NHS was doing less than before the pandemic, despite more staff and funding.
But this one is designed to highlight the complexities and mitigating factors, concluding there are significant long-term changes to the health and care landscape worthy of further investigation.