It is still far from clear what the cost of the pandemic has been to the UK economy, but one thing is certain: expenditure on health has seen an unprecedented rise

According to preliminary estimates from the Office for National Statistics (ONS), healthcare expenditure in the UK during 2020 reached about £269bn, a rise of 20 per cent compared with 2019.

Government health expenditure rose by 25 per cent in part because it invested in new initiatives to stem the viral tide of Covid, such as testing, tracing and vaccination. The Government also funded additional expenditure by existing services, such as PPE for frontline workers (including, eventually, pharmacy teams).

While healthcare expenditure went up, the UK’s ability to fund the increase declined. As a share of gross domestic product (GDP), healthcare expenditure rose from 10.2 per cent in 2019 to 12.8 per cent in 2020, a 2.6 per cent jump. To put this in context, the largest previous single-year change was a 0.8 per cent rise in 2009 following the fall in GDP after the 2008 financial crisis.

Financial picture hard to decipher

Much still remains unclear. The ONS notes that the estimates of expenditure in 2020 are more uncertain than usual because of the challenges of data collection during a pandemic. Yet while there is no data about the cost of treating Covid-19 patients, we can get some idea.

On average, Covid-19 patients occupied 8 per cent of beds overall and 24 per cent of mechanical ventilator beds in England between April and December 2020. The number of elective treatments and A&E visits fell during 2020 but while less activity lowers expenditure, the costs of providing some services rose. More GPs and specialists are delivering consultations via video or phone, for instance, the cost of which probably differs from face- to-face contact.

Nor does the data capture the costs as the NHS struggles to keep pace with renewed demand, a situation now greatly exacerbated by rapidly rising numbers of Delta variant Covid infections.

“The NHS is already at the busiest [it] has been since the beginning of the pandemic – with emergency departments having had the highest attendance for years with delayed presentations and other specialties catching up with the huge backlog that has resulted from the previous two Covid peaks,” Dr Raghib Ali, senior clinical research associate, MRC epidemiology unit, University of Cambridge, has commented.

“The patients who will really suffer from an increase in Covid admissions are our non-Covid patients, particularly those with serious conditions like cancer and heart disease, who have suffered enough already.”

Government spending accounted for 82 per cent of total healthcare expenditure but households and other non-governmental spending also changed during the pandemic. Household out-of-pocket spending on items such as over-the-counter drugs and PPE increased by around 4 per cent. Spending on voluntary insurance schemes declined by about 23 per cent.

Picking up the pieces

According to the ONS, a survey of voluntary organisations in December 2020 found that 59 per cent of charities with a health, hospital and nursing home focus offered an increased range of services during the pandemic. Some of these charities have dealt with the mental health fallout. The number of individuals with depression almost doubled during the pandemic, for example.

An analysis published in the DARU Journal of Pharmaceutical Sciences (2021; 29:217-221) reported that 78 million prescription items for antidepressants were dispensed in England during 2020. That is a rise of 4 million compared with 2019 at an additional cost to NHS England of £139m. Expenditure on sertraline alone rose by £113m during 2020 compared with 2019.

The authors argue that further studies need to assess the age distribution of antidepressant prescriptions. They note that adolescents and young adults in particular are at risk of serious adverse events.

All these estimates barely scratch the surface. There are the costs of missed and delayed diagnoses, not to mention long-Covid. We won’t know the full bill for many years to come. However, in the meantime, quite how Boris-nomics will balance the NHS budget and the country’s books – well, that remains to be seen.

• Just how far e-cigarettes have come in terms of recognition of their role in helping smokers quit is demonstrated by their prominent inclusion in a new draft guideline from NICE (writes Richard Thomas).

The clinical watchdog pointed to evidence showing that nicotine-containing e-cigarettes are similarly effective to other cessation options such as a combination of short- and long-acting nicotine replacement therapy and that people should be able to use e-cigarettes as one of several options to support smoking cessation.

So does it not seem rather incongruous that there are still no medically licensed e-cigarettes on the market since e-Voke was axed by British American Tobacco? And was it ever desirable for a tobacco company to be taking the lead here anyway?