Hospital bed crisis preceded COVID-19, and will survive it – Byline Times

NHS acute hospital consultant David Oliver considers how the COVID-19 pandemic has exposed structural health problems caused by years of neglect and underfunding

In my 31 years as an NHS hospital physician, 2020 stands out as a year in which structural health issues have been more widely understood than ever.

The coronavirus pandemic has exposed the endemic problems that our health and social care services have faced for years, many of which were hiding in plain sight.

This includes the relentless and mounting pressure on a shrinking and understaffed hospital bed base, which the pandemic has made even more difficult to manage. As a doctor who works in acute rooms caring for hundreds of sick COVID-19 patients, these are my experiences.

First of all, it is worth noting that the concerted tirade in select media outlets, suggesting that the bed shortage is not a big problem and does not require us to reduce viral transmission, is misleading, useless, and runs from bad information even what seems like deliberate misinformation.

I understand that people are upset that Christmas has been ruined for many. I understand the serious and legitimate public concerns about the government’s inept and passive response to the pandemic and the damage to well-being, the economy, and general freedom due to repeated lockdowns. I know there are serious concerns about trade-offs between acute care for COVID-19 patients and planned care for other groups with conditions such as cancer.

But those arguments must be made on their own terms and not, as some have tried to do, by claiming that COVID-19 is a trivial, overdiagnosed disease or that hospitals and intensive care units are half empty. Bed pressures and capacity crises are real and are here to stay.

The sick of Europe

The UK is already at the bottom of the OECD ranking table for hospital beds per 1,000 inhabitants, around 2.7. If decentralized nations are removed, England’s numbers are even lower. They are 25% below the EU average, about half the capacity of France and a third of that of Germany. Overall, the number of beds in England more than halved between 1988 and 2018 even though, during that time, hospital emergencies and admissions more than doubled.

Readers will be surprised to learn that we only have around 140,000 beds for an English population of 56 million people, of which just over 100,000 are “general and acute beds”, into which seriously ill or needy adults can be admitted. planned operations.

The UK only has 6.6 intensive care beds (sometimes called ‘intensive care’ or ‘ICUs’) per 100,000, well below the league table compared to, for example, the United States at 34.7 , Germany with 29.2, Italy with 12.5, France with 11.6 or Spain with 9.7. Yet all of these countries have seen their ICU beds overwhelmed during the Coronavirus pandemic.

During March, April and May, a heroic effort, but not a long-term sustainable solution, allowed us to double our bed capacity in the ICU with borrowed staff, borrowed space, and at times a relaxation from the usual nurse ratios per patients. This also meant canceling planned operations for which the same personnel and space would have been used.

NHS hospitals have been operating at more than 90% bed occupancy at midnight in the fall, winter and early spring for the past five years, with emergency department wait times increasing and overcrowding, a risk to the morale of patients and staff.

Meanwhile, at the back door of the hospital, delayed care transfers have grown to record levels due to serial cuts in social care and a lack of capacity in community services to support people outside the hospital.

Plague Year DiaryAnd what to expect in 2021

After the massive outbreaks of COVID-19 in nursing homes in the spring, partly caused by discharges from acute care hospitals, the system is now doubly paralyzed. Therefore, beds are often occupied by people who are medically stable enough to leave, but with nowhere to go.

the Health Services Journal reported in October that the country likely has 3,000 beds below 2019 capacity. And that’s before we take into account the impact of COVID-19 on bed availability. At the time of writing, more and more beds in England are occupied by people with COVID-19, with a growing number of people in ICUs.

Then we have the problem of COVID-19 outbreaks within the hospitals themselves. Unfortunately, around a quarter of all infections are currently classified as hospital acquired. If a few patients begin to test positive, an entire room bay or even an entire room will be temporarily closed for new admissions, making it even more difficult to discharge patients to community facilities. There are still fewer beds available.

This further illustrates the false dichotomy between patients with acute COVID-19 disease and others. With some notable exceptions in England, treatment for both is done in the same hospitals. There is a huge national push from NHS England to catch up on canceled and postponed work, but vulnerable people with pre-existing conditions like cancer are at serious risk if they contract COVID-19 in hospital.

To complete this perfect storm, a bed is useless without staff. The NHS already had one of the lowest ratios of doctors and nurses per 1,000 in the OECD, before the pandemic. One in eight nursing positions was empty. Now, there are thousands of sick or self-insulating employees due to COVID-19. A recent Scottish study showed that clinical staff in COVID-19 wards are three to six times more likely to be infected and around one in 10 of all admitted patients are front-line healthcare and care workers.

Sometimes COVID-19 skeptics talk as if hospitals should be bursting. Unless photos of patients in carts in the hallways make the news, it seems they will never be convinced that lockdowns, behavior restrictions, or even vaccinations should be entertained.

But ask them to consider the idea of ​​contracting COVID-19, requiring an acute bed or intensive care, and discover that there is no room at the inn. I’m pretty sure they won’t be so accommodating, nor will they argue with seasoned professionals who get the job done every day.

The first wave of the Coronavirus pandemic peaked at a traditionally calmer time for acute care. The second adds to an annual seasonal crisis, and all NHS workers are suffering the effects.

David Oliver is a seasoned NHS acute hospital consultant who has worked in COVID-19 wards during the first second wave in 2020 and held a variety of high-level roles in health policy and leadership. Writes a weekly column in the ‘British Medical Journal’

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