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More than 100 NHS trusts in England could be at or above full capacity this winter if they faced a second wave of coronavirus admissions in addition to the usual seasonal workload, with figures suggesting dozens would have 10% less. of beds of the necessary ones.
The Guardian compared the winter 2019/20 capacity of each trust to the number of beds they needed for Covid-19 patients in April, when an average of 16,000 beds were required for coronavirus patients per day, and in May, time. in which the blockade and physical distancing had been closed. reduced the number requiring hospitalization.
Analysis conducted in collaboration with Edge Health suggested that if NHS England were to experience the April levels of Covid-19 pressure in addition to the normal winter pressures, 107 out of 132 trusts (81%) would have fewer beds than were available in winter. past, with 46 trusts exceeding capacity by 110% or more.
But even if Covid pressures are closer to May lows, 79 out of 132 trusts (60%) could reach capacity with seven trusts overwritten by at least 10% compared to last year.
Six trusts could be overwhelmed in any scenario, meaning some NHS hospitals would have a difficult time accommodating all seriously ill patients in need of admission.
The analysis excluded additional capacity provided through Nightingale hospitals or the private sector due to the lack of available data, and does not take into account those who could reasonably have been expected to have been transferred to the hospital with or without a diagnosis of Covid-19.
A spokesperson for England’s NHS noted other measures, including its recently distributed third-phase Covid-19 plan, which contains a commitment to maintain current NHS staff, beds and capacity this winter. It highlighted additional funding of £ 3bn to enable the capacity of the independent sector, Nightingale hospitals and the safe discharge of patients from NHS hospitals until March 2021.
“During the winter, the NHS will flex hospital capacity and community services as needed, along with a major winter flu vaccination campaign.
While the number of patients hospitalized for Covid is currently low as we approach winter, the success of these efforts will, of course, also depend on controlling the virus in the community, including through testing and tracking, an action. quickly to control local outbreaks and, of course, the continuity of support for hand hygiene and social distancing measures ”.
However, NHS Providers Executive Director Chris Hopson said: “These figures illustrate the point that trust leaders have made strongly in each of the last five winters: that there is no acute bed capacity and no community capacity. to face the winter. demand.
“That is not entirely surprising after nearly a decade of the longest and deepest funding squeeze in NHS history, when the NHS has been unable to increase its capacity to meet growing demand because it simply cannot afford it. We also know that our bed capacity has much higher occupancy levels, often 95% or more, than in other comparable European countries.
Niall Dickson, Executive Director of the NHS Confederation, which represents organizations across the healthcare sector, said: “We are concerned and our members are concerned. The NHS is facing a pressure collision this winter and this is a lot like the calm before the storm.
“It’s not just about the usual winter pressures, or even the real concern about another surge that could disrupt efforts to restore services. The reality is that frontline service providers have to work with significant infection control measures to contain the virus, including PPE and social distancing, which reduce productivity. They also have to cope with staff shortages, and frankly there are quite exhausted clinical and support staff who have made it through this traumatic period. “
George Batchelor, Co-Founder of Edge Health, said: “As the NHS prepares for a second wave of Covid-19 this winter, it is critical that it does not become a National Covid Service again.”
The largest of the six trusts that would be overwhelmed, whether in the April or May modeled scenarios, is the King’s College Hospital NHS foundation trust in London.
King’s College London had an average of 1,444 beds (including adult intensive care) open last winter, with an average of 1,427 of these occupied at any time between December and February. This left a capacity of 17 beds on an average winter day, or only 1.1% of them available.
In April, 442 beds of the hospital beds were occupied by coronavirus patients and 238 in May. If these figures were repeated in a second wave in addition to last year’s winter demand, the trust would exceed capacity by 29.4% based on April demand and 15.3% in May demand.
Responding to The Guardian, a spokesperson for the King’s College Hospital NHS Foundation said: “Managing bed capacity in a hospital setting is detailed and complex. These calculations oversimplify a much more nuanced image.
“We have been using sophisticated models to plan for the winter, forecast a possible second increase in coronavirus patients, and manage the expected number of emergency patients.
“Our capacity planning includes the reuse of rooms and other clinical areas; work collaboratively with partners across South East London, as we did during the peak of the pandemic, to ensure that patients receive the appropriate care for their needs; and reducing the length of stay for inpatients, including the repatriation of patients who have been referred to us for specialty care back to their local hospital. “
Five other trusts would have at least 10% overcapacity if they added April or May coronavirus patients to last winter’s demand: Walsall Healthcare NHS Trust, Countess of Chester Hospital NHS Foundation Trust, East Cheshire NHS Trust, Northampton General Hospital NHS Trust and Blackpool Teaching Trust of the NHS Hospital Foundation.
In response to requests for comment from these trusts, all said they had developed or are developing plans for any increase in patients in the winter, including additional equipment, staff and critical care beds and noted collaboration with nearby hospitals or the private sector. and the administration. of patients in their own homes.
While the trusts were not overwhelmed at the height of the closure, this came at the cost of the cancellation of a large number of routine appointments, scheduled operations and cancer referrals.
