Sorry for another Covid read.
Covid hospitalisation peaked in early April, with the highest single day admissions of around 3,500 and about 19,500 beds taken up by Covid patients.
Whilst know the system was struggling in places, I don't know how close to capacity this was. Any idea what the capacity might be?
I appreciate that we are also coming in to seasonal flu season, which also puts pressure on hospitals.
As an extension of the number crunching that I posted on the circuit breaker thread, I think that we are 3-4 weeks from hitting that early April peak if we don't do something significant.
Presumably capacity depends on what other medical procedures and care you are willing to cancel? I was under the impression that there are no spare beds, it's all waiting lists. So if we prioritise space for covid purposes, we increase waiting lists elsewhere? Other than the nightingale hospitals, I guess. They are specific for covid I think?
Good point. Looks like about 140,000 beds not including the Nightingale Hospitals (30,000 less than 5 years ago). Question is how many of those can be handed over to Covid.
I can't help with an absolute figure, but I would say that it is secondary to localised concentrations. 2000 admissions would be a problem if they are all in one place.
There's about 100,000 general/acute medical beds in England - these are normally 90% full, so about 10,000 spare beds.
edited to include reference
In most hospitals 20 admissions with covid would be a problem if it was in addition to usual admissions
The real question is, are there enough nurses to deal with the patients?
Capacity isn't a meaningful idea nationally. Whilst patients do get moved (or more usually diverted pre-admisison) to other hospitals if one is overwhelmed, this is a sub-regional process generally.
Capacity also isn't just beds. It's covid-dedicated beds, other beds, ITU beds, and key categories of staff. In several places last time it was oxygen - not so much a shortage of gas, as the pipe runs to wards couldn't deliver enough high flow to enable all covid designated beds. a lot of that is now fixed or planned round.
Capaicity is also not a homogenous thing - so cancelling electives may gain you little in terms of covid response. Whilst all doctors are at some level generalists, many have specialised for 30 years in things other than respiratory disease. Set against that is the fact that we better understand the management now and the role of steroids etc. Treatment is being optimised.
We missed an opportunity over the summer - covid was low but we didn't get back on to the "business as usual" demands urgently. The reasons were plural: staff were tired and taking overdue leave; there was ongoing concern about a flare up of covid and still C19 patients in hospital; the Royal Colleges for different disciplines published guidance for their members that ranged from innovative and forward thinking to regressive and obstructive; and then that guidance was interpreted by local teams. The consequence is that some specialties are better than they ever were; and others are in paralysis. GPs need a special mention - a funding approach that pays for the list size pretty much irrespective of activity is a potentially perverse incentive when somehting like covid arises.
NHSE/I have suggested no electives in January/February...and yet have an incentive scheme inplace now to achieve pre-covid elective capacity/throughput. Unfortunately the structure of the incentive is such that many trusts will give up in some specialties.
The media will focus on the waits >52 weeks, There is an obvious, yet unannounced iceberg below that tip of 18-51 week waits, which is now in hundreds of thousands. The additional demand currently being "held" by GPs is unknown.
As we go into winter, the hospitals are currently fuller than they were when the first wave came. The drive to empty beds is a bit less as there isn't a blank cheque for care placements, and the autumn always brings increased occupancy. 'Flu is likely to be lower this year, but the second and third week of January will be bleak.
Do you work for or with the NHS?
Another thing to consider is that whatever someone admitted for, it is unknown if they might also have Covid. So that’s an additional challenge in terms of resources in order to avoid asymptomatic admissions spreading Covid throughout hospitals.
Certainly in my health board, one solution in place is that wards for non Covid related admissions are being split as amber (not yet had COVID test result), red (has Covid as well as whatever they were admitted for), and green (tested negative). So there is the issue there that one ward is dealing with all admissions until a COVID test comes back, which is concentrating huge additional pressure in some wards. It also massively increases the resources needed for patient transport since the different wards are not necessarily in the same hospital - e.g. the green, amber and red psychiatric wards are in different counties (since there are only the 3 wards) and every patient will be moved after their Covid test returns.
So while there may be an extra bed in ward X for a new admission, you can’t necessarily put someone straight into it if there is a risk that they could infect everyone else on the ward with Covid.
The Scottish Government has announced a £2 million support package for the residential outdoor education sector, which has taken a severe financial hit due to the COVID-19 crisis.