In reply to The New NickB:
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.