England’s National Health Service is to cancel all non-urgent surgery, send home any patient fit enough to leave, and turn to the private health sector for help, in an attempt to find 40,000 more hospital beds for coronavirus patients.
The dramatic action, which follows a similar step to postpone operations already taken in Wales, is designed to ready the health service to handle the biggest challenge since its foundation more than 70 years ago.
Simon Stevens, chief executive of NHS England, said the measures announced on Monday would “make a big difference” in reducing the “peak pressure” on the NHS but the situation would need to be kept under review.
He said that much would depend on whether people obeyed the new social distancing measures announced by the prime minister Boris Johnson on Monday, including self-isolation for the over-70s and avoiding pubs, restaurants and theatres. “We all accept there is a degree of uncertainty about how this will play out over the next month, two months, three months and beyond,” he said.
Earlier, Patrick Vallance, the government’s chief scientific adviser, had said the measures announced should keep deaths below 20,000 which he described as “a good outcome” in light of the severity of the disease, but nevertheless a “horrible” figure that would put “enormous” strain on the NHS.
In a letter to hospital leaders and GPs, Sir Simon said his aim was “to expand critical care capacity to the maximum”. This would involve freeing up 30,000 or more of the English NHS’s 100,000 general and acute beds, and supplementing them with additional capacity, notably from the independent sector.
He told hospital chief executives to “assume that you will need to postpone all non-urgent elective operations from April 15 at the latest, for a period of at least three months”.
He gave hospitals “full local discretion to wind down elective activity over the next 30 days as you see best” to free up staff for refresher training, beds for coronavirus patients, and to adapt theatres and recovery facilities to take patients.
Emergency admissions, cancer treatment and other clinically urgent care “should continue unaffected”, he added.
Anyone in hospital medically fit to be sent home should be discharged, with community health providers taking “immediate full responsibility” for doing that. Emergency legislation would allow anyone needing social care to be discharged without the usual need for an eligibility assessment backed up by new government funding, he said.
Nationally, the NHS was also in the process of block-buying capacity in independent hospitals and a deal should be completed in a fortnight. NHS trusts and foundation trusts were told to free up their private pay beds.
In his letter, Sir Simon also sought to address criticism from many clinicians about a failure to test them even when they had symptoms. He said that, as more testing capacity came online, Public Health England was being asked “as a matter of urgency to establish NHS targeted staff testing for symptomatic staff who would otherwise need to self-isolate for seven days”.
MPs also quizzed Sir Simon about the availability of protective equipment for staff, amid numerous reports around the country that doctors and nurses were having to work unprotected. He blamed shortages on a “distribution issue” that meant that while there was sufficient equipment nationally it was not always available where needed.
The problem was being addressed, he said, as he warned that domestic production of gowns and face masks, for example, would have to ramp up. “Will we need more of this stock in the coming months? Yes we will,” he added.
MPs also questioned whether the health service had enough ventilators to cope with the expected upsurge of patients suffering from the respiratory symptoms associated with the virus. Sir Simon said that the service could currently call on about 8,000 and had “a line of sight” to acquiring more, taking the number up to 12,000.
Asked by Jeremy Hunt, the former health secretary who chairs the committee, whether this would be sufficient to cope with the expected number of cases, he said that “will partly depend, frankly, on the extent to which we as the people of this country respond to the ask being made of us”.
Mr Johnson has called on industry to design a British-made medical ventilator “from scratch” to help address the shortage and bypass any threats to imports of medical equipment as a result of the global pandemic.
Sir Patrick said on Tuesday that the new social distancing guidance should bring down the rate of spread of the virus “in two or three weeks’ time”. He added that he would like to see many more people being tested. He said: “I think we need a big increase in testing and that is what I’m pushing for very hard.”
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