How likely is the NHS to be overwhelmed by Covid?

17 October 2020

12:34 AM

17 October 2020

12:34 AM

Over the summer, NHS chiefs were told not to worry too much about a second wave because the £12 billion test-and-trace would be zapping new cases. That, to put it politely, didn’t work – and the NHS is dealing with the fallout. Matt Hancock now faces a normal winter hospital surge combining with Covid. He now wears a ‘protect the NHS’ facemask, a message controversial with doctors who fear it deters the sick from getting the treatment they need. The idea of an NHS meltdown is being invoked to help sell lockdown to sceptical local government figures – but how likely is it? I look at it in my latest Daily Telegraph column.

The NHS had been all set to scale up for a potential second wave with ‘Seacole Centres’ for Covid convalescents. This was deemed unnecessary given the expectation that test-and-trace would would work So funding for more Seacole Centres was refused by the Treasury, and billions funnelled to Dido Harding’s outfit instead. When test-and-trace failed, the NHS ended up being used as the backstop.

But NHS has learned a lot from the first wave. PPE equipment is in bountiful supply. Basic techniques – better use of blood thinners, oxygen therapy, steroids etc – has had a big impact on survival rates. When Boris Johnson went into intensive care, his survival chances were about 50 per cent. Now, they would be closer to 70 per cent.

Merseyside is at the eye of the new Covid storm, but the NHS there is simply not close to keeling over. Liverpool University Hospitals had 320 Covid patients earlier this week, vs 400 at the peak last time. But elsewhere the story is very different. Indeed, there are about 350 Covid patients in hospitals across the entirety of South West and South East of England, for example. Should Liverpool get too busy, extra capacity will be added and patients routed to other hospitals: this is how the NHS works. It’s a world leader in scaling up – and triage. Elective operations can be cancelled and yes, this creates problems down the line, but at present there is no realistic prospect of hospitals being overrun by Covid. There are other hospitals within half an hour’s drive (in St Helens and Clatterbridge, for example) and specialist hospitals (like the Liverpool Heart and Chest Hospital) that can take on other routine operations. There are many ways of creating capacity in hospitals, and that’s before you get to the Nightingale overflow units.

It’s normal to have intensive care units (ICUs) in a hospital running at 90 per cent of capacity is pretty normal for a hospital. But right now, they’re running at 60 per cent. There are about 475 Covid patients on ventilators right now across the NHS – but the number of ventilator beds available is about 4,750. So this is not a health service at risk of collapse, or anywhere close to collapse. The issue is more the staff, and the 14-day quarantine rules that kick in if, for example, your kid is off school. About 12 per cent of nurses in Liverpool University Hospitals are off work right now: but the NHS can transfer staff if that becomes an issue.

It’s also worth looking at London which is now under the Tier 2 restrictions that Sadiq Khan has long been lobbying for. The capital was hit hard first time around, with hospitalisations peaking at 880 a day. Now, they are not doing even a tenth of that. We have not been told much about why London is being put into Tier 2 – but it certainly isn’t to ‘protect the NHS’.

Of course, the concern is the lag: where the NHS will be in a fortnight’s time – which can be gauged, more or less, from today’s infection rates. This explains the concern in Manchester, that they’re two to three weeks behind Liverpool in the infection curve. But even if today’s infections treble the hospital load, there is nothing to say the system cannot cope. You can look beyond a fortnight, and come up with bigger figures – but the error margin in the projections becomes unworkable. In mid-March, for example, the advice coming out of SAGE was that there could be 90,000 Covid patients needing intensive care – quite a challenge for an NHS with only 100,00 beds in total. Britain was badly hit, but the peak demand ventilators was 2,881. This shows the problem of four- to five-week extrapolations. The lesson is that SPI-M projections, provided to SAGE, should be taken with a pinch of salt. A policy of agile response – as the NHS now has – makes more sense.

I have several criticisms of the NHS – why, for example, can’t it publish daily, regional ICU data like France does to reassure people worried about overload? Why are it’s general performance figures so hard to find? When the figures are vague, it allows for huge misunderstandings – including the idea that the NHS is about to keel over. But the NHS has, in fact, held up surprisingly well – and continues to do so now.

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