The hospital bed crisis preceded COVID-19 – and will outlive it – the Byline Times

NHS Acute Hospital Advisor David Oliver believes the COVID-19 pandemic has exposed structural health problems caused by years of neglect and underfunding

In my 31 years while I was a doctor at NHS Hospital, 2020 stands out as a year in which structural health issues are understood more broadly than ever before.

The coronavirus pandemic has revealed endemic problems that our health and social services have been facing for years, many of which have been in sight.

This includes relentless and growing pressure on the hospital bed base, which is shrinking and has a short staff, which has made the pandemic even more difficult to manage. This is my experience as a medical person working in acute wards and caring for hundreds of sick COVID-19 patients.

First, it is worth noting that harmonized diatribe in selected news – suggesting that bed shortages are not a big deal and not requiring us to reduce viral transmission – deceives, does not help and ranges from ill-informed to what appears to be deliberate misinformation.

I understand that people are upset that Christmas has been ruined for many. I understand the public’s serious and legitimate concerns about the government’s incompetent, passive response to the pandemic and the damage to welfare, the economy, and general freedom due to repeated blockades. I know there are serious concerns about the trade-off between acute care for patients with COVID-19 and planned care for other groups with diseases such as cancer.

But these arguments should be made on their own terms, not – as some have tried – claiming that COVID-19 is a trivial and pre-diagnosed disease or that hospitals and intensive care units are half-empty. The pressure on the bed and the capacity crisis are real and we will stay there.

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The patient of Europe

The UK is already at the bottom of the OECD league table for hospital beds per 1,000 inhabitants – around 2.7. Remove the delegated states and the number of England is still lower. They are 25% below the EU average, about half of France’s capacity and a third of Germany’s. Overall, the number of beds in England more than halved from 1988 to 2018, although hospital ambulances and admissions more than doubled during that time.

Readers may be surprised to learn that we have only about 140,000 beds for the English population of 56 million people, of which just over 100,000 are “general and acute beds” – which can accommodate adults with acute illness or those who need planning. operations.

The UK has only 6.6 critical care beds (sometimes referred to as “intensive care” or “ICU”) per 100,000 – well below the scale compared to the US with 34.7, Germany with 29.2 , Italy with 12.5, France with 11.6 or Spain with 9.7. Yet all of these countries have seen their beds on the ICU flooded during the Coronavirus pandemic.

Throughout March, April, and May, a heroic effort — but not a sustainable, long-term solution — resulted in us nearly doubling the capacity of the bed on the Internet unit with borrowed staff, borrowed space, and occasionally relaxing the usual nurse-patient relationship. It also meant canceling planned operations that would be used by the same staff and space for support.

NHS hospitals have had more than 90% occupancy at midnight in the fall, winter, and early spring over the past five years, while the waiting time of the Department of Development and Health has grown and overwhelmed the risk to patient and staff morale.

Meanwhile, at the back door of the hospital, delayed care transfers have risen to record levels due to a serial reduction in social protection and a lack of capacity in community services to support people outside the hospital.

After mass epidemics of COVID-19 in spring nursing homes, in part caused by discharges from acute hospitals, the system is now doubly restrained. The beds are therefore often occupied by people who are medically stable enough to leave but have nowhere to go.

The Journal of Health Service reported in October that there are probably 3,000 fewer beds in the country than 2019. And that before we consider the impact of COVID-19 on bed availability. At the time of writing, more and more beds in England are occupied by people with COVID-19, with an increasing number of ICUs.

Then we have the problem of the outbreak of COVID-19 in the hospitals themselves. Unfortunately, about a quarter of all infections are currently classified as hospital-acquired. If several patients begin positive testing, the entire ward or even the entire ward will find itself temporarily closed for new admissions – making it even more difficult to discharge patients to community facilities. Fewer free beds, still.

This further illustrates the false dichotomy between acutely ill patients with COVID-19 and others. With a few notable exceptions in England, the treatment of both takes place in the same hospitals. NHS England has a major national effort to make up for canceled and delayed jobs, but vulnerable people with pre-existing conditions such as cancer are seriously at risk if COVID-19 is infected at the hospital.

To complete this perfect storm, the bed is not used without staff. The NHS already had the lowest proportion of doctors and nurses per 1,000 in the OECD, before the pandemic. One eighth sister position was not filled. There are now thousands of staff ill or self-isolating due to COVID-19. A recent Scottish study showed that clinical staff in COVID-19 wards are between three and six times more likely to become infected, and approximately one in 10 of all patients admitted are health professionals in the foreground.

Sometimes COVID-19 skeptics talk as if hospitals should shoot at the seams. If photos of patients in wheelchairs in the hallways do not appear on the news, it seems that they will never be convinced that they should have fun because of locks, behavioral restrictions or even vaccines.

But ask them to have fun with the idea of ​​catching COVID-19, requiring an acute bed or intensive care, and finding that there is no room in the inn. I’m pretty sure they won’t be quite as complacent, nor will they argue with experienced professionals who do the job on a daily basis.

The first wave of the coronavirus pandemic peaked in traditionally calmer times for acute care. The second is at the peak of the annual seasonal crisis – and all NHS workers are suffering the consequences.

David Oliver is an experienced acute hospital advisor at the NHS who worked in the departments for COVID-19 during the first second waves of 2020 and played a number of senior roles in health leadership and policy. He writes a weekly column in the ‘British Medical Journal’

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