Beds aren’t the problem. It’s the shortage of doctors and nurses

Hospitals have been ordered to mobilise their “surge capacity” over new year as they face a triple whammy of soaring infections, rising staff sickness and longer patient stays.

Andrew Gregory, Health Editor

Doctors are bracing themselves for a spike in admissions — already at their highest level since mid-April — over the next fortnight after cases increased by 57% last week.

The threat was underlined in a leaked letter to hundreds of local NHS bosses on Wednesday from the service’s chief operating officer, Amanda Pritchard. In the six-page memo on NHS winter priorities, she ordered trusts “to safely mobilise all of their available surge capacity over the coming weeks”. She added: “This should include maximising use of the independent sector, providing mutual aid, making use of specialist hospitals and hubs to protect urgent cancer and elective activity, and planning for use of funded additional facilities such as the Nightingale hospitals, Seacole services and other community capacity.”

However, there are concerns about how extra facilities such as the seven Nightingale hospitals in England could be used because of the lack of staff. Thousands of NHS staff were already off last week with mounting numbers infected or self-isolating.

“Remember that we were more than 80,000 staff short even before the pandemic took hold,” said Saffron Cordery, deputy chief executive of NHS Providers, which represents hospital trusts. “It’s clear we are now embarking on the most testing time in the history of the health service.”

Hospital capacity was a problem before the coronavirus hit. The NHS has among the lowest per capita numbers of doctors, nurses and hospital beds in the western world.

A King’s Fund analysis of data from 21 countries, collected by the Organisation for Economic Co-operation and Development (OECD), found the UK had the third-fewest doctors among the 21 nations, with just 2.8 per 1,000 people, barely half the number in Austria, which has 5.1 doctors per 1,000.

The UK also had the sixth-fewest nurses for its population: 7.9 per 1,000 people — way behind Switzerland, which has the most, at 18 nurses. As for hospital beds, the UK has just 2.6 for every 1,000 people, less than a third of the number in Germany, which has the most — 8.1 beds — and leaves the UK 18th overall out of the 21 countries for which the OECD gathered figures.

“The pressure on beds is growing,” Cordery said. “The overall bed base is down by 11,000 because of social distancing measures, and the number occupied by Covid-19 patients is rising relentlessly. Trust leaders tell us it’s proving very difficult to discharge Covid-positive patients once they are medically fit to leave because of the need to find safe, suitable care.”

The staffing and beds crisis is being compounded by an emerging trend of Covid patients spending longer in hospital. Improvements in care coupled with the advent of new drugs and treatments means many who might have died in the first wave of the pandemic are now surviving — but taking up vital beds.

Those fighting for their lives in hospitals now are also slightly younger and healthier to start with. While Covid case rates have increased across all age groups, the highest rate of 434.6 infections per 100,000 population is for those aged between 30 and 39.

While the prospect of more people surviving after being taken to hospital with the coronavirus is a welcome one, it has implications for hospital capacity. Dr Chaand Nagpaul, chairman of the British Medical Association, said the NHS was “in a very precarious position” and in danger of becoming completely overwhelmed. Britain would usually see about 1,000 new respiratory-related admissions a day at this time of year. It is already close to double that for the coronavirus alone.

“We must not be under any illusion of the serious state the NHS is in and the impact that will soon have on patients, not just with Covid, but a whole host of other serious illnesses at this time,” Nagpaul added.

The NHS had made great strides over the summer to catch up on delayed treatment and resume routine operations. But officials privately admit those efforts have been derailed by Covid for months.

Some hospitals are now having to cancel some planned surgery in January and February. In addition to the coronavirus crisis, next year could bring with it the longest NHS waiting times for decades.

Nagpaul said the NHS was in “desperate need” of more staff and had been for years before the pandemic hit.

But with the training of more doctors and nurses likely to take years, medics say that in the meantime all NHS staff must be vaccinated to slash the risk of them getting ill with coronavirus.

“Without a universal policy to vaccinate frontline patient-facing staff as a priority, we could be facing avoidable staff sickness and absence over the already difficult winter months,” said Dr Zainab Najim, of the Doctors’ Association UK. “We call on Matt Hancock to act on this immediately and prevent what will be a potential disaster this winter.”