The NHS in Wales is postponing routine outpatient appointments and operations, in the most striking sign yet of how the coronavirus outbreak is set to strain vital services in the UK.
The move comes amid a growing expectation among health staff in England that a similar edict to postpone non-urgent treatment may shortly be issued there too.
Explaining the Welsh move, health minister Vaughan Gething said: “I have acted now before we see significant numbers of very ill people come into our NHS. This time is important for our staff to prepare.”
Some hospitals in England have already begun postponing non-essential surgery, even without a formal instruction to do so, as they prepare to cope with thousands of coronavirus cases, the service’s biggest challenge in a generation.
At least two hospitals have already taken their own decisions to delay operations, according to one person familiar with the development.
The postponements are particularly affecting operations with long recovery times, which would require an extended stay in hospital.
The NHS was already enduring one of its worst winters on record, even before the full scale of the unfolding public health crisis became clear. However, publicly NHS and health department leaders remain confident it will cope.
Giving evidence to MPs on the health select committee last week, Chris Whitty, England’s chief medical officer, said: “The NHS is an emergency service. It is incredibly good at flexing to meet whatever demands are made of it.”
Explaining the thinking behind stopping non-urgent procedures, one senior executive, who did not wish to be named, said: “You try and start with as un-decongested a hospital as possible, to prepare for a massively increased caseload due to a pandemic. And that’s what we’re in the process of doing.”
He added: “It’s not because, at this point, hospitals are already struggling.”
Overall, the strain on capacity from the epidemic is likely to be most keenly felt in intensive care units. NHS England figures published on Thursday indicate that in January there were 4,123 adult critical care beds available with 3,423 occupied — an occupancy rate of 83 per cent.
Although estimates of the number of intensive care beds that could be needed vary, most projections are way above what could be available and leaders including former health secretary Jeremy Hunt have suggested the NHS may be unable to cope.
“If 5 per cent of the population get the virus and 5 per cent of those people need an intensive care bed, that’s over 150,000 people who will need intensive care and we only have 4,000 beds,” he told C4 News on Thursday.
Helen Buckingham, director of strategy at the Nuffield Trust, the independent health think-tank, said the NHS could free up capacity for extra critical care by cancelling elective surgery to free up beds, or create new bed capacity, which would require obtaining new equipment. Capacity could also be found in the private sector, or in repurposed operating theatres if surgery was cancelled.
“If you’re stopping elective surgery and repurposing your theatres there’s actually a lot of capacity you can create,” she said.
But if too much focus was placed on improving hospital facilities while neglecting community care people could end up being admitted to hospital unnecessarily, she said, further straining the service.
The crisis has also turned a spotlight on whether sufficient equipment is available to cope with a surge in patients with the respiratory symptoms associated with the virus, as well as appropriate numbers of staff. “Generally intensive care is very full all the time. There’s very very little slack in the system,” Dr John Puntis, a retired paediatrician and co-chair of Keep Our NHS Public, a campaign group, said.
“They will need to provide a lot more ventilators and of course the expert staff to look after them. It’s very difficult to see how they could significantly increase numbers.”
Staffing shortages are likely to hamper further the ability of intensive care facilities to cope with the expected rush of demand. Between July and September 2019 there were 92,149 advertised vacancies in the NHS.
One manager at a London hospital said outpatient appointments were not being booked unless they were clinically urgent, and that some of those already scheduled had been cancelled.
He stressed the decision to postpone appointments would be clinically led and on a case-by-case basis, based on consultants’ assessment of individual needs and the demands of their schedules.
“People are very calm, there isn’t a sense of panic but it’s occupying most people’s head space,” he said. “Cancellations are already under way.”
Internal guidance for consultants, circulated by one London trust, said booking of future appointments had been suspended unless clinically urgent, and that as many appointments as possible were being conducted remotely over Skype or similar apps.
Vin Diwakar, the regional medical director of NHS England, told the health committee of the London Assembly on Wednesday that the “underlying principle” was to ensure that NHS facilities were available for those in most urgent need of care.
“Our main priority is to make sure that we treat patients in order of clinical priority,” Dr Diwakar added.
The Nuffield Trust pointed out that last month had seen “some much-needed let up” in accident & emergency. John Appleby, director of research, said public health messaging “may be getting through to the public, who appear to be thinking carefully about staying away from hospital and are seeking advice through NHS 111”.
Meanwhile to some of those on the front line, postponing operations, especially those with extended recovery times, is simple commonsense, rather than a cause for panic.
One executive said: “If you’ve got somebody coming in that you think might be there for a week or two weeks to recover, but it’s not absolutely vital and it can be delayed by three, four, five months, why wouldn’t you do that at this point?”
