Hospitals are trebling the size of their intensive care units and preparing to replace A&E doctors with other specialists as the NHS braces itself for a surge in patients whose life is at risk from the coronavirus.
Millions of patients will have their care delayed as hospitals cancel non-urgent operations, including some surgery for people with heart and lung conditions.
Hernia repairs, cataract removals and hip and knee replacements will be among the many procedures affected. Around 700,000 people a month in England have a planned procedure. Single rooms freed up will be used as isolation facilities for Covid-19 cases.
One senior official told the Guardian that hospital trusts across England were moving rapidly to “a footing unlike anything ever seen in peacetime, for something that will be far harder to deal with, and will go on much longer, than even a bad winter crisis”.
Hospital bosses and senior doctors have outlined the unprecedented range of measures the NHS is preparing to implement. The disruption could last for months.
Trusts have started writing to those affected to alert them and to warn that they do not know when they will be able to rearrange treatments.
Cancer and vascular procedures and other urgent operations are expected to still go ahead, as long as they are deemed to be clinically justified and not a drain on resources.
Many outpatient clinics will be scaled back, held by telephone or video instead or scrapped altogether, affecting many of the 8 million patients who attend them every month.
With the prime minister warning that the UK must brace itself for a sharp rise in cases over the coming weeks, hospitals have begun setting up dedicated wards.
These include makeshift intensive care beds in operating theatres, in which to treat patients who are struggling to breathe as a result of Covid-19 and are on a ventilator.
Senior doctors who spoke to the Guardian said they were increasingly concerned that the NHS had too few beds and specialist staff to treat the expected influx of patients with the disease.
There are also growing fears that doctors and nurses who treat them will be putting themselves at risk. Repeated exposure to those infected could push “morbidity through the roof” among healthcare workers, the boss of one A&E unit said.
“We are stopping most elective surgery and most outpatient reviews, and have suspended staff leave,” Prof Steve Field, the chair of the board of the Royal Wolverhampton NHS Trust, which runs the city’s New Cross hospital, told the Guardian.
He added: “Stopping elective operations has helped us to more than double the number of ventilators we have to 70. We are also reorganising our acute medical wards to cope with patients who have coronavirus, and getting doctors and nurses to work across specialities. And we have bought lots of new kit.”
At a London hospital, managers and doctors are seeking to treble their capacity of intensive care beds.
However, one source said it was constrained by shortages of space and the “finite number of intensive care doctors and nurses”.
It plans to cancel all elective (non-urgent) procedures to free up beds for Covid-19 sufferers.
A&E doctors and nurses there will be redeployed to treat coronavirus patients, with orthopaedic staff – who usually deal with conditions affecting bones and joints such as broken limbs – given extra training to take on their roles in the emergency department.
A raft of trusts have already decided to cancel some, most or all elective surgery, including Guy’s and St Thomas’, King’s College hospital and Imperial healthcare trusts in London and University Hospital Birmingham (UHB) trust, which runs four local hospitals.
Earlier this week Guy’s and St Thomas’ trust wrote to a patient to explain a delay to potentially life-saving surgerybecause it was “expecting all non-urgent surgeries to be cancelled due to the current crisis”.
The letter said: “Due to the ever-changing state of Covid-19 we have just been informed that we cannot book any surgeries later than three weeks from now and there were no slots with the surgeon available before then.”
In a memo seen by the Guardian, a senior manager at King’s College trust has also told staff: “With immediate effect the trust is escalating its response to Covid-19. This will enable us to continue to effectively and safely manage the expected and increasing number of patients testing positive for coronavirus.
“At Denmark Hill [King’s College hospital] and Princess Royal University hospital [in Orpington, Kent, which it also runs], with the exception of surgery for cancer and other life-threatening conditions, all elective inpatient activity will stop until further notice,” he added.
In a statement to the Guardian, Lisa Stalley-Green, UHB’s executive chief nurse and director for infection prevention and control, said: “Unfortunately we will need to postpone some non-urgent routine elective activity, such as operations which patients don’t need straight away.
“Consultations and outpatients appointments … will instead be carried out by telephone or teleconferencing. We are also looking to increase the number of beds in critical care [intensive care and high dependency], currently 120, across the trust.”
In a sign of NHS chiefs’ anxiety over the increasing spread of the coronavirus, growing numbers of hospitals, including the Imperial group of four acute hospitals in west London, have begun restricting visitors to one per patient as a safety precaution.
Dr Samantha Batt Rawden, a co-founder of the Doctors’ Association UK, said the unprecedented shutdown of normal NHS activity was justified.
“Covid-19 may well be the biggest challenge the NHS has yet to face and will no doubt require extraordinary measures to be taken.
“However we cannot ignore the state that the NHS has been left in by this government. After years of short-staffing our health service is much less equipped to deal with this pandemic whilst continuing to provide care for non-Covid related illness or injury.”
