Hospitals have been ordered to cancel all non-urgent operations for at least three months as the head of the NHS warned that coronavirus is “arguably the greatest challenge” the health service has ever faced.
Sir Simon Stevens said all routine surgery should be stopped and hospitals cleared of all patients fit enough to leave in a bid to free up around 30,000 beds – one in three of all NHS beds.
On Tuesday, hospitals were ordered to take measures, including putting staff up in hotels if family members were self-isolating, in a bid to relieve pressure on services.
A letter to hospitals said the NHS is in the process of “block-buying” beds from the private sector in a bid to cope with the heavy pressure expected, and hopes to obtain 10,000 more beds. It added that all workers will be trained in how to treat coronavirus patients within the next two weeks.
The instructions follow warnings from the UK’s chief medical officer that clinical staff will be expected to work in unfamiliar circumstances and outside their usual practice as the “abnormal emergency” takes hold.
The letter also acknowledges the problems staff have had in obtaining protective equipment such as masks. It says there is a nationally adequate supply of of personal protective equipment (PPE), but adds that “locally, distribution issues are being reported.”
On Tuesday, the former health secretary Jeremy Hunt relayed the concern of several doctors as he questioned key Government figures about coronavirus in front of the Health Select Committee.
He referred to a social media post written by an anonymous A&E doctor in London, who said they were being “thrown to the wolves” with only “a bit of paper across their mouth”. It added: “Some of us are going to die.”
On Tuesday night, the Government published emergency measures to bolster the response to coronavirus. The legislation includes employment safeguards, meaning volunteers can pause their main job for up to four weeks and receive compensation for lost earnings in order to boost the number volunteering in health and care settings.
The measures also include police powers to detain those with suspected coronavirus to protect public health.
Plan to bring in thousands more ventilators
Ministry of Defence ventilators will be brought in to bolster NHS capacity, with data from Italy suggesting more patients than expected require help breathing.
In total, the health service currently has access to 8,175 mechanical ventilators, including those set up for children and those used by the armed forces.
Sir Simon told the Health Select Committee on Tuesday that “for some weeks now we’ve been out preparing and procuring mechanical ventilators and can see a line of sight over the next few weeks to another 3,799”. If realised, this would bring the total to nearly 12,000.
He refused to say whether this would be enough to cope with a flood of patients, however, telling the MPs: “It depends on how we, the people of this country, respond to the asks that have been made of us. It’s very important that we do things that will keep the infection right down.”
Emerging international and UK data on Covid-19 patients suggests a significant proportion who are hospitalised require respiratory support, particularly mechanical ventilation.
Boris Johnson is trying to encourage a national effort to get major manufacturing firms to start building ventilators, with JCB and Dyson among the manufacturers who have been asked to help.
Concerns over face mask availability
Health workers on the frontline of the coronavirus crisis have claimed they only have enough protective gear to last a matter of days, leaving some fearing for their lives. Hospitals are said to be facing such severe shortages of PPE that doctors have had to buy their own face masks from DIY shops.
It is believed those treating coronavirus are at increased risk of becoming seriously ill due to prolonged exposure or, without proper protection, passing the infection on to others.
Face masks were said to be at “dangerously low levels” by one union, at the very point at which the NHS has been told to brace for a sharp upswing in the number of cases nationwide.
One doctor working in an intensive care unit (ICU) – among the most high-risk areas for NHS staff – claimed his team would have enough supplies to last two days once cases in his area reached the same level as London. He said his colleagues had been forced to plan how to respond in the event crucial equipment such as face masks ran out.
“People were genuinely asking: ‘Do we actually go in and treat or do we not treat?’, because we are at the highest risk,” he told The Telegraph. “We are placing ourselves at significant personal risk, and our families and everything else.”
The man, who asked not to be named, said he had to go to a branch of Screwfix to buy a respirator mask – one of the last he could find in any DIY shop in Yorkshire.
On Tuesday, however, NHS England chiefs insisted there was “sufficient supply available nationally” of PPE and any apparent shortages were due to “local distribution problems”.
The Department of Health and Social Care suggested supplies had come under strain globally due to an export ban imposed by China, a major manufacturer, as it tried to bring its own outbreak under control.
Anxiety about the safety of hospital staff has been stoked by updated advice from Public Health England (PHE) scaling back the amount of protection most medics should wear.
More extensive protection – such as respirator masks, known as FFP3, gloves and eye protection – is now only advised for staff working in ICU, intensive therapy units (ITU) and high dependency units (HDU).
In other parts of hospitals, such as wards, health workers are told less PPE is needed – for example, surgical masks instead of FFP3 masks – unless they perform specific procedures.
Dr Nick Phin, the national infection service deputy director at PHE, suggested the change in advice was not linked to PPE shortages, saying: “FFP3 masks are only needed for specific situations, and we have updated the guidance to reflect this.”
More than 30,000 beds to be freed up
Nearly a third of NHS hospital beds are to be emptied and private hospitals block-booked to create space for patients with coronavirus.
NHS trust chief executives have been told to postpone all non-urgent operations for at least three months from April 15, and to start doing so earlier if they see fit.
Health service leaders revealed on Tuesday that they aim to free up more than 30,000 general and acute beds in English hospitals in the coming weeks.
The postponement of non-urgent procedures like hip and knee replacements will not only free up beds but also staff, who will be “refresher” trained to treat coronavirus patients. Operating theatres and recovery bays will also be repurposed, with NHS England hoping the move will yield up to 15,000 beds.
As well as block-booking private hospital beds – which could bring a further 10,000 online – health chiefs have ordered the urgent discharge of all hospital inpatients medically fit enough to go home.
However, asked on Tuesday by the health committee whether the cumulative measures would enable the NHS to cope in a worst-case scenario in which around 80 per cent of people catch coronavirus, Sir Simon said: “This is a global health threat. There is no health system in the world that would be able to cope if this virus let rip.”
Mr Hunt asked whether the “absolutely heartbreaking” scenes from northern Italy, with doctors forced to choose which patients got an intensive care bed, would happen in England and whether there would be guidance for medics.
NHS national medical director Stephen Powis said the health service and the Government were doing “everything we possibly can not to get into that circumstance”.
He said: “Doctors make clinical decisions with patients, with relatives, every day, and what we want to be able to do is to support doctors to make those continued decisions on the basis that they are currently making them. Because we are ahead of Italy in terms of the curve of the epidemic … that gives us the opportunity to do that planning ahead.”
Staff offered hotel space if relative could be ill
The NHS will pay for staff to stay in hotel accommodation if they wish to keep away from a family member who may be infected with coronavirus.
Amanda Pritchard, NHS England’s chief operating officer, said: “If a family member has been exposed, then absolutely if you wish to continue working, as long as you’re not going home to that person, then if we can offer you accommodation that allows you to continue to work so that you are separated from that family member then we would wish to be able to do so.”
She said infected people were not likely to be symptomatic and to have “any risk of infecting other people for the initial part of the time that they have been exposed to a family member”.
And she added: “So, actually, the risk is that you continue to stay exposed to that family member for an extended period of time, and then of course you can’t work, because you’re at a much higher risk of both getting the virus and passing it on, unless you have been tested and we know definitely … that they are negative.”
Staff attendance is reportedly being badly hampered by a lack of testing, meaning many who have coughs and colds are being sent home unnecessarily for fear they might spread the virus.
NHS leaders on Tuesday urged Public Health England, the agency responsible for testing, to ramp up testing capacity “as a matter of urgency”.