NHS hospitals outside London are at greater risk of becoming overwhelmed during a major coronavirus epidemic, according to new analysis.
Rural areas will be hit hardest by a national shortfall of hospital beds as the virus outbreak sweeps across the country, modelling seen by The Telegraph suggests.
Meanwhile, senior doctors warned that elderly and frail people may be denied critical care if hospitals run out of room. Health chiefs are discussing plans to “move the goalposts” so priority is given to younger patients with better survival chances, it is understood.
On Wednesday night, senior NHS sources defended the controversial approach, saying it would help the health service to “flex” during a potential crisis.
According to the new analysis, produced by Edge Health – which advises NHS trusts across England – London is better prepared than other regions to cope with coronavirus, although the capital will also face substantial pressures.
The largest shortfall in hospital beds is in the Midlands, where 2,900 extra beds and ventilators will be needed during the epidemic’s expected peak over the coming weeks:
In the south-west, the region with the oldest population and the highest expected mortality rate, hospitals are equipped with the lowest number of critical care beds per head of population, although infection rates in the area are currently low.
“Our ‘balanced scenario’ (mitigated growth and isolation of vulnerable) estimates a requirement for an additional 155,000 beds and 18,000 beds with ventilators,” the report says.
“The maps show that existing bed capacity, much of which has high occupancy, is located away from rural communities where the age profile is older.”
Ministers are drawing up plans to put London in lockdown because the capital is currently “ahead of the curve”, with more than 19 Covid-19 infections per million people.
However, it also has the youngest population – so the lowest expected mortality – and the highest number of critical care beds per head of population.
“Even if the entire NHS bed capacity were re-created in just six weeks, we would still have patients in need of a bed by the middle of May,” the report warns.
“This pressure is most significant for patients that need critical care beds with ventilation support, which if not met will likely result in increased mortality rates.”
Senior doctors warned that a major shortfall in beds would be likely to result in clinicians having to deny critical care to the weakest and oldest patients.
“The first thing to say is that we will make every effort to treat as many people as possible,” said Dr Ron Daniels, the founder of the UK Sepsis Trust and an intensive care consultant at the Heart of England NHS Foundation Trust in Birmingham.
“But it doesn’t surprise me that the Midlands will fare much worse than London if the epidemic hits hard. Investment has long been focused on London and the north-west.
“The prospect of having to deny care to people who we may be able to help in a normal situation is terrifying. However, that’s the reality we may be faced with, so we have to prepare properly.”
Across the country, doctors are drawing up similar plans for “aggressive triage” amid concern that the UK only has a fraction of the intensive care beds needed.
The plans are referred to in guidance issued last week to every critical care doctor in the country.
According to a letter sent by the Intensive Care Society, the UK’s representative body for intensive care professionals, medical chiefs are now considering “declining a patient on the basis of capacity rather than the usual triage by likely outcome/benefit”.
The letter, seen by The Telegraph, advises: “Trust systems such as ‘three wise people’ should be deployed for mutual multi-disciplinary support.”
During the swine flu outbreak in 2009, the so-called ‘Three Wise Men’’ protocol was adopted by NHS Trusts as an ethical framework on how to manage a major pandemic. Under the rules, three senior consultants should be consulted before any elderly or infirm patient is denied critical care. The protocol states: “Everyone matters equally – but this does not mean that everyone is treated the same.”
Senior health chiefs told The Telegraph they had already begun discussions on how to prioritise younger and healthy patients, but stressed that the system was “not there yet”.
“There are discussions taking place at our hospital, and others too, about moving the goalposts in the event of an outbreak,” one senior doctor said. “Of course, making decisions about who would benefit from intensive care, and who would not, is a key part of the job already.
“The uncomfortable truth is that during an outbreak we will be forced to make clinical judgments about who is most likely to benefit from hospital care. There may not be beds available for some elderly people with severe underlying health problems, for example, compared to adults of working age.
“If your 85-year-old grandmother with cancer develops symptoms, then we would be likely to decide that a bed in intensive care is not appropriate given the level of demand. The expectation of families as to what is possible will have to change.”
An NHS England spokesperson said: “As the chief medical officer has said, as coronavirus expands the NHS will flex its response in line with well-established escalation plans.”