The 360: Can the NHS deal with a coronavirus pandemic?
“The 360” shows you diverse perspectives on the day’s top stories
What’s happening
On Thursday afternoon, the government confirmed there have been two more deaths from coronavirus and 134 confirmed cases in the past 24 hours – the biggest jump in the UK since the outbreak began.
With every passing day, the UK is suffering a surge of coronavirus cases. Before long, the NHS could find itself under massive strain – and there are serious questions about whether it would cope.
In its coronavirus action plan, the government has said a minority of people who get Covid-19 will develop complications severe enough to require hospital care, with some cases leading to death.
However, with a worst-case scenario of 80% of Brits becoming infected, that “minority” could equate to tens of thousands of people needing hospital treatment from a health service that critics say is already under massive pressure.
Why there’s debate
In December’s general election – back in the days when the public had never heard of coronavirus – the NHS was the only issue that could match Brexit for importance.
Never was this more apparent than when four-year-old Jack Williment-Barr was photographed sleeping on the floor of an overcrowded A&E unit due to a lack of beds. The boy had suspected pneumonia, and it painted the picture of an NHS unfit for purpose after insufficient investment.
At the same time, the service is also suffering long waiting times, high bed occupancy and high staff vacancies.
If the coronavirus spread truly takes hold, these problems will be exacerbated further. The government says as much in its action plan, admitting it is planning to call recent NHS leavers and retirees back into duty to make up for staff shortages.
What’s next
The government will pump emergency cash into the NHS as it tries to get a grip of the outbreak, though whether it abates the existing problems remains to be seen.
How the NHS copes with coronavirus will have implications even for those who avoid being infected, with the government having said lower-priority healthcare appointments will be delayed.
And, if the NHS does suffer to the extent speculated by numerous doctors, a growing number of fingers will be pointed at Boris Johnson and his Conservative Party, which has been overseeing the service for the past 11 years.
Perspectives
Woefully unprepared, even for a modest rise
“The UK appears woefully unprepared for coronavirus. The NHS is already in bad shape, with the worst ever A&E waiting times, over 95% bed occupancy, 100,000 staff vacancies and the prospect that a no-deal Brexit will majorly disrupt the supply of medicines. With the worst-case scenario suggesting up to 50 million infections and up to 250,000 deaths in the UK alone, there can be little doubt that both health and social care services will be severely challenged by even a modest intensification of the outbreak.” – Dr John Puntis, Independent
Specialist bed capacity will not be enough
“Several of my medical colleagues say they hope to get hit by coronavirus early, when there are beds available with oxygen and sufficient NHS staff to cope. On 1 March, health secretary Matt Hancock claimed that the NHS has around 50 beds currently suitable for ventilating isolated patients, and the ability to scale rapidly to 500 and then 5,000 beds before too long. But based on the estimated number of people likely to become infected, even Hancock’s optimistic aspiration of 5,000 beds will not be enough.” – Prof Michael Barrett, New Statesman
Best hope is public co-operation
“It is right to hope that the effects of this dangerous microbe can be mitigated in a way that avoids disruption on such a scale and, above all, does not overwhelm the precious resources of the NHS. As the government seeks to bolster the number of volunteers available to the health service, it is increasingly clear that that hope of mitigation will rely heavily on us – the ability of individuals and communities to shoulder the responsibilities of this crisis, from our new national religion of hand washing to accepting whichever ‘social distancing’ measures come our way.” – Cahal Milmo, i
Strain could be grave
“If the virus escalates in scale, the impact on an NHS that is already under intense strain – with record numbers of patients on waiting lists, people routinely being treated in hospital corridors and others waiting weeks for a GP appointment – will be grave. The public and our members will be rightly worried about how services will cope.” – Dr Helena McKeown, British Medical Association
Extreme precautions are being taken
“The challenge from Covid-19 to ICU (intensive care unit) services in the UK is enormous and pressing. Throughout the UK, ICUs are preparing exceptional plans and training all staff to manage these patients with skill and safety, for the patient and themselves. Hospitals are acting to expand ICU care outside its existing footprint and double or even treble ICU capacity, most likely by taking over operating theatres. This expansion will involve engaging anaesthetists and others to provide ICU medical care and nurses from elsewhere in the hospital to work as ICU staff. To facilitate this, much or all routine surgery will need to stop. Many patients with Covid-19 will also be hospitalised outside ICU and care of these patients and those in ICU will have major consequences for caring for other patients who do not have Covid-19. Whether these extreme precautions will be needed is unknown. If they are, whether even these measures will be sufficient is also unknown.” – Dr Tim Cook, The Guardian
Success depends on delaying spread
“Much, perhaps all, will depend on the success or otherwise of the strategy to push back and flatten the curve of the epidemic. In Wuhan and Italy, where hospitals were caught on the hop and overwhelmed, the death rate is running at more than 3%. Many readers will assume the NHS is in a better position but consider this: Italy has almost twice as many critical care beds per head of the population as us. They are at capacity now but just a few weeks ago only 60% were in use. Critical care beds in NHS are already running at nearly 80% occupancy - and the epidemic here has not even got going yet.” – Paul Nuki, The Telegraph
Already under-performing
“One of the problems is the NHS is already under much more pressure than it was 10 years ago. Key waiting time targets are being missed across the UK, while record numbers of seriously ill patients are ending up on trolleys stuck in corridors because there are no beds available. Staffing vacancies are also high – one in 12 posts is unfilled in England.” – Nick Triggle, BBC
Implications for social care
“One of my biggest worries is the ability of social care providers to keep their services going. Because of the well-documented squeeze on social care funding, those who do receive care tend to have the most serious health problems. If Covid-19 puts further pressure on social care, many people receiving care will end up hospitalised, putting further pressure on their services.” – Helen Buckingham, Independent
The numbers don’t add up
“If we are now contingency planning for 20% of the workforce to be absent at the peak of an outbreak, that’s six million people. To understand how badly that might affect us, just consider the potential strain on the NHS. There are around 102,000 general and acute beds in the NHS in England. Of these, around 9,000 are routinely free overnight. In China, the location of the only full-blown outbreak so far, around 8% of reported cases have become “serious or critical”. If the proportions were the same here, then only 113,000 people would need to be reported as infected to fill those 9,000 spare beds with coronavirus cases. That’s a long way short of six million and, long before we reach the higher figure, the NHS would be overwhelmed.” – Paul Mason, News Statesman
Impact on doctors’ morale
“We are being advised there is no need to panic, and with my logical hat on, I would agree with the health authorities that individual risk is low. However, having recently come into contact with a patient who was possibly infected (he later tested negative), it suddenly felt all too close to home. I’m also in the third trimester of pregnancy so this heightened my sense of panic. Working on the frontline, I have to admit that I've started to feel a little worried.” – Dr Punam Krishan, i
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