Hospitals in England urgently discharging patients and private firms called in to help

This article is more than 6 months old

This article is more than 6 months old

Millions of operations are being postponed, patients urgently discharged from hospital and private operators called in to help the NHS cope with the coronavirus crisis.

The moves are intended to help the already overstretched health service manage the “intense pressure” that the growing epidemic will put on it by leaving large numbers of people struggling to breathe.

Hospitals in England have been told to postpone all non-urgent elective operations from 15 April at the latest, for a period of at least three months. Emergency surgery and cancer operations will still go ahead, however.

Millions of patients will have to wait longer than planned for procedures such as a cataract removal, hernia repair or hip or knee operations, with 700,000 people a month usually undergoing some form of non-urgent surgery.

NHS England hopes the measures will free up 30,000 hospital beds – about 30% of the 100,000 total – which can be used for patients left seriously unwell with Covid-19.

Hospital bosses said the unprecedented changes would disappoint patients but were needed, given the scale of the threat.

Quick guide What to do if you have coronavirus symptoms in the UK Show Hide Symptoms are defined by the NHS as either: a high temperature - you feel hot to touch on your chest or back

a new continuous cough - this means you've started coughing repeatedly NHS advice is that anyone with symptoms should stay at home for at least 7 days.

If you live with other people, they should stay at home for at least 14 days, to avoid spreading the infection outside the home. After 14 days, anyone you live with who does not have symptoms can return to their normal routine. But, if anyone in your home gets symptoms, they should stay at home for 7 days from the day their symptoms start. Even if it means they're at home for longer than 14 days. If you live with someone who is 70 or over, has a long-term condition, is pregnant or has a weakened immune system, try to find somewhere else for them to stay for 14 days. If you have to stay at home together, try to keep away from each other as much as possible. After 7 days, if you no longer have a high temperature you can return to your normal routine. If you still have a high temperature, stay at home until your temperature returns to normal. If you still have a cough after 7 days, but your temperature is normal, you do not need to continue staying at home. A cough can last for several weeks after the infection has gone.

Staying at home means you should: not go to work, school or public areas

not use public transport or taxis

not have visitors, such as friends and family, in your home

not go out to buy food or collect medicine – order them by phone or online, or ask someone else to drop them off at your home You can use your garden, if you have one. You can also leave the house to exercise – but stay at least 2 metres away from other people. If you have symptoms of coronavirus, use the NHS 111 coronavirus service to find out what to do. Source: NHS England on 23 March 2020

“This is sensible. Trusts need to increase bed capacity to deal with the added pressures of coronavirus,” said Chris Hopson, the chief executive of NHS Providers, which represents care trusts.

“Postponing elective operations in this way will free up beds, space and staff to support this effort, strengthening their ability to provide critical care. While this will be disappointing for those waiting for treatment, it is clearly a necessary move.”

Scrapping elective surgery will allow time for staff to be retrained and operating theatres and recovery facilities to be adapted for patients with Covid-19, as well as freeing up beds.

Hospitals also plan to urgently discharge all inpatients who are medically fit to leave. Between them they occupied an average of 3,450 beds a day in acute hospitals in January, which meant a total of 160,637 bed days were lost to people who did not need to be there.

Providers of community-based health services and social care will have to arrange packages of care to keep discharged patients – mainly the frail elderly – safe back at home or find them a place in a nursing home.

The private healthcare sector will also play a key role in helping the NHS deal with what service bosses and senior doctors believe will be the biggest challenge it has ever faced.

According to the NHS, privately run hospitals will have to:

Greatly expand the number of operations they already perform on NHS patients in order to keep the waiting list down “before Covid constraints curtail such work”.

Perform urgent surgery, a new departure from their usual more limited role of planned procedures.

Allow their beds, operating theatres and recovery suites to be “repurposed” so they can be used by Covid-19 patients.

In a dramatic extension of the independent sector’s role in providing NHS care, the NHS will also take over beds in private patient units which, although based at NHS hospitals, are run by for-profit companies.

Together with the enhanced role for private hospitals, that could free up about 10,000 beds in NHS hospitals, NHS England said.

Most hospital trusts are switching as many of the 8m outpatient appointments that occur each month to be done as video or telephone consultation, in order to free up doctors’ time.

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“We are pleased … that the independent sector will be working in partnership with NHS England as part of the response to Covid-19, including by making thousands of hospital beds available and engaging the skilled staff employed by independent sector providers in care at every level,” said David Hare, the chief executive of the Independent Healthcare Providers Network, which held detailed talks with NHS officials about the details of how the collaboration would work.

“It’s important to be clear that over the next few weeks, until there is a national decision, both NHS and private planned care will continue in independent providers. We are doing everything we can to make sure people can still get access to care until the point when it is agreed to focus exclusively on Covid-19 and essential services.”

The NHS has also pledged to ramp up supplies of oxygen to hospitals so they can operate the greatly increased number of intensive care beds with ventilators that are planned.

However, in a letter to NHS trusts, the NHS England chief executive, Sir Simon Stevens, insisted the service as a whole had adequate supplies of personal protective equipment for dealing with Covid-19 patients but that some “local distribution issues” had created problems.

Dr Samantha Batt Rawden, the co-founder of the Doctors’ Association UK, welcomed a plan for the NHS to pay for staff to stay in hotels while the rest of their family is self-isolating. But she cautioned that “separating doctors from their unwell families to allow them to continue to work in the NHS should not be seen as a long-term solution. Instead, we call on Public Health England to extend testing to household members of frontline NHS workers to allow NHS staff to return to the frontlines rather than undergoing 14 days of household isolation.”