Hospitals will be forced to cancel routine operations across England due to pressures from resurgent Covid despite the new lockdown measures, doctors’ leaders have warned.
The NHS is facing potentially “impossible” demands in the months ahead and hospitals everywhere would soon have to follow the lead of those in the north of England and Midlands by cancelling non-essential surgery, against the wishes of NHS bosses and ministers.
Doctors’ leaders also said the new lockdown in England was necessary and inevitable but warned that tens of thousands of NHS vacancies across the service would make the Nightingale field hospitals hard to staff during a surge of Covid patients.
“Things are going to get worse in the NHS before they get better, even with the lockdown, because it takes time for people who have been infected to get sick and come to hospital. So the impact on changes to transmission rates from the lockdown will take a while to show up,” said Dr Tom Dolphin, a consultant anaesthetist and member of the British Medical Association’s council.
Dr Claudia Paoloni, president of the Hospital Consultants and Specialists Association, said: “It’s difficult to predict if this [lockdown] will be sufficient, being implemented so late and missing the opportunity of half-term school closures, especially as it is a modified and not full lockdown, with schools, universities and manufacturing kept open.
“Although this can certainly reduce the infection rate, if adhered to fully, whether it can get the R rate [the average number of people each case infects] below 1 and keep NHS capacity to a manageable level will need close monitoring.”
Hospitals will find it hard to treat both Covid patients and those with other illnesses unless the public strictly follow the new rules from Thursday, warned Dr Alison Pittard, the dean of the Faculty of Intensive Care Medicine. “The NHS won’t collapse but patients with non-Covid illnesses will suffer if we don’t control transmission and more people will die,” she said.
“Intensive care units have seen a steady increase in the number of Covid cases. Staff are back in full PPE, working in surge capacity, non-ICU staff are helping out. Routine operations are being cancelled in order to accommodate Covid patients. It all feels like deja vu but with the added burden of trying to maintain as much non-Covid activity as possible.”
NHS England and Boris Johnson want normal NHS care, especially surgery, to continue during the second wave, unlike in the spring, when it was mostly suspended. But Dr Sue Crossland, president of the Society for Acute Medicine, said that was unlikely to prove possible and that the needs of people needing life or death care because of Covid must take priority.
“A second lockdown was inevitable given the exponential rise in cases. We are now at a point where we have to minimise the risk between caring for Covid patients and ensuring that other patients waiting for treatment are also cared for in a timely fashion. It is difficult, if not impossible, to square this circle,” she said.
“The difficult decisions being advised by the scientific evidence and SAGE are not easy, but we need to ensure we protect the vulnerable and keep the NHS working for those who need it most.”
The BMA’s Dolphin agreed. “You can’t turn Covid patients who are septic and breathless and unwell away at the front door. You’ve got to admit them. [But] then you’ve got no beds to admit people in for other conditions,” he said.
Senior doctors are divided over what role the seven Nightingale field hospitals might play this time. The first to open, in London, was the only one to care for patients in the spring.
Paoloni said: “The NHS has one of the lowest hospital bed bases in Europe. There are 246 beds per 100,000 population in the UK compared to 800 per 100,000 in Germany. [Given that] I suspect the Nightingales will have to be used, but staffing levels will restrict what they can be used for.” Nightingales in Manchester, Harrogate and Sunderland have been put on standby.
Dolphin cautioned that the more than 100,000 vacancies in the NHS makes staffing the field hospitals difficult. “A lot of people are saying ‘the Nightingales will save us’. But I’m not convinced they’re necessarily going to be the answer to everything. They are physically there and have beds and equipment you need, like ventilators. But who is going to staff them? There aren’t any extra doctors or nurses sitting out there doing nothing, waiting to be called up to the Nightingales.”