Report 27 Adapting hospital capacity to meet changing demands during the COVID-19 pandemic

To meet the growing demand for hospital care due to the COVID-19 pandemic, England implemented a range of hospital provision interventions including the procurement of equipment, the establishment of additional hospital facilities and the redeployment of staff and other resources. Additionally, to further release capacity across England’s National Health Service (NHS), elective surgery was cancelled in March 2020, leading to a backlog of patients requiring care. This created a pressure on the NHS to reintroduce elective procedures, which urgently needs to be addressed. Population-level measures implemented in March and April 2020 reduced transmission of SARS-CoV-2, prompting a gradual decline in the demand for hospital care by COVID-19 patients after the peak in mid-April. Planning capacity to bring back routine procedures for non-COVID-19 patients whilst maintaining the ability to respond to any potential future increases in demand for COVID-19 care is the challenge currently faced by healthcare planners. In this report, we aim to calculate hospital capacity for emergency treatment of COVID-19 and other patients during the pandemic surge in April and May 2020; to evaluate the increase in capacity achieved via five interventions (cancellation of elective surgery, field hospitals, use of private hospitals, and deployment of former and newly qualified medical staff); and to determine how to re-introduce elective surgery considering continued demand from COVID-19 patients. We do this by modelling the supply of acute NHS hospital care, considering different capacity scenarios, namely capacity before the pandemic (baseline scenario) and after the implementation of capacity expansion interventions that impact available general and acute (G&A) and critical care (CC) beds, staff and ventilators. Demand for hospital care is accounted for in terms of non-COVID-19 and COVID-19 patients. Our results suggest that NHS England would not have had sufficient daily capacity to treat all patients without implementing hospital provision interventions. With interventions in place at the peak of the epidemic, there would be no capacity to treat elective CC patients. CC shortfalls would have been driven by a lack of nurses, beds and junior doctors; G&A care would have been limited by bed numbers. If interventions are not maintained, 10% of elective CC patients can be treated once the number of COVID-19 patients has fallen to 1,210; 100% of elective CC patients can be treated once the number of COVID-19 CC patients has fallen to 320. Hospital provision interventions would allow 10% of CC electives to be treated once the number of COVID-19 CC patients has fallen to 2,530 and 100% of CC electives once the number of COVID-19 CC patients has fallen to 1,550. To accommodate all elective G&A patients, the interventions should not be scaled back until the number of COVID-19 G&A patients falls below 7,500. We conclude that such interventions need to be sustained for patients requiring care to be treated, especially if there are future surges in COVID-19 patients requiring hospitalisation