The media is full of alarming reports of NHS hospitals being on the brink of armageddon, such is the surge in coronavirus patients. “As we head into the new year we are seeing a real rise in the pressure on NHS services, particularly across London and the south-east,” Saffron Cordery, the Deputy Chief Executive of NHS Providers told the Guardian.
A letter from NHS chiefs sent to the chief executives of all NHS trust and foundation trusts on December 23rd contained this alarming paragraph:
With COVID-19 inpatient numbers rising in almost all parts of the country, and the new risk presented by the variant strain of the virus, you should continue to plan on the basis that we will remain in a level 4 incident for at least the rest of this financial year and NHS trusts should continue to safely mobilise all of their available surge capacity over the coming weeks. This should include maximising use of the independent sector, providing mutual aid, making use of specialist hospitals and hubs to protect urgent cancer and elective activity and planning for use of funded additional facilities such as the Nightingale hospitals, Seacole services and other community capacity. Timely and safe discharge should be prioritised, including making full use of hospices. Support for staff over this period will need to remain at the heart of our response, particularly as flexible redeployment may again be required.
And the Independent reports that the London Ambulance Service has issued a warning saying it can no longer guarantee an ambulance will turn up if women giving birth at home require emergency care.
Sounds like a major crisis, right? Better move the rest of England into Tier 4, make mask-wearing mandatory in all settings and close schools until Easter.
Or is it?
If you look at ICU occupancy in NHS hospitals across England on December 20th it was lower than the December average in 2019 in most of the country – and it’s worth remembering that the 2019-20 flu season was unusually mild.
Admittedly, the total number of ICU beds occupied in London on Dec 20th was quite a bit higher than the average for December 2019, but according to the ZOE app daily symptomatic cases in London are falling. The ZOE data in the graph below shows rising and falling daily symptomatic cases up to December 27th.
It’s also worth bearing in mind that there are more ICU beds this year than last year, so if you calculate the percentage of ICU beds occupied in NHS hospitals across England and compare that to the average percentage in December 2019 the picture looks even less bleak. In every region, including London, the percentage of ICU beds occupied at the moment is lower than it was this time last year.
Dec 2019 average: 76.3%
On Dec 20th 2020: 74.0%
Dec 2019 average: 88.7%
On Dec 20th 2020: 86.3%
Dec 2019 average: 82.2%
On Dec 20th 2020: 67.0%
North East and Yorkshire:
Dec 2019 average: 78.4%
On Dec 20th 2020: 69.8%
Dec 2019 average: 82.6%
On Dec 20th 2020: 68.7%
Dec 2019 average: 83.7%
On Dec 20th 2020: 75.4%
Dec 2019 average: 79.5%
On Dec 20th 2020: 73.3%
I’m not suggesting that NHS hospitals aren’t under pressure – nor even that they aren’t under more pressure than they were this time last year. But the issue isn’t a lack of ICU beds and it doesn’t appear to be a surging number of patients admitted to ICU beds with COVID-19. After all, if those numbers were surging on top of the usual December admissions for respiratory diseases you’d expect the total number of ICU beds occupied to be much higher this year than last and, as you can see from the Spectator data, the totals are lower in four of England’s seven NHS regions.
The reason for the crisis – if indeed there is a crisis – must lie elsewhere.
My money’s on a combination of higher-than-average staff absences and poor management. Disappointing, considering the NHS has had over six months to prepare for this “crisis”.