NHS leak reveals true impact of coronavirus second wave on hospitals

Hospitals in the north of England hit hard by increasing surge in Covid-19 patients

Leaked NHS data has revealed the full scale of the impact of the second wave of coronavirus on hospitals in England with some now treating more patients than they did during the spring.

There were almost 6,100 patients with the virus in hospitals across England on Thursday, with 4,670 receiving oxygen and 653 in critical care. A total of 563 patients were on ventilators to help them to breath.

The data, obtained as part of a joint investigation by The Independent and the Health Service Journal, showed hospitals in the north of England were the hardest hit with more than a quarter of beds, 408, at the Liverpool University Hospital Trust occupied by Covid-19 patients.

But the problem is spreading with nearby Lancashire and South Cumbria region seeing 15 per cent of hospital beds, or 544, occupied by Covid-19 patients. While in the northeast and Yorkshire there were 1,531 patients with coronavirus in hospital, 9 per cent of the whole region.

The data, which is routinely collected but not published by NHS England, also reveals the extent of the virus in Greater Manchester which has been at the centre of a political row in recent days. Despite repeated requests the NHS has refused to make the data on how the virus is affecting hospitals public.

On Thursday there were 685 patients in Manchester hospitals, 11 per cent of the total beds available, with another 100 patients suspected of having the virus. There were 62 patients being ventilated with 522 needing oxygen. The region’s Nightingale hospital is to be the first to re-open it was announced on Thursday.

The numbers of patients are in-line with a worst-case scenario trajectory produced by NHS managers on the 6 October which said the numbers of patients on 20 October would be 664. If the trajectory holds the region will have 1,460 coronavirus patients by the 10 November.

One of the region’s intensive care doctors told The Independent: “The numbers are clearly following that line and not deviating from it. It is absolutely terrifying. If that prediction comes true it would be the end of routine operations and even cancer care at that rate.”

In Birmingham, where hospital bosses have begin cancelling some operations and turning non-emergency patients away from A&E there were 171 Coronavirus patients with 26 in critical care and 18 patients on a ventilator. More than 150 patients were on oxygen.

Across the Midlands as a whole there were 1,161 patients with coronavirus on wards, 6 per cent of the total number of beds available. There were 142 patients in critical care.

A senior clinician at Liverpool University Hospitals FT said non-urgent operations had been "hit hard" by the surge in covid patients and had an impact on critical care capacity. They said the trust had transferred some critically ill patients to the nearby Walton Centre FT and Liverpool Heart and Chest Hospital, which both have critical care units. Cancer and urgent electives are continuing for now, they said.

During the first wave of the virus the trust never saw more than 400 coronavirus patients on its wards but as of Thursday had 408. Similarly in Lancashire and South Cumbria it reached a maximum of 501 patients on 12 April but now has 544 patients.

One NHS manager in the region said: “The Lancashire and South Cumbria system is in real trouble and yet NHS England are telling us we must continue with electives.

“Electives can’t keep carrying on as they are, problem is the on the day cancellations will grow, especially as the ICU surge capacity sits inside most of the theatre capacity so by default you can’t have both simultaneously.”

The number of “unoccupied” hospital beds is much lower now than in the spring, when the NHS discharged thousands of patients in anticipation of a peak in admissions. In the north west, up to 5,500 acute beds were reported as “unoccupied” in the spring, whereas the figure now is about 2,500.

Critical care beds are the key to whether hospitals can continue to operate on routine patients. Almost half of Liverpool’s mechanical ventilation beds (29 out of 62) are occupied by confirmed Covid patients; and a third of those across the north west (178 of 556).

So far the NHS has yet to open many extra “surge” beds where patients are looked after in makeshift intensive care units set up for example in operating theatres or nearby recovery rooms.

It suggests the pressures on hospitals is being managed by cancelling routine operations or moving activity to private hospitals or other NHS trusts rather than stretching staff to look after more patients which was what happened during the first wave.

Intensive Care Society president Ganesh Suntharalingam said: “Going into surge capacity is not trivial – it is at the expense of staff in terms of stress and PTSD and possibly of patient outcome, so flexing staffing ratios is justified only as a crisis response.

“Alternative responses should be considered first, which may include temporarily transferring other work such as planned care to other hospitals or even other parts of the UK. This may not sit well with local targets or inter-organisational politics, but needs to be part of the debate.”

Nicki Credland, chair of the British Association of Critical Care Nurses, said: “We are certainly looking at a second surge now. There are some areas that are now seeing intensive care admissions that are higher than they were in wave one but it’s much more localised. The [northwest] is being hammered more at the moment but it is spreading into the northeast.”

She said stopping many routine services during the first wave meant staff could be redeployed but this was not possible while other services were still going ahead.

She added: “This time the increase in patients has been more of a slow burn which is good because you can manage these patient increases better, but it means staff being under pressure for a longer period of time when they have already been through wave one.”

An NHS England spokesperson did not comment on the figures but said: “Coronavirus cases and hospital admissions are rising and so it is vital everyone does what they can to control the virus, particularly by following government guidelines.

"Social distancing is the first line of defence, followed by the test and trace programme, but if infection still then spreads, the NHS has no choice but to activate local and regional escalation plans."