Covid-19: Hospitals forced to suspend routine care amid second surge

Medical leaders have warned that the health service is already under “extreme pressure” this winter after several large NHS hospitals were forced to suspend routine care because of the high number of patients critically ill with covid-19.

On Friday 6 November, the Queen Elizabeth hospital in Birmingham1 announced that it would be cancelling all planned procedures to cope with a rise in “very sick” patients. This was followed by all hospital trusts in the Greater Manchester area suspending non-urgent surgeries from 9 November. Both areas said they would prioritise the continuation of urgent and emergency care such as cancer treatment.

The news came after the NHS was placed on the highest alert level amid warnings that some hospitals are now seeing more patients with covid-19 than they did at the height of the pandemic in April.2 NHS England’s chief executive, Simon Stevens, said that the NHS currently had the equivalent of 22 hospitals full of patients with covid-19 and that it was “once again facing a serious situation.”

BMA West Midlands regional council chair Stephen Millar said the decision to suspend routine care in Birmingham was “a clear indication of the extreme pressure facing the health service,” and was likely to be replicated at many hospitals across the country this winter. “It’s incredibly concerning that a hospital of this size is having to adopt such drastic measures at this very early stage of winter,” Millar said.

“Despite claims from NHS leaders that lockdown should mean that we do not face mass cancellations, hospitals are clearly already at this tipping point. The government must be forthcoming and deliver urgent resources to ensure that hospitals can cope in the coming months and resume care as quickly as possible.”

As of Sunday 8 November, there were 12 949 people across the UK in hospital with covid-19, 1185 were on a mechanical ventilator.3

According to reports,4 the high volume of patients in intensive care has prompted NHS England to temporarily suspend the 1:1 rule that advises that each nurse in critical care should not look after more than one patient at a time.

Figures shared with The BMJ from the Faculty of Intensive Care Medicine showed that as of 5 November, a quarter (51, 25.7%) of 198 intensive care units which provided data to a national dashboard were working at a nurse-patient staffing ratio of more than 1:1.

Alison Pittard, dean of the faculty and a consultant in intensive care medicine in Leeds, said flexibility in staffing ratios may be required at the present time, but cautioned, “It’s not sustainable on a long term basis, running the risk of adversely affecting staff health and wellbeing and further diluting our workforce.”

Meanwhile, the Royal College of Physicians reported that a poll of its members on 2 November had shown that 92% of 451 doctors who responded expressed concern about the impact of increasing covid-19 admissions on their hospital’s ability to deliver effective care. And a third (30%) said that non-covid-19 patients are coming to them with more severe illnesses than before the pandemic.

RCP president Andrew Goddard warned of “a long and difficult winter ahead.” “We must also do all we can to ensure that services are maintained for our non-covid-19 patients,” he added.