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His colleagues in the right-wing media were quick to magnify this claim. The Spectator’s Frazer Nelson noted that, in the first wave of the pandemic, there were four times as many overnight beds as there were before the pandemic. Kate Andrews, who has spent years peddling anti-NHS propaganda, claimed that modelled estimates of the potential number of COVID-related hospitalisations were too high and that most of the extra ventilators ordered had never been necessary.
Johnson’s comments were those of someone who didn’t like having to implement public policy measures to suppress the spread of the virus, and commentators supporting this technique tried to show that such measures were never destructive or justifiable in the first place.
Both show a deliberate blindness to the context of the time, to the wider realities and a denial of the role played by years of Conservative governments in creating systems that put the NHS at risk.
The first documented cases of COVID in the UK occurred in January 2020 and the first death in March. At the time, we had already noticed that the intensive care hospital systems of northern Italy, New York, and Spain were absolutely defeated: trendy health systems with more hospitals. and more care beds and more doctors and nurses per capita than the NHS. Complacency is not an option.
During the first wave of the pandemic, our testing capacity was very limited. Only a few thousand COVID tests could be carried out per day for the whole of England. Obviously, how hard we fought on the front line of the NHS to get other people tested or get the results. The ability to test, isolate, and hint at contacts simply didn’t exist.
Although COVID-19 has had major implications for primary and network care services, and in particular for social care, “protecting the NHS” meant “protecting hospitals”. This is not a surprise.
England has around 100,000 general care and intensive care beds for 56 million people. This is the lowest bed base in the OECD and is significantly lower than the EU average or the number of beds, for example in France or Germany.
It also has one of the lowest intensive care bed capacities in the OECD, with 6. 7 intensive care beds per 100,000 inhabitants. Again, this figure is much lower than in other high-income Western countries. There are only about 4,000 intensive care beds for the whole of England.
It is also rare in the NHS for outpatient clinics, investigations and planned surgeries to be located in separate ‘cold’ hospital sites, away from the emergency branch and the intensive care hospital. Both activities tend to be located in the same building and with much of the same staff.
Given that many COVID cases were contracted in hospitals, the idea that we could have continued to take many patients, many of whom were clinically vulnerable, to intensive care sites where they would be in danger and continue their business as usual was never considered viable in the first or second wave of the pandemic.
We also had to make any and all efforts to separate inflamed and non-inflamed patients into other intake streams and service areas, and build capacity to cope with the expected increase in COVID-related admissions.
Therefore, we emptied some beds by canceling elective care, in an attempt to reduce infections. The government’s COVID exit fund and England’s NHS COVID exit rules have allowed NHS hospitals for a few months to free up much more beds by bringing patients directly into the network. fitness and social care facilities outside hospitals and removing what Johnson called “bed locking. “
But this has not been without a human cost. There have been COVID outbreaks in nursing homes, in part due to unscreened patients being discharged from the hospital and patients being stored in “discharge for evaluation” nursing home beds without much ongoing evaluation and rehabilitation. a movement of paints to already overloaded net painting equipment.
Let’s imagine the counterfactual; No path has been taken for hospitals to continue operating as usual and operating at the same bed occupancy rate of more than 90% at midnight, with no margin to cope with the increased pressure.
As for intensive care beds, during the pandemic waves of spring 2020 and winter 2021, they nearly doubled in size. Since nursing and critical care medicine are professional and highly specialized positions without a magical pool of professional staff, they may only grow by borrowing staff. of other clinical spaces and departments (adding operating rooms and anesthesia rooms) and diluting their staff. This has also had a knock-on effect on planned operations, especially for patients who infrequently want extensive post-operative care themselves.
The transfer of critically ill patients to the intensive care unit is intended for multi-organ support and not just ventilation. The idea that many COVID patients were not ventilated invasively meant that the scale of the challenge had been exaggerated, it is ridiculous.
In addition, only one in nine COVID patients required intensive care. Many dying and very poor health patients were being cared for in general wards and oxygen intake increased dramatically.
Unseemly efforts to hire personal corporations to buy a lot of ventilators or create a lot of ICU beds in the London Nightingale unit were the government’s only fetish. The beds and enthusiasts are dead without Array and were already defeated as the number of beds increased.
Protecting the NHS also meant, in practice, “protecting the population”. In 2020, we had as many as one in four hospital beds occupied by COVID patients, and at the much higher peak in 2021, that figure was about one in three.
If COVID mitigation and suppression measures had not been put in place and hospitals (as they did in Italy and New York) had been overwhelmed, it would have meant that other people with genuine desires for intensive care would have been turned away and the dystopian situation we live in. heard at the time, I would have taken a stand. Last week’s investigation into Matt Hancock deciding “who deserves to live or die” has a grim authenticity to it.
People didn’t want much encouragement to stay home or away from emergency departments in the face of the threat of being in poor enough health to want hospitalization and there were no beds available.
Hindsight is unreliable testimony, i. e. when there is no operational or clinical experience in NHS care and facts are selectively selected to match and taken out of context.
At the end of the day, we have to face the political decisions of the party that ran the government for thirteen years and the effect they had. If you think I’m biased, read the Institute of Government’s January 2023 report. on the NHS crisis.
In the last thirteen years, we’ve lost even more hospital beds, we’ve experienced serial cuts in social care investment, we’ve noticed a developing crisis in social care and the NHS workforce exacerbated by Brexit, we’ve had points-based immigration regulations and a deterioration in terms and conditions. conditions, cuts to public health subsidies, a protracted era of traditionally low real-terms investment increases for the NHS and a lack of investment in hospital facilities and equipment, coupled with a decline in GPs and a collapse of the NHS and public satisfaction.
So while Boris Johnson blamed the NHS for not being able to temporarily free up beds enough to bypass lockdown measures, he was blaming his own party. Meanwhile, in trying to tailor the facts to make them compatible, the narrative that infection suppression measures were never mandatory will not work. It would be enough for anyone who was dealing with the challenge in the hospital.
David Oliver has been a doctor in an NHS intensive care hospital for 34 years, tended a coronavirus pandemic ward, and held a range of medical and political leadership roles. He is a regular columnist for the British Medical Journal.
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