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Another spike in cases is possible following the release of restrictions this month, and although we are currently in the midst of a heatwave, assessment of preparedness ahead of the winter season needs to start now. In a report published last week, the Academy of Medical Sciences warned that the combined impact of Covid-19, seasonal flu and the respiratory virus Respiratory Syncytial Virus (RSV), could push the NHS to breaking point this winter.
It says new modelling suggests flu and RSV related hospital admissions and deaths could be two times that of a ‘normal’ year and could coincide with an increase of Covid-19 cases, as well as the usual winter burden from conditions such as asthma and COPD. The effect on elective care and other non-urgent services in hospitals at the centre of a local outbreak could be devastating.
Hospitals will face a range of challenges going into the winter season, including reduced bed capacity due to infection control measures, high bed occupancy, staff shortages and a risk of further localised outbreaks of Covid-19 or new variants emerging. Add to this the backlog caused by the initial suspension of non-urgent services during the initial lockdown and disruption during subsequent outbreaks, and it is easy to see the urgency with which the issue needs to be addressed.
As well as protecting elective services from impact during future outbreaks of Covid-19 or other infectious diseases, additional capacity is also needed to reduce the existing elective care backlog. Clinical prioritisation is one proposed strategy, but this can have a negative effect on patients’ lives and is unlikely to lead to a reduction in the overall number of people waiting. It is clear that additional capacity and scalable solutions are needed.
The BMA has estimated that even with a 10% increase on pre-pandemic activity, it could take up to five years to reduce the backlog of elective care in England back down to March 2019 levels. An increase of up to 20% would be needed to tackle the backlog within a more reasonable timespan, with endoscopy requiring a 30% increase on March 2019 activity. Since those estimates, the backlog has risen further.
Flexible healthcare solutions, such as modular operating theatres and procedure rooms can help with reducing waiting lists. They can be set up relatively quickly in almost any configuration; and can be assembled into complete surgical complexes incorporating a wide range of services. Surgical hubs such as these are increasingly used by NHS Trusts for high volume surgery to make a real difference to escalating waiting lists.
Improving patient flow
It’s not just about increasing capacity. A successful solution starts with an evaluation of the whole environment and the flow and layout of activities, including potential Covid-19 free areas or ’green pathways’ in both clinical and non-clinical areas. A stand-alone elective surgery hub can provide a Covid-free zone where patients can continue to be seen regardless of the situation inside the main hospital with winter pressures or Covid-19 cases, and where patients can be admitted directly onto the facility. Such a solution has many advantages over outsourcing to the private sector; the Trust retains control over the patient pathway, staff and costs, and there is less disruption for patients.
Primary and emergency care are also at risk of being under growing pressure in the winter. While the ‘stay at home’ messaging was successful in limiting the spread of the virus, it has deterred people from seeking timely access to healthcare, causing a ‘hidden backlog’.
Sporting and recreational activities have not yet returned to pre-pandemic levels, and neither have traffic levels. As restrictions release and some form of normality resumes, emergency admissions will increase and more people will also attend with non-urgent concerns, potentially at the same time as winter pressures intensify and further waves or local outbreaks of Covid-19 occur.
In A&E departments there is an ongoing need to be able to isolate patients with Covid-19 symptoms, and to be able to deal with the expected higher levels of demand. Efficient assessment and triage processes are key, and additional areas for assessing and treating patients - such as minor injuries units or dedicated space for assessing respiratory symptoms - may be needed. Modular MIUs can be placed adjacent to emergency department entrances, enabling an effective pathway and reducing waiting times for patients - as well as Covid-risk in the main A&E department.
With the majority of older people fully vaccinated, recent outbreaks have been among children. The government has announced children will not be vaccinated, so new outbreaks are likely when children go back to school in the autumn. If a higher percentage of hospitalisations are children, there could be a need to expand paediatric space within hospitals. Modular facilities are built bespoke and the layout, design and decoration can be adapted to suit any purpose; they can also be connected to existing paediatric space.
Why is it so urgent?
The degree to which the current surge in Covid-19 infections will put pressure on the health service is uncertain, but there is a clear risk that services could be stretched over the next two to three months or into the winter period - not only due to a rise in infections but also due to the combined effect staff disruption caused by requirements to self-isolate and emergency admissions increasing as the country opens up. The rapid spread of the Delta variant demonstrates that the UK will remain at risk from future variants as long as the virus continues to circulate globally.
The backlog is substantial. It is estimated that some 1.5 million operations were cancelled in 2020 alone and there are now more than 5.3 million people waiting for elective procedures in England and Wales. This backlog is not reducing – despite activity having returned to near normal levels, the number of people waiting is increasing each month.
The situation remains fragile. If we allow an increase in Covid-19 or non-Covid emergency admissions and the usual winter pressures to lead to further cancellations of elective or diagnostic activities this year, the waiting list could rise to a point beyond reasonable recovery.
Do you have sufficient surge capacity to deal with the extra pressure this winter? If not, a modular solution could be the answer. Temporary infrastructure can provide the additional physical capacity needed to maintain elective surgery through the winter, or to boost elective surgery activity beyond 100% capacity to make substantial dent into existing waiting lists to get ahead.
Preparations need to start now; the availability of fully compliant modular healthcare solutions fitted to your requirements is limited. Get in touch now to book a consultation.