NHS England would not have had sufficient capacity to treat all COVID-19 and other patients in March and April 2020 without the hospital provision interventions, which alleviated significant shortfalls in CC nurses, CC and G&A beds and CC junior doctors. All elective surgery can be conducted at normal pre-pandemic levels provided the other interventions are sustained, but only if the daily number of COVID-19 patients occupying CC beds is not greater than 1550 in the whole of England. If the other interventions are not maintained, then elective surgery can only be conducted if the number of COVID-19 patients occupying CC beds is not greater than 320. However, there is greater national capacity to treat G&A patients: without interventions, it takes almost 10,000 G&A COVID-19 patients before any G&A elective patients would be unable to be accommodated.
To prevent overwhelming hospital capacity, several interventions were implemented in England across March and April 2020. The main interventions which could be quantified on a national level were those managing patient admissions and those increasing the supply of resources (Table 2). Cancellation of elective surgery and setting up of field hospitals increased available bed capacity, whereas deployment of newly qualified and final year medicine and nursing students and the return of former healthcare staff increased staff capacity. The use of private hospitals led to increases in beds, ventilators and staff.
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Our analysis is conducted at the national level and thus does not consider the geographic distribution of hospital capacity, COVID-19 admissions and hospital utilisation patterns. Patterns of patient admissions may have varied spatiotemporally, with heterogeneous impact on available capacity due to variation in their average length-of-stay, but the necessary data to assess this are not currently available. Reorganisation of care within individual hospitals occurred during the surge in April, including upskilling of staff and converting operating theatres to CC wards [4], and it may be the case that recommended staff-to-bed ratios were not always able to be maintained. Furthermore, hospital infection control typically involves cohorting patients according to COVID-19 status as well as quarantining elective patients before surgery, which create local capacity challenges. As there are no consistently collected national data available on these practices, they cannot be included in the analysis. We aimed to use data from only the most robust sources, but in the absence of this, we used the best available data at our disposal. 2ff7e9595c
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