Hospitals aren’t going to be overwhelmed...because we’re going to cancel routine care again

[Redolent]

Mass cancellations of NHS operations inevitable this winter, say doctors

www.theguardian.com/society/2020/oct/23/mass-cancellations-of-nhs-operations-inevitable-this-winter-say-doctors

“ Organisations representing frontline doctors, including the British Medical Association (BMA), also criticised NHS England for ordering hospitals to provide “near-normal” levels of non-Covid care in the second wave of the pandemic.

“Things are very, very difficult at the moment, very challenging,” said one official in the South Yorkshire NHS. “It feels like a juggling act every day.

“The problem is both the growing numbers of patients coming into hospital with Covid and the numbers of staff we have off sick due to Covid, either because they are ill themselves or because someone in their household has symptoms, so they are isolating,” the official said.”

This is going to have very grim consequences; the waiting list is already shockingly high. It’s also inevitable. The figures for people in hospital are doubling approx every two weeks. If things don’t change, in another month we’ll have more people in hospital than we did at the peak. No way can normal services be sustained.

Covid patients in hospital in England:

23-10-2020 /// 6,518
22-10-2020 /// 6,074
21-10-2020 /// 6,018
20-10-2020 /// 5,828
19-10-2020 /// 5,402
18-10-2020 /// 4,974
17-10-2020 /// 4,814
16-10-2020 /// 4,647
15-10-2020 /// 4,379
14-10-2020 /// 4,156
13-10-2020 /// 3,904
12-10-2020 /// 3,665
11-10-2020 /// 3,451
10-10-2020 /// 3,225
09-10-2020 /// 3,090
08-10-2020 /// 3,044
07-10-2020 /// 2,944
06-10-2020 /// 2,783
05-10-2020 /// 2,593
04-10-2020 /// 2,329
03-10-2020 /// 2,194
02-10-2020 /// 2,088
01-10-2020 /// 1,995

Absolutely. There's only a finite resource in the NHS. This week alone (tier 1) we've had to cancel clinics to divert resources to inpatient critical care because various people off with symptoms or self isolating etc. We've also have to close 2 surgical wards to repurpose into covid wards so any surgery that is still happening, the patients may only get a medical bed anywhere in the hospital rather than proper post op bed. Our ICU is nearly turned into a red only ICU so we won't then have proper beds for non covid ICU without closing down another service and refitting it. Nightingales have a very low threshold for admission when / if they open.

The more COVID there is in general, the worse the health system is for everyone. Anyone who has a stroke, car accident, fall, severe infection etc - everyone will feel the effects.

They always cancel lots of "non-essential" procedures in winter.

A couple of years ago my mum had an operation cancelled when she was waiting to go into the operating theatre because they'd taken over the orthopaedic ward for flu cases.

Annnnddd

Cue all the anti-lockdown people moaning about how "COVID is not the only thing that matters!" and "COVID is not going away, we need to learn to live with it!"...

...because they don't understand that skyrocketing COVID numbers means that the NHS will need to divert resources from elsewhere.

It's awful but what's the alternative? I'm asking seriously to anyone who says this shouldn't happen. We hear every year the NHS is especially stressed over winter and people already see routine treatment delayed during this time. I can't even imagine what it'll be like with covid as well

My MiL has been waiting for a hip replacement since April. Thing is, she cant risk having one til hospitals are pretty much COVID free because she's on high doses of steroids and so has a suppressed immune system.

Its shit - she's in pain and can barely move around her house. But there's no way she'd wants op right now, even if one was offered. It's not just about having capacity, it's about it being safe.

This really shouldn't happen, I really feel for people who are battling for their routine care.

I have a regular procedure which was put on hold, should have been done in June. Fought to get an appointment which was eventually in September and by telephone. Agreed procedure but had to go through negative swabs and travel a huge distance to a hospital in another part of the country, got it done recently. Now I hear that hospitals are shutting the doors to non-COVID cases again. It really is tragic. Not getting such treatments can be more terrifying than COVID for some people.....

@cologne4711

They always cancel lots of "non-essential" procedures in winter.

A couple of years ago my mum had an operation cancelled when she was waiting to go into the operating theatre because they'd taken over the orthopaedic ward for flu cases.

Okay... but it’s autumn. Flu season doesn’t really kick in till late November/early December and there’s no cold weather related exacerbation of illnesses or falls.

Already happened in our trust, departments closed and staff redeployed again, we are gutted for our patients who have been so patient in having to wait for treatment, who have just been booked back in and are going to be cancelled now.

If only nurses and other healthcare staff hadn't been treated like crap over the years we might have enough left to be able to staff the nightingale hospitals.

Sadly this was inevitable when they opened too much up too soon - including all kids back to school & all universities back.

And when the deniers or the 'I'm alright jacks' keep spreading it.

I just don't know what you have to do, to get through to the people who think 'the old' should just stay home if they don't want to get it & everyone else should just 'live their lives' the irony would be funny if it wasn't so fucking scary.

And when the deniers or the 'I'm alright jacks' keep spreading it

Or people that wanted schools to stay open? What a bunch of bastards to want all children to have equal access to education and for the gap between them not to grow even wider. Or those who needed their businesses to reopen to be able to keep their heads above water, what swines. If covid is the only concern and you can happily revolve your life around it, then that's quite fortunate.

I’m still not sure why we don’t count the cancellation of routine care as being ‘overwhelmed’. Granted it’s the beginnings of it but it’s certainly a sign the system can’t cope.

The hospitals were overwhelmed in the spring, the presentation of it was tidier because there weren’t pictures of people lining the corridors - they were suffering at home,

@Fajitanita

I've actually never heard anyone say they didn't want children to get an education, only that they want children to be educated safely..which currently isn't happening.

Unfortunately, education and industries cannot be successful with COVID rates skyrocketing so the numbers need to be kept under control. The NHS becoming overwhelmed will mean healthcare outcomes and access will be poor across the board. I am at low risk of dying from COVID, so actually dying of COVID is not a real fear of mine. But living without basic healthcare certainly is.

You cannot have a functioning health service with rampant Covid infection in the community. It’s the maths of the disease. So you can keep saying “let’s just crack on, Blitz spirit, other things are more important than Covid etcetc” but the reality is the health service will be swamped so everything routine will be cancelled, people won’t be able to access emergency care for non-Covid health issues and the Covid death toll & associated morbidity will be huge.
It’s an awful situation compounded by years of underfunding of the NHS.

Dh and I both nhs and both off with covid three weeks now. He's a paramedic so that's an ambulance off the road. Occasionally it runs with staff on overtime or staffed with techs who are not qualified in all procedures so can't be sent to lots of jobs. But mainly it is off the road. In my Trust 6% of staff either have covid or are isolating plus there are loads of vacancies and staff get sick with other things. This is all pretty unsustainable.

@Cornettoninja

I’m still not sure why we don’t count the cancellation of routine care as being ‘overwhelmed’. Granted it’s the beginnings of it but it’s certainly a sign the system can’t cope.

The hospitals were overwhelmed in the spring, the presentation of it was tidier because there weren’t pictures of people lining the corridors - they were suffering at home,

Yes I agree.

In April lack of beds was not the problem, it was adequate staffing. This was despite all routine services being cancelled and staff redeployed.

Also, we were in a strict lockdown, so there were reduced admissions for other reasons.

Without these measures we would have been totally overwhelmed....

@Whatshouldicallme

Annnnddd

Cue all the anti-lockdown people moaning about how "COVID is not the only thing that matters!" and "COVID is not going away, we need to learn to live with it!"...

...because they don't understand that skyrocketing COVID numbers means that the NHS will need to divert resources from elsewhere.

This. Drives me mad.

We were very short staffed anyway, there are not many staff available to divert...

The nhs support was very short-lived.

NHS workers on here, thank you for everything. I know from family members that some of you are already running on empty. I am so sorry it’s happening again & yet idiots go on about empty beds & casedemics.

This is already the case in NI, quite a few cancer surgeries cancelled. I think we are a few weeks ahead of England in terms of this wave. Hospitals have been close to capacity all week (two hospitals currently over capacity), almost 3000 healthcare staff self isolating. The Trust in the North West begging for volunteers to staff care homes.

www.bbc.co.uk/news/uk-northern-ireland-foyle-west-54612567
www.bbc.co.uk/news/world-europe-54666558
www.bbc.co.uk/news/uk-northern-ireland-54652226
www.bbc.co.uk/news/uk-northern-ireland-54647700

Indoor mixing apart from bubbles has been banned for over a month now, numbers are finally starting to come down, but the hospital peak is still estimated to be 1 or 2 weeks away.

The problem is what solution do you want? The country can’t afford further lockdowns. Children can’t afford their education to be compromised further. Working parents can’t afford for schools to be closed so they lose their jobs. Anti lockdown people aren’t just ‘we’re alright jack’ - it’s about looking at the tragically bare cupboard of options in front of us!

Quote fail, sorry. My post was for @Storyofcats
I’m not being argumentative btw. I completely get that covid compromises the ability of the NHS across the board but we’re seemingly stuck between a rock and a hard place here

@YouSetTheTone

The problem is what solution do you want? The country can’t afford further lockdowns. Children can’t afford their education to be compromised further. Working parents can’t afford for schools to be closed so they lose their jobs. Anti lockdown people aren’t just ‘we’re alright jack’ - it’s about looking at the tragically bare cupboard of options in front of us!

At this point I’m not really in favour of a lockdown - it has to be for many weeks, and very stringent, and even then it won’t get the R number that much below one, if everything reopens right back again. There could be some measures implemented, eg over 16s in full remote learnings, or certainly those university students who can. But it’s no longer a straightforward choice.

The only plausible option left if things get very bad in hospitals is an emergency shielding programme with financial support.

@Redolent

“The only plausible option left if things get very bad in hospitals is an emergency shielding programme with financial support.”

This would work if the vulnerable who were shielding never had any contact with anyone who wasn’t shielding, or the outside world. But you must know this can never happen.

A large number of vulnerable people are young and working, with young families. Would you expect them all to shield as well?

Another large number of vulnerable people are reliant on others for personal or medical care, which obviously is usually in close contact.

I agree with you that there’s no easy answer, and I’m very glad I’m not in charge having to make all these difficult decisions.

Basically people will lose out economically and health wise no matter what happens. It’s damage limitation.....but we all need hospitals to be able to function and not be overwhelmed.

[quote Watermelon999]@Redolent

“The only plausible option left if things get very bad in hospitals is an emergency shielding programme with financial support.”

This would work if the vulnerable who were shielding never had any contact with anyone who wasn’t shielding, or the outside world. But you must know this can never happen.

A large number of vulnerable people are young and working, with young families. Would you expect them all to shield as well?

Another large number of vulnerable people are reliant on others for personal or medical care, which obviously is usually in close contact.

I agree with you that there’s no easy answer, and I’m very glad I’m not in charge having to make all these difficult decisions.

Basically people will lose out economically and health wise no matter what happens. It’s damage limitation.....but we all need hospitals to be able to function and not be overwhelmed.[/quote]
Yes I know that “shielding the vulnerable” is a highly flawed strategy. Society is far too interconnected for it to be an easy choice. But there will soon come a point - probably by mid-November- where we will have very options left on the table, short of another devastating national lockdown.