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Covid-19: Hospitals move to create extra bed capacity to relieve pressure

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2775 (Published 12 November 2021) Cite this as: BMJ 2021;375:n2775
  1. Gareth Iacobucci
  1. The BMJ

NHS hospitals across the UK are creating extra bed capacity to relieve ongoing operational pressures from covid-19 and to tackle the growing backlog in elective care.

Reports are increasing of trusts being forced to cancel elective operations in the face of major pressure on services (box 1), and ongoing bed shortages are prompting some trusts to add more capacity.

Box 1

Elective operations cancelled

Last week it was reported that most elective surgery had been cancelled at the Princess Alexandra Eye Pavilion in Edinburgh until March 2022 to allow staff to be redeployed to the nearby Edinburgh Royal Infirmary.1

Meanwhile, five hospitals in Leeds were reported to have cancelled most “priority 2” elective operations on Tuesday 2 November after a surge in numbers of patients with covid-19 and in the emergency department.2

In a statement Mark Liddington, medical director of operations for planned care at Leeds Teaching Hospitals NHS Trust, confirmed that said some procedures “that are not assessed as clinically urgent” had been postponed but said “the situation has eased a little this week, and the majority of our elective operations are going ahead as planned.”

Elsewhere, Royal Cornwall Hospitals NHS Trust recently declared a critical incident because of “unprecedented demand” on the trust. Allister Grant, medical director, said, “Even though they are already working extraordinarily hard, our staff are supporting the opening [of] extra inpatient areas not only in our hospitals but in care homes who have beds available but not the staff to open them.

“Families, friends, and neighbours are urged to help us, too, by offering to support someone waiting for home care to leave hospital sooner, and we would ask them to contact the ward directly if they can help in any way. Getting someone home a day or two sooner will mean we can free up a vital hospital bed for someone else in urgent need.”

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Nottingham University Hospitals NHS Trust is seeking to establish a new 20 bed ward for elective surgery to tackle what it describes as “significant bed shortages.” A paper discussed at the trust’s board meeting on 10 November said the case for the new £7.8m ward had been approved but that a revenue case was still required.3 “There is a considerable elective backlog with patients at increased risk of harm due to long waits for surgery. This build not only provides additional surgical bed capacity, but also unlocks cross campus moves that are in line with [the trust’s] strategy,” it said.

Cambridge University Hospitals NHS Foundation Trust is also planning to add capacity in response to bed shortages. In comments reported by the Cambridge Independent news site,4 Roland Sinker, the chief executive of the trust, which runs Addenbrooke’s Hospital, was said to have warned that it was “ceasing to function as a hospital” and that patients could be sent to hospitals in Birmingham or London if it did not resolve its ongoing bed crisis.

In its board meeting on 10 November Cambridge University Hospitals said that capacity and staffing pressures were continuing to result in elective activity being cancelled, with a growing number of patients experiencing “very long waits for treatment, with some waiting times in excess of 104 weeks.”5

In response to bed shortages Addenbrooke’s opened a new 19 bed ward in May. The trust has now produced provisional plans to add more capacity next year,5 proposing a new 40 bed unit for elective orthopaedics to open in June 2022 and a 56 bed unit for non-elective medical care in September 2022.

The trust told The BMJ that it was engaged in “active and ongoing recruitment” of staff to fill the additional capacity. The trust currently estimates that around 186.44 extra whole time equivalent (WTE) staff would be recruited to the 40 bed ward and 90.2 extra WTE for the 56 bed ward. The 56 bed ward will be able to be scaled up or down, depending on demand, and will also house some existing staff while another ward is refurbished, the trust added.

Elsewhere, In Northern Ireland, which has the longest elective treatment waiting times of all the UK nations,6 the health minister, Robin Swann, has said almost 600 extra acute care beds would be made available this winter, after modelling by NHS trusts indicated that there would be a shortfall.

“[Mitigating] actions vary across the trusts but include increasing the bed stock, improving discharge and flow, and reducing delivery of elective care,” he said in a written statement.7 “In total, the trusts have identified options to create additional acute bed capacity of 586 beds in advance of this winter.”

Footnotes

  • Correction: On 15 November 2021 we corrected a misspelling of Robin Swann’s name.

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