David Oliver is an experienced NHS consultant physician and medical writer from Manchester.
Now working in the South East, he has looked after Covid wards and patients for many months over the past two years. He also writes a weekly column in the British Medical Journal.
Here he shares his perspective for the Manchester Evening News , explaining the numerous layers of pressure currently on the NHS system, including a lack of beds, a social care system in crisis, and an exhausted workforce - all before the latest surge in Covid cases.
On December 27, Health Secretary Sajid Javid announced that there would be no new Covid rules until the new year. Ministers in England have said that while they are keeping a very close eye on the data, the current number of hospital admissions or occupied beds for patients with Covid did not justify any change in policy. But people should “remain cautious” and “celebrate outside”.
As of December 20, according to the government’s own website, there were 1,171 admissions across the UK nations for patients testing positive for Covid-19.
On December 22, there were 8,240 patients with Covid in hospital beds and 827 on ventilators on Intensive Care Units, many of them sadly unvaccinated – even though over 80 per cent of the population is double jabbed and around half already boosted.
None of these numbers are anywhere near the levels we saw in in winter 2021, or spring 2020 – which were four times higher at their worst. And although death certification figures lag a couple of weeks behind, daily recorded Covid-19 deaths are also far lower than during pandemic peaks.
The North West had not, for some time, been hit harder than other regions, though admissions in the region are now accelerating faster than some other parts of the England.
So, while the daily number of people testing positive has now hit the highest level during the pandemic at over 100,000 a day and the Omicron variant numbers double every two to three days, some readers might wonder what all the fuss is about when we talk about the need to “protect the NHS” from pressures, including pressures from Covid-19.
Well, firstly, we know it takes around seven to 10 days for people infected with Covid-19 to get sick enough to be admitted to hospital and often many days after that before they get home, die, or require transfer to intensive care. So, decisions we take now affect the pressure on hospitals in two weeks' time.
Secondly, hospitals are already running at well over 90 per cent bed occupancy – meaning every day is a struggle to find beds to admit people to. Unlike earlier pandemic waves, the numbers of people coming to A&E are now back up to usual winter levels, often higher. England has among the fewest number of hospital beds per 1,000 people in the developed world, and has lost around half its beds over the past 30 years.
Hospitals also now face record numbers of “stranded patients” who are medically stable enough to leave hospital, but are waiting for ongoing social or community healthcare services. These services are now as short of capacity as the hospitals, with the festive season making funding cuts and lack of staff even worse.
Outbreaks of usual winter infections on the wards. and the measures needed to separate, stream and distance patients with Covid from others needing care, means even more beds effectively out of commission.
With beds full, there aren’t enough to admit patients coming from A&E departments. This, in turn, means longer waits, overcrowding and ambulances stuck waiting to hand patients over, meaning paramedics cannot get back out on the road. Even as number of ambulance calls has gone up rapidly over the past few years, there has been no increase in the number of ambulance technicians and paramedics.
Thirdly, the service is now under major pressure to play “catch up” with all the planned operations, tests and procedures postponed over the past two years - and work faster than ever before to get the waiting lists down. Any Covid surge leading to more cancellations will be bad news all round.
Finally, NHS and social care staff are living in the same communities as the rest of society, but are also at far greater risk of catching Covid at work than people in most jobs. With little prospect of home working, they are going off sick or self-isolating because of infection or contacts with infectious people, including those in their own home.
We already have a workforce exhausted by two years of pandemic healthcare, with high levels of burnout and stress. Around 100,000 posts in the NHS and another 100,000 in social care are unfilled and the staffing gaps are getting worse, putting the people who are still in post under ever greater pressure.
I am not here to say whether England should go the way of Scotland, Wales or some European countries, like the Netherlands, in its Covid health protection plans.
But I do hope that politicians, press and public alike don’t take the latest Omicron-fuelled surge lightly just because the symptoms seem to be milder for most people than earlier variants, and hospital admission rates and length of stay might not be as high.
With our hospitals already under so much pressure, it would only take a small percentage of the high daily number of Covid cases to get very sick and we’d have serious problems.
That’s why we shouldn’t take chances with public health protection measures or incomplete vaccination programmes.
In the long run, though, we need more capacity, funding and staff in our health and social care systems if we want more ability to cope with future surges of community infections that also affect frontline staff.
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