Could UK's response to coronavirus provide the answer to NHS 'winter pressure' capacity issues?

Design and construction expert claims speedy response to COVID-19 crisis could be replicated to provide additional beds during annual winter pressures

The new Nightingale Hospital at the ExCeL in London was constructed in just nine days, and could be used as a template for similar emergency capacity solutions for ongoing pressures faced by the NHS every winter

There are thousands of unnecessary deaths every winter in the NHS because of a lack of capacity.

And the pressure on the system in the early stages of the coronavirus outbreak highlighted this issue further.

“The construction of the temporary hospitals that are being built across the country typify the herculean efforts that are being made to increase NHS capacity to combat COVID-19,” said Steve Woodward, director of construction and design consultancy, McBains.

“The NHS Nightingale Hospital at the ExCeL centre in London, for example, provides an additional 80 wards and 4,000 beds, and was fully built and fitted out in just nine days thanks to a team of health workers, architects, engineers, construction workers and the Army working round the clock.

“This ability to react at speed to a crisis hitherto unimaginable is admirable. But it can also serve as an inspiration of how we can respond to the pressures that face the NHS on an annual basis through a lack of capacity.”

This ability to react at speed to a crisis hitherto unimaginable is admirable. But it can also serve as an inspiration of how we can respond to the pressures that face the NHS on an annual basis through a lack of capacity

Every year, the NHS faces an increase in the number of hospital admissions because of the likes of flu, pneumonia and norovirus, or because of respiratory system diseases like asthma becoming worse in the colder months.

“Yes, COVID-19 is more infectious, more fatal, and has more potential to overpower our healthcare system; but let’s not forget the impact of winter,” says Woodward.

“Public Health England figures show the average number of deaths due to flu-related complications alone for the last five years over the winter months was 17,000, including 28,330 in 2014/15.

“And, in the 2017/18 winter period, there were an estimated 50,100 excess winter deaths overall in England and Wales, the highest recorded since 1975/76.

“In comparison, it is hoped the total numbers of deaths from coronavirus could be limited to 20,000 if the Government’s lockdown strategy succeeds.”

The current pandemic has highlighted the lack of beds in the NHS.

McBains has worked on a number of hospital projects and has seen first hand the impact winter pressures can have on the NHS

But the health service has been coping with this same problem for years in winter.

As the King’s Fund has noted, the UK has fewer acute beds relative to its population than many comparable health systems around the world.

In particular, the numbers of general and acute beds have fallen from 121,756 in 2009/10 to 101,598 at the latest count – a drop of more than 20,000 – despite warnings that bed reductions were unwise given the increased pressure caused by the ageing and growing population.

Last summer, Simon Stevens, chief executive of the NHS, even admitted bed closures had left hospitals powerless to manage increasing numbers of patients.

And, in 2018/19, overnight general and acute bed occupancy averaged 90.2 %, and regularly exceeded 95% in winter, well above the level many consider safe.

The construction industry is now increasingly using modern methods of construction to build more homes, more quickly to address the housing crisis – why not use it more widely to extend into healthcare too?

Woodward said: “This double whammy of cold-weather-related illnesses, and a shortage of beds, kills thousands of people each year, yet the numbers tend to pass us by – they’ve almost become acceptable and are often casually dismissed as a consequence of ‘winter pressures’.

“It means our hospitals are, at the same time each year, under severe strain for a period of a few months.

“Yet the Government and the health service knows this problem is coming.”

As Nigel Edwards, chief executive of the Nuffield Trust, puts it: “The system works on a knife edge in terms of the balance between capacity and demand.

“You see it every winter and it doesn’t take much of a surge to put the system into quite-severe difficulties from which it has increasingly found it hard to recover.”

Lessons learnt from the response to the coronavirus pandemic could be used in the longer term to help the NHS with the impact of the annual pressures seen during winter

So, says Woodward, shouldn’t we consider how we’re responding to the current pandemic as an example of what might be possible to lessen the impact on the NHS in winter moving foward?

“It took nine days to construct a 4,000-bed facility at the ExCeL, so something similar could potentially be done on a smaller scale ahead of winter – for example, using separate areas of conference centres to create temporary wards to increase capacity,” he adds.

“We’re not talking huge numbers in the context of the current pandemic: the British Medical Association estimates that around 3,000 beds would be needed across the whole of England.

“The Government could also look at how quickly new facilities could be erected on a temporary basis.

“The construction industry is now increasingly using modern methods of construction to build more homes, more quickly to address the housing crisis – why not use it more widely to extend into healthcare too?

“Such construction methods mean components of buildings being put together offsite. To give an example of the speed of build possible, just look at the construction of 101 Great George Street in Croydon, the world’s-tallest residential towers at 38 and 44 storeys high. The project was completed in just 35 weeks – the time it would take to construct smaller medical facilities would be considerably shorter.”

The Government is starting to face hard questions over its coronavirus response – it knew it was coming, why didn’t it do more? Isn’t it, therefore, time to apply the same focus to the crisis that it knows hits the health service every year?

Finding available land to build such facilities is unlikely to be a problem as, he says, there is plenty of brownfield land that for many reasons is effectively of no use for housing that instead could be utilised for the public sector.

“Clearly, such commitments would mean increased investment from the Government,” he concludes.

“But we’re talking a fraction of the funding that’s been ploughed into the NHS to tackle the current pandemic.

“The Government is starting to face hard questions over its coronavirus response – it knew it was coming, why didn’t it do more?

“Isn’t it, therefore, time to apply the same focus to the crisis that it knows hits the health service every year?

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