Coronavirus; Hospitals face ‘hard choices’ as routine NHS services restart, expert says

Pooling hospital waiting lists, strictly segregating patients and a complete reconfiguration of departments are just some of the measures required to restart routine NHS activity, a healthcare policy expert has suggested.

Nigel Edwards, chief executive of the Nuffield Trust, argued every patient who comes to hospital will now need to be treated as a potential infection risk and the layout of accident and emergency departments must be completely changed to ensure social distancing guidelines are adhered to.

He emphasised such adaptations would affect the capacity of healthcare services, possibly by more than a third.

“The net effect of all of this, and of the testing required before planned or elective treatment, is to slow the pace with which the NHS has traditionally treated patients, maybe by as much as 35 percent and in some cases more,” he said.

Hospitals suspended routine procedures to deal with the coronavirus crisis, and the challenge is now how to deal with the enormous backlog that has built up, as well as manage a likely uptick in demand as those who avoided seeking care due to worries about the virus do start to use services again.

“Every month about 1.6 or 1.7 million people [typically] start a new course of treatment, and although referrals are down that demand will come back,” said Mr Edwards, who was speaking at an online discussion organised by the Royal Society of Medicine.

He suggested hospitals will need to ‘pool’ waiting lists over whole areas, balancing capacity and need, adding that tough decisions will need to be made on the criteria for prioritisation.

“There will be some fairly hard choices about patients who are lower down that priority list about what we say to them about when they’re likely to be treated. It’s a big concern.”

There have been particular concerns about a backlog of cancer cases, with the need to find capacity for both diagnosis and treatment. Work led by UCL and University College Hospitals NHS Foundation Trust does suggest pooling of resources and careful segregation of patients will help, however.

Researchers there report that a ‘Covid-19 free site’ set up to carry out non-emergency cancer surgeries has successfully operated on 500 consecutive patients. The North Central London and North East Cancer Hub covered 14 separate hospital trusts. The procedures were mainly for the diagnosis or treatment of cancer and, while 10 patients were diagnosed with coronavirus following surgery, there were no deaths from the virus at 30 days.

John Kelly, professor of uro-oncology at UCL Division of Surgery and Interventional Science and consultant surgeon at UCLH, said: “This study is important as we are finding that many patients don’t want to have their surgery anymore because they are worried about COVID-19.

“The results show that it is safe for them to continue with their surgery providing appropriate service reconfiguration takes place. Delaying surgery can lead to patients’ cancers progressing, which could result a worse quality of life. This setup allows the highest risk cancer patients, who would benefit most from surgery to be prioritised.”

Lead author of the research paper Dr Veeru Kasivisvanathan, NIHR academic clinical lecturer at UCL Division of Surgery and Interventional Science and specialist registrar at UCLH, added: “The study was carried out during the peak of the pandemic in the UK, which now has one of the world’s highest numbers of coronavirus cases and deaths.

“By working together with 14 other hospital trusts, as part of a coordinated effort to keep one surgical site free from COVID, we have shown it is safe to continue high volume urgent cancer surgeries.

“Our model gives other institutions around the world an example of how to reconfigure their services to offer safe surgery.”