‘Brutal’ NHS pressures stop Covid testing

Overstretched hospitals are stopping routine Covid tests for new patients as “brutal” pressures mount on doctors and nurses, The Independent understands.

On Monday there were 1,702 new Covid admissions to hospitals in England as of 9 April – with 16,442 positive patients occupying beds – the NHS leaders warn their ability to tackle the backlog in planned care is at risk.

Despite pleas from NHS chiefs to measures such as mask-wearing back into force, ministers said there were no plans to change guidance.

The Independent understands at least two major hospitals, in Newcastle and York, have dropped testing of all patients without symptoms in order to alleviate pressure on beds – raising fears that Covid could spread on unchecked wards. Other hospitals are also likely to do the same as bed pressures worsen.

Sources have told The Independent some trusts have begun to drop “red” Covid only wards, while some are considering not separating patients in A&E.

Emergency pressures on NHS hospitals have been getting progressively worse in recent weeks with regions declaring critical incidents due to the lack of beds and “perfect storm” brought by Covid admissions combined with staff absences.

Healthcare leaders have called for the government to bring in new measures such as mask wearing and limits on indoor mixing to help guard the NHS against “brutal” pressures.

One expert, critical care doctor Tom Lawton, who analyses hospital-acquired infection data, said that stopping patient testing in hospitals was “worrying” and that the NHS would be putting “blinkers on” just as in-hospital infections were “as high as they’ve ever been”.

However, several hospital leaders have said not having beds to treat patients is the greater risk. Glen Burley, an NHS chief, warned hospital infection controls were “creating more safety issues than benefits”.

Last week The Independent revealed patients waiting for more than 12 hours from arrival in A&E hit 1,721 a day on average, while ambulances were taking four hours to get to stroke and suspected heart attack patients.

On Monday, the NHS Confederation, which represents hospitals in England accused the government of abandoning any interest in Covid and “washing its hands of responsibility”.

Asked whether there could be a return of Covid restrictions, a No 10 spokesperson said there is no change to current guidance but that it would monitor the behaviour of the virus with the Office for National Statistics survey.

open image in gallery

Dr Lawton, said that the decision to stop testing was “worrying” and that putting “blinkers” on was not a justified response to the problem.

He explained: “We don’t know exactly how dangerous hospital-acquired Covid is, but people have been dying with it, and we know from studies like CovidSurg that Covid adds risk to surgical patients in the form of clots and heart attacks.

“If we don’t have the resources to do infection control properly, we should at least do what we can, such as keeping Covid and non-Covid patients as far apart as possible. Stopping testing means we can’t do anything to reduce the risk.”

He pointed out that the risks of hospital-acquired Covid are “as high as they’ve ever been”. In the 28 days to 3 April there were 11,936 probable or definite cases in England, which amount to 23 per cent of hospital cases in total.

However, Dr Chris Green, associate clinical professor and consultant physician in infectious diseases, warned that “getting this right is not going to be easy”.

He said that a positive test does not define when someone is infectious, and so the safest course of action is to isolate all patients who test positive, but this places a “huge additional burden” on hospital resources when they are already limited.

“We really need patients under the right specialists at the right time, and anything that disrupts hospital efficiency risks adding to the indirect burden or impact from Covid,” he said.

“It will always be a difficult balance: protecting patients from hospital-acquired infections and at the same time making our resources go as far as possible for the many people who desperately need [treatment].”

open image in gallery

Internal guidance on infection control in Newcastle hospitals, seen by The Independent, show the trust is no longer testing patients who are not symptomatic on admission.

Patients needing to be discharged to a care home will be tested within 48 hours before leaving.

One NHS source in Newcastle explained: “We ran into huge problems with incidental cases on routine testing of inpatients, [which] started closing large numbers of beds, so a decision was made to just test symptomatic emergencies and electives.”

“Things really are a mess right now. It’s a genuine challenge that there aren’t good evidence-based answers to. This seems like the right thing to do, but we wouldn’t be doing it if we had any resilience left in either beds or staffing.

“The incidental Covid patients are less infectious, and so the logic follows that not knowing about them keeps beds open, and overall risk to everyone is lower. You can’t treat anything if you don’t have beds,” they said.

The internal staff guidance for Newcastle also says that staff caring for patients on a “standard” pathway do not need to wear personal protective equipment for aerosol-generating procedures.

York hospitals have also moved to the same measures, and both trusts have dropped Covid testing for patients on days three, five and seven of their admission.

One senior leader in the northeast suggested that the move by Yorkshire to drop patient testing was “unsafe” as it had hundreds of Covid patients in beds.

According to an analysis by Dr Lawton, York and Scarborough Teaching Hospitals Foundation Trust has one of the worst rates of hospital-acquired Covid infections.

Official NHS guidance, published on 5 April, said that all symptomatic and asymptomatic patients requiring emergency or unplanned admission should be offered a PCR test. This could be a rapid PCR test.

It added that lateral flow devices could be used within emergency departments as a means of early detection.

Saffron Cordery, deputy chief executive of NHS Providers, said in a statement to The Independent: “NHS trusts right across England are still under enormous strain as the number of people with Covid in hospital continues to rise.

“The NHS still needs appropriate infection-control measures, to separate Covid and non-Covid patients [and] to do everything possible to keep rates of hospital-acquired infections down.

“Reducing infection-control procedures can help trusts significantly in dealing with mounting pressures as they tackle existing care backlogs on top of growing demands, but given the ongoing risk from Covid-19 and the need to protect patients, staff and visitors, trusts must strike a careful balance.”

Yorkshire and Scarborough Teaching Hospitals Trust said it had “endorsed a risk-based approach to the trust’s ‘living with Covid’ guidance, in conjunction with the regional infection prevention team at NHS England and NHS Improvement. This is in response to the current critical situation, and will be reviewed on a regular basis and de-escalated as required.”

A spokesperson for Newcastle upon Tyne Foundation Trust said: “Keeping our patients and staff safe is our first priority. Any changes to patient pathways and Covid testing take into account national guidance and our own extensive internal risk assessments.”

“Our IPC guidance is reviewed regularly, and changes are made where necessary. We have low-level hospital-acquired infection throughout the pandemic,” they added.