Was the NHS overrun by Covid during lockdown?

The decision to implement lockdown was inspired partly by the appalling scenes from Lombardy, where hospitals were overrun and dying patients left in corridors. In London, ministers were terrified by the prospect of the same happening here. Today’s Sunday Times has published a long investigation from its Insight team looking at the Covid disruption in hospitals, which makes for disturbing reading. The NHS, it says, faced “an unmanageable deluge of patients” during lockdown, and it offers several examples of things going badly wrong. As we debate whether the NHS may be overwhelmed now – and what steps are needed to prevent this – it makes sense to ask how close the it come to finding Covid unmanageable the first time? The Sunday Times report reveals fascinating unpublished documents and offers a powerful snapshot of the misery caused by the pandemic. But on general strategy, three points jump out.

1. Were infections “rocketing” until lockdown? Boris Johnson, it says, dithered for nine days before locking down on 23 March and “during this time the number of infections had rocketed from an estimated 200,000 to 1.5 million”. This, it says, meant Britain had one of the biggest Covid caseloads in Europe. The idea of the virus was surging until lockdown is a theory, popular at the time – but hard to reconcile with hospital numbers we now have. Covid deaths peaked on 8 April, which was 16 days after lockdown. We now know Covid’s infection-to-death timescale is closer to four weeks than two weeks. This points to fatal infections peaking well before lockdown. So Covid cases were probably falling fast – not rocketing – in the runup to 23 March. Simon Wood, a professor at Edinburgh University, has looked at this. Other European countries have used hospital numbers to estimate the trajectory of the virus and its R-number and have come to similar conclusions.

2. Was Covid spread to care homes by discharged hospital patients?  Insight also looks at hospital patients being discharged early and sent to care homes without a Covid test. Did they then spread the virus in these homes, where almost half of fatal infections were caught? It’s a plausible theory. NHS decks were certainly cleared, 30,000 beds were emptied. But dig deeper and the theory collapses. The Sunday Times mentions that 25,000 hospital patients were sent back to care homes between March and April. I was struck by this figure when I first came across it – but then found out that far more patients (35,000) were discharged over the same period last year. 

If NHS discharges had been a major driver of Covid in care homes, the UK’s share of care home deaths – at 45pc – would be high compared to other countries. Instead, our ratio is standard for Europe. The same as Sweden,  lower than Canada (80pc) and Spain (63pc). Studies have found a link between Covid infections and care homes who use agency staff who work in several locations (58pc more likely to contract an infection). I wrote a Daily Telegraph column about all this in July, and subsequent studies have reinforced the point. 

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3. Was the NHS ever “deluged”? Ever winter, some hospital wards will be overrun – and the Sunday Times story gives some chilling stories of things going badly wrong, as you’d expect in a system that treats millions of patients a year.  It also points out that the UK “has ‘fewer intensive care beds” than many European countries. But in fact the NHS as a whole never came close to capacity because throughout the crisis, it had far more empty beds, ventilators and intensive care units than normal. It had feared otherwise. The Sunday Times reveals fascinating details about a plan to triage patients if the NHS was overwhelmed in the way SAGE indicated. But the tsunami never arrived so a ‘triage’ plan – deciding which lives to save – was neither published or needed.

Plenty did go wrong, as PPE shortages showed. Routine operations were postponed and, more worryingly, there was a collapse in new patients presenting for care. But the NHS always had plenty spare capacity, far more than normal. Every day, the NHS Covid dashboard reported how many beds and ventilators were occupied by Covid patients. This data is not made public (a mistake, in my view) but the Health Service Journal quoted regularly from it during the pandemic, frequently quoted in The Spectator’s daily Covid-19 email.

The peak Covid day was 12 April, with 17,152 inpatients. The next day, the Health Service Journal broke the story of unused NHS capacity.

“Figures from the national NHS operational dashboard, seen by HSJ, show that 40.9 per cent of NHS general acute beds were unoccupied as of the weekend — 37,500 of the total 91,600 relevant beds recorded in the data. That is 4,500 more than the 33,000 the NHS said had been freed up on 27 March, and nearly four times the normal amount of free acute beds at this time of year.”

The Department of Health would not comment at the time, but the NHS has just confirmed these figures in its response to the Sunday Times. `So there was never any need to “protect the NHS” because it was doing fine – with many wards half-empty. On the peak Covid caseload day, 42pc of ventilator beds were unoccupied as were 32pc of intensive care beds and 44pc of General & Acute beds. This was why Nightingale units were not needed. Fewer patients were going on to ventilators because, world over, doctors were learning that this often made things worse: administering oxygen in standard beds was enough. Meanwhile, very few patients were coming forward for standard care – perhaps heeding the message to “protect the NHS”. A&E attendance plunged. This will have created a huge backlog of untreated medical problems, something we can see reflected in the recent rise in at-home deaths.

I’m no NHS cheerleader and have plenty concerns about how it is run. But Matt Hancock is right to say that it was never overwhelmed by Covid. It coped as better than anyone could expect with the virus: the NHS staff deserved their praise. The real scandal is the collapse in non-Covid healthcare at a time when hospitals and A&E wards were not deluged or overrun but half-empty. What happened to the people who would otherwise have been treated? What’s happening to them now? This is a question that deserves a lot more attention.