Precisely how prepared is the NHS for this?

Former health chiefs cast a critical eye over our capacity, which appears dangerously lacking in comparison to some other European nations

They don’t like to call it a gamble. Nor even a calculated risk. But if one asks civil servants, former health secretaries and NHS leaders how it is that Britain stands on the brink of a pandemic with so few intensive care beds that the country is forced to enter partial lockdown, clear themes emerge.

The UK has probably never had enough facilities to cope with the kind of crisis it is now facing, without relying on major sacrifices by the public to reduce the spread of disease.

Our hospital bed numbers are the second lowest in Europe, with around 128,000 beds, down from 144,000 a decade ago, following long-term trends which have also seen shorter stays and higher occupancy levels.

But when it comes to coronavirus, the most critical element is intensive care capacity, including the ventilators to assist those struggling to breathe. Here, Britain’s bed numbers have risen significantly, almost doubling in the past 20 years. Where does this leave us? With just over 4,000 critical care beds, and plans to ramp this up to 5,000 as pressures mount.

Consider this: Germany’s population may be a quarter greater than that of the UK, but it has 28,000 such beds, and plans to double this. Its total hospital bed numbers are 500,000, five times that of the UK.

Jeremy Hunt, Britain’s longestserving health secretary, says: “I was always nervous about the total number of beds, because of the pressures we would get, especially in January and February.” But as pressures mount on hospitals across the country, his greatest regret is waiting too long to expand the NHS workforce. “If I had my time again I would have increased training places for doctors and nurses earlier,” he says.

Those measures he did implement meant an extra 1,500 medics a year in training from 2018-19. But Mr Hunt is well aware it takes seven years to train a doctor – meaning the move came too late to assist in the current crisis.

He does not recall Britain’s intensive care capacity being one of the greatest threats the NHS faced. And experts say many of the international comparisons take little account of the various definitions of critical care.

As chairman of the Commons health and social care committee, he has repeatedly raised concerns about the Government’s handling of the virus.

Chief among them is the NHS failure to test staff and to ensure those who need it are given protective garb.

“We need a massive ramp-up in testing and protective equipment for staff on the front line,” he says. “We cannot afford to take them off the front line – and also it is morally and ethically wrong to put them at risk.”

On Tuesday he questioned Sir Simon Stevens, the NHS chief, on precisely this. “I asked them three times to sort out distribution within a week and got no answer – that seems to me totally unreasonable,” he says.

He is worried, too, that lack of virus testing for NHS staff means rising numbers are at home for weeks, simply because someone in their house has a cough.

Lord Crisp, the NHS chief executive and Department of Health permanent secretary from 2000 to 2006, raises the same concern. “I would want to know where the bottlenecks are,” he says. “It sounds like the most obvious one is lack of testing for staff so we know who can come back to work.

“We see situations where you have three junior doctors living as flatmates; one has a cough and all three are off work for two weeks. That’s ridiculous.”

Hospital beds and occupancy levels were a worry during his time as chief executive and permanent secretary. He says: “We always felt it was running too hot. We wanted it at 85 per cent.

“But the bigger issue in my time was paediatric critical care beds, and we reviewed that.”

When it comes to overall provision of health, decisions are made by the Government – and ultimately the taxpayer, he points out. “These are political decisions. Germany and France spend 20 to 30 per cent more per head of population,” he says.

Lord Crisp’s biggest public health crisis came in 2005, with bird flu. The Government’s decision to stockpile 14.6million vaccine doses later came under fire, after its effectiveness was questioned. In the search for treatments and vaccines this time, the Government’s scientific advisers may face a similar dilemma.

“In a way, whatever you do you’re screwed,” says Lord Crisp. “People said we overreacted but we’d have been in more trouble if we hadn’t.”

Past and present officials suggest it is easy to suggest Britain made a fatal error in running its hospitals so lean.

But even those nations like Italy, whose hospitals had 60 per cent occupancy levels before the crisis, quickly became overwhelmed, suggesting Britain’s strategy of trying to delay and suppress the virus, has wisdom in it.

Sir David Behan, the former chief executive of the Care Quality Commission, and before that the Department of Health’s director general for social care, says no service could be in a permanent state of readiness for a crisis on such an unprecedented scale.

“In a way this is a black swan event. It’s unpredictable and even if you had known about it, it wasn’t preventable for the UK,” he says.

Sir David, now the executive chairman of the HC-ONE care home group, thinks the Government should address areas of concern that affect care homes as much as the NHS.

“We need to be getting the PPE [personal protective equipment] to the right people, quickly,” he says. “And we need staff to be tested so we don’t have so many out of the workforce for two weeks when they may not be suffering from the virus – which means they may well need another fortnight off further down the line. We don’t have the capacity for that.”

Yesterday, the Government published 30 reports explaining the thinking behind the most draconian demands being made of the public in modern history. The messages, from the Scientific Advisory Group for Emergencies (Sage), co-chaired by Prof Chris Whitty, the Chief Medical Officer, and Sir Patrick Vallance, the Chief Scientific Adviser, are stark.

One report dated Feb 26 warns: “In the event of a pandemic, without action the NHS will be unable to meet all demands placed on it. Demand on beds is likely to overtake supply well before the peak is reached.”

Decisions to enact strict measures, such as discouraging non-essential travel, social distancing and school closures are “political”, it notes.

It also suggests large-scale rioting is unlikely, though queues at takeaway restaurants are not.

On Monday it became clear that decisions about restriction of public movement are being driven by one key factor – the ability of the NHS to cope.

Modelling by Prof Neil Ferguson, of Imperial College London, shows that if Britain took no measures it could expect 510,000 deaths, as well as requiring 180,000 critical care beds at the peak of the pandemic. NHS plans to provide 5,000 such beds and 20,000 ventilators pale in comparison.

This, plus news from Italy that one in three hospitalised cases requires intensive care, is what triggered this week’s new measures, which have been ramped up on a daily basis.

The calculations by Prof Ferguson, now himself in self-isolation after coming down with symptoms, show a range of policies are required to suppress the outbreak sufficiently that the NHS has a fighting chance of coping. Estimates suggest the combined policies of case isolation, 14-day quarantine for households of suspected cases, school closures and social distancing – shunning pubs, offices and non-essential travel – could significantly lift pressures on the NHS.

As well as bringing deaths down to around 20,000 it could mean that the NHS needs between 1,200 and 4,900 intensive care beds at the peak of the coronavirus. But the doomsday document is littered with health warnings, notably that such measures would need to be maintained until a vaccine becomes available – which could take 18 months or longer.

Many of the assumptions of its working groups have yet to be tested, as they require changes in human behaviour which have never before been seen. They also require altruism and public understanding on an unprecedented scale.

Last night, Boris Johnson ordered the closure of pubs, bars and gyms, amid concern that too many people were ignoring advice to stay home.

Meanwhile around the country, individuals were taking private

‘No health service in the world could cope if the virus was left to let rip, which is why there is social distancing’

decisions about whether their journey was “essential”. Tomorrow, Mothering Sunday, poses perhaps the biggest test.

The country’s chief scientific advisers have been clear. If you love your mother – or grandmother – do not visit for Sunday lunch.

Boris Johnson was last night far more hesitant on the matter, saying he “hoped” to see his own mother, while advising the country to follow the scientific advice.

For at least four months, all those aged 70 or over, pregnant women, and adults of all ages with underlying health conditions, are being told to stay home as much as they can, and to “significantly limit face-to-face interaction with friends and family.”

For most of us, this is a high price to pay. Families across the country are trying to find ways to maintain human contact with their loved ones, without endangering them.

Skype and Facetime may save the digitally savvy. But for others the best hope of getting through the toughest times, there may be a simpler solution: Prof Chris Whitty this week was enthusiastically in favour when asked if meeting one’s elderly parents for a walk in the park (keeping at a distance of 6ft) could prove a solution.

As well as providing human contact – even if a hug is out of the question – officials are fearful that four months of isolation could mean the most vulnerable will lose mobility and health. So they are keen to advise that daily exercise, indoors or out, is vital.

But officials fear there is one message that keeps getting lost in translation.

Young and healthy people who are cavalier about their own risk of getting the virus – knowing they will likely suffer only mild symptoms – may not realise that the reasons for such actions are two-fold.

Firstly, that suppression of the virus in the public could save the nation’s parents, and grandparents – and secondly, that it could save the NHS.

Prof Stephen Powis, the national medical director of the NHS, says the health service is working hard to prepare for the surge in demand it is expecting, freeing up tens of thousands of beds, ramping up testing, and bringing in more staff and protective equipment.

“However, this is an unprecedented global health threat,” he continues. “No health service in the world could cope if the virus was left to let rip, which is why countries around the world are bringing in social distancing measures to slow the spread.

“It is vital that people follow the expert guidance and wash their hands, stay at home and use the NHS responsibly, so that services are there for those who really need it.”

Sir Patrick also calls on young people to do right by their grandparents. “The mixing in pubs and restaurants and so on is really part of allowing the disease to spread. It needs to stop, and it needs to stop among young people as well as among older people,” he told a briefing.

Advice on social distancing is not just about individuals, but about the need for younger people to behave altruistically, to protect those who are most vulnerable, experts stress.

Caroline Abrahams, charity director at Age UK, says: “Now is the time to do the right thing by listening to the expert advice and by staying in at night time. We must do this for the safety of our mums, dads and grandparents – and for all of our older friends.”