A briefing for MPs and peers from NHS Providers shows why national NHS statistics do not reflect the true pressures on the health service, underlining the need for caution in considering COVID-19 restrictions.

Current NHS Pressures is published as MPs prepare to debate and vote on the government's proposed new tiered restrictions. It says that although national level data on bed occupancy and hospital demand may appear to be manageable, this is not a good guide to the pressures on the NHS.

The briefing focuses on hospitals but many of the issues raised in the briefing also apply to community, mental health and ambulance trusts which are similarly stretched.

It explains why running a hospital is much more difficult and complex than normal due to COVID-19.

That is because of the pressing need to treat three sets of patients:

• those with COVID-19
• those caught in the backlog of planned care
• those requiring emergency treatment
  
  

Trusts face difficult challenges in managing these competing priorities, which are not captured in the national data on demand and bed occupancy:

• infection control measures requiring separate areas, reducing capacity by up to 20% – red for COVID-19, amber for patients waiting for test results , and green for non-COVID-19 patients
• slower or disrupted planned surgery caused by limited theatre space, time consuming donning and doffing of personal protective equipment (PPE), and the need to convert elective surgery recovery wards to treat COVID-19 patients,
• although overall demand for urgent and emergency care is slightly down on the same point last year, trusts are reporting higher numbers of very sick patients requiring admission and more people in A&E with complex mental health needs
• increased staff absences (compounding severe workforce shortages) because of COVID-19, and staff transferred from other duties to look after COVID-19 patients
• these issues exacerbated by current lack of access to rapid turnaround testing.
  
  

The briefing also tackles misconceptions about the figures for intensive care units and the use of Nightingale hospitals.

The figures for intensive care units (ICUs) are not a good indicator of hospital pressures because they only account for a small proportion of a hospital's total bed base, and many more COVID-19 patients are now being treated on general wards without the need for ventilators.

There is also a widespread misunderstanding about the purpose of Nightingales. They were always intended as a last resort insurance policy to avoid the NHS being overwhelmed.

   

There is also a widespread misunderstanding about the purpose of Nightingales. They were always intended as a last resort insurance policy to avoid the NHS being overwhelmed.

They are not purpose built hospitals so the patient experience would not be as good, and they can only be staffed by taking people from existing hospitals, reducing the quality of care there as well. So the NHS would always want to use capacity in existing hospitals, with existing staff, before triggering the use of Nightingales.

The briefing concludes that a combination of vaccines, mass scale rapid turnaround testing and therapeutic advances offer a way out of the current COVID-19 challenges in the spring and early summer. But in the meantime restricting social contact is the only way of reducing the spread of infection.

The chief executive of NHS Providers, Chris Hopson said:

"It's important that MPs understand the true extent of pressures faced by the NHS as they consider the new tiered restrictions.

National statistics tell only part of the story. In reality the situation for trusts is much more difficult.

"National statistics tell only part of the story. In reality the situation for trusts is much more difficult.

"Trust leaders understand only too well the impact of these restrictions on people's livelihoods and liberties and on their mental health.

"Vaccines, therapeutic drugs and mass scale rapid turnaround testing offer a clear way out of this next spring.

"But there is an immediate need to get through winter, avoiding a damaging third surge in infections with the virus, and ensuring the NHS is able to provide appropriate high quality care for all patients, COVID and non-COVID."