The conditions for re-introducing elective surgery in the English NHS whilst managing COVID-19 patients have been evaluated in a new report.

** UPDATE (16-10-2020): This research (Report 27) has now been peer reviewed and published in BMC medicine. **

Its authors found that all elective surgeries performed in the English NHS on a normal day could be reintroduced once COVID-19 patients require less than about 320 critical care beds. As of 15 June, there were about 390 COVID-19 patients in critical care beds.

We have shown that re-introducing elective procedures can only be sustained with a combination of other hospital provision interventions. Alessandra Lochen

Resuming normal elective surgeries would not clear the backlog of patients who had their elective surgeries postponed or cancelled in March, April and May to free up beds for the impending surge of COVID-19 patients requiring life-supporting treatment. The study did not model clearing the backlog after elective surgeries are resumed. 

Dr Katharina Hauck, from the School of Public Health at Imperial, said: "It is impressive how the NHS adapted to provide life-saving treatment to COVID patients, but we have now many patients who are waiting for essential surgery. Our research shows ways to get them the treatment they need." 

The report is by researchers from the WHO Collaborating Centre for Infectious Disease Modelling within the MRC Centre for Global Infectious Disease Analysis, Jameel Institute (J-IDEA) at Imperial College London and Imperial College Business School.

Hospital provision interventions

It suggests that NHS England would not have had sufficient daily capacity to treat all patients at the peak of the pandemic in April without implementing hospital provision interventions. These interventions, which were implemented to increase capacity in general & acute and critical care, included cancellation of elective surgery, the use of field hospitals and private hospitals, and deploying former medical staff, newly qualified medical staff and final year nursing and medical students in hospitals.

Even with these interventions in place, critical care capacity was at its limits in April, says the report. The greatest constraints in the English NHS are on the numbers of critical care nurses, critical care beds and junior doctors available. The report authors stress it is important to invest in these crucial critical care resources, particularly if COVID-19 hospitalisations were to increase again.

Ms Alessandra Lochen said: "It is vital for decision-makers in England to understand where the limits of the NHS's capacity are and the threshold of COVID-19 patients that will allow them to safely re-introduce non-urgent operations. We have shown that re-introducing elective procedures can only be sustained with a combination of other hospital provision interventions."

Since the emergence of the new coronavirus (COVID-19) in December 2019, the Imperial College COVID-19 Response Team has adopted a policy of immediately sharing research findings on the developing pandemic. 

The full report, ‘Adapting hospital capacity to meet changing demands during the COVID-19 pandemic’, is available on the MRC GIDA report website.