Coronavirus and the NHS: can Welsh hospitals withstand the extra pressure?

Published 06/11/2020   |   Last Updated 27/05/2021   |   Reading Time minutes

A difficult winter ahead

Cases of coronavirus have been rising sharply in Wales, and the number of people admitted to hospital with coronavirus symptoms continues to grow. The Welsh Government publishes data on coronavirus and NHS activity and capacity every Thursday.

A short, sharp firebreak was introduced across Wales from 6pm Friday 23 October until 12.01am Monday 9 November 2020 to help regain control of coronavirus. The Welsh Government said the firebreak is needed to “save lives this winter”. The firebreak will be followed by a new set of national measures, which will come into force on 9 November. These will be reviewed after two weeks.

According to the Welsh Government, the national and local measures put in place across Wales to date have helped to keep the spread of coronavirus under check. But with the R number in Wales currently between 1.1 and 1.4, the Welsh Government said it needed to act to prevent the NHS from being overwhelmed. The firebreak aims to slow the spread of the virus – to ensure Welsh hospitals can cope with demand in the weeks and months ahead.

The First Minister confirmed in Plenary on 3 November that the Welsh Government has taken steps to strengthen its response to the virus during the 17-day firebreak, and to implement its NHS winter protection plan.

Winter pressures/ Scientific modelling

Each year the NHS faces additional winter pressures due to a rise in seasonal illnesses and a worsening of chronic health conditions. This is due to a combination of seasonal infections such as flu, and the effects of colder weather, for example, on heart and lung conditions.

Last winter, operations had to be cancelled at hospitals across Wales due to pressures on health services. Routine planned operations were postponed in a number of Welsh hospitals as the NHS struggled to meet demand. This year, there is a significant backlog of patients who were not treated in the Spring and the added pressure of a second wave of coronavirus to deal with.

Scientific modelling suggests that Wales needs to prepare for a peak in hospital admissions between December 2020 and January 2021. In the worse case scenario this could lead to 6,300 coronavirus related hospital deaths.

The firebreak, proposed by the Technical Advisory Group to the Welsh Government, is intended to minimise transmission of coronavirus in the community. We won’t know whether the Welsh firebreak has been successful in slowing the spread of the virus for a few weeks yet because of the lag time in people becoming infected and showing symptoms.

NHS capacity and activity

Throughout the first wave of the coronavirus pandemic, the Welsh NHS did not run out of critical care capacity. But as we head into the winter months – a period of peak demand for the NHS - the pandemic pressures are somewhat different. The NHS was severely disrupted by the first wave of the pandemic, with staff and facilities redeployed to look after people seriously ill with coronavirus. The extra pressures of winter will mean a similar reorganisation will not be possible.

Currently, the number of people being treated in critical care for coronavirus is increasing. Around a third of critical care capacity is being used for coronavirus-related patients. The number of people being admitted to hospital with coronavirus symptoms is moving toward the same levels as the April peak.

Health Boards do have plans for additional critical care capacity. Field hospitals are now being used across Wales to help the NHS respond to the second wave of the pandemic.

But unlike the Spring, when non-urgent appointments and procedures were halted, the Welsh NHS is busier now than it was in April 2020. In Plenary on 3 November 2020, the First Minister explained;

There are currently 1,275 COVID-related patients in Welsh hospitals, 18 per cent higher than last week, and the highest number since late April. We expect this rising trend to continue until the impact of the firebreak is felt. In spite of this increasing pressure, our hospitals continue to provide planned activity, with cancer referrals returning to expected levels and the number of new out-patients 75 per cent higher in September than in April. Our actions have been designed not simply to protect our NHS’s ability to provide care to COVID patients, but to go on doing all those other things that matter so much to patients across Wales.

NHS staff are working not only to treat patients with coronavirus, but also to provide services to patients who have other serious health conditions. The NHS is trying to deal with the growing backlog of patients needing assessment and treatment after postponements during the first wave of the pandemic.

NHS Wales’ CEO Andrew Goodall has already apologised to patients for the disruption to NHS services. He wants to see services restored and has asked for the public’s understanding as the Welsh NHS attempts to increase the number of non-coronavirus related activities it can carry out. But providing non-coronavirus services becomes increasingly difficult as cases of coronavirus rise in hospitals.

Efforts to ensure Welsh hospitals have capacity to continue to respond to the coronavirus pandemic, emergency and winter pressures, and to maintain as much NHS activity as possible, will be hampered if the rapid rise and spread of coronavirus cannot be brought under control.

The second wave of the pandemic will also put pressure on community and primary care services. This sits alongside the urgent need to address the challenges faced by the social care sector.

On 19 October 2020, the First Minister acknowledged that the local lockdowns had succeeded in slowing the spread of the virus but they couldn’t succeed “far and fast enough to turn back the tide of coronavirus as it is currently accelerating across Wales”. The Welsh Government will be monitoring the data on cases and hospital admissions very closely over the next two to three weeks, looking for early signs that the firebreak has been successful. It will want to see that the action it has taken to protect the NHS, and to save lives in Wales over this winter will be enough to regain control of the virus – and avoid a much longer national lockdown.

Article by Sarah Hatherley, Senedd Research, Welsh Parliament