The NHS has declared a national major incident over the coronavirus outbreak and ordered all hospitals to review their numbers of intensive care beds and how they could be increased to cope with a surge in patients.
A letter sent to health chiefs on Tuesday by NHS England reveals patients infected with the virus could soon start to be treated on hospital wards instead of specialist units as the numbers affected grow.
Hospitals have been told all patients in intensive care who have signs of a lung infection should now be tested for coronavirus, amid fears the virus could already be in hospitals and could spread between patients.
NHS chiefs have been told to work up plans to segregate wards such as A&E departments, critical care and diagnostic areas in the event of a “significant escalation” in cases of coronavirus.
Trusts will also discharge patients earlier and have been told to consider plans to treat patients remotely and where possible, see some patients in the community.
The letter, sent by Professor Keith Willett, NHS England’s strategic incident director, instructs hospitals to “review your critical care and high dependency capacity and consider how you could increase capacity and the impact of doing so”.
There have been fears the NHS could be overwhelmed in a large-scale outbreak with doctors forced to ration access to critical care.
The letter says: “To date Covid-19 has been managed as a high consequence infectious disease through our specialist centres so we could learn as much as possible about the virus and of course the illness. It is now appropriate to begin to manage some patients within wider infectious disease units and, in due course if the number of cases continues to grow, we will need to use all acute units, for example through the cohorting of patients.”
In light of the virus spreading around the world the letter said the NHS was now demanding all trusts establish 24 hour, seven-day a week incident teams which will be overseen by regional and national teams to coordinate the NHS response to any surge in cases.
Explaining the rationale for intensive care patients to be tested the letter said: “In recent days, new Covid-19 infections have been diagnosed in intensive care units in a number of European countries, without any epidemiological links to high-risk areas. Nosocomial [hospital] transmission has occurred in these units affecting other patients and staff.
“It is essential that we detect cases admitted to intensive care at the earliest opportunity.”
Trusts have been told to ensure staff have been trained and fitted for specialist equipment and it said any member of staff who has to self-isolate as a result of fears they may be infected with the virus should get full-pay. This includes temporary staff and sub-contractors.
The letter said hospitals needed to “consider the impact that a possible surge in medical patients might have on services and stocks” but added there was no need for stockpiling by organisations which could make shortages worse.
It added: “Where possible, consider implementing alternative models such as remote consultations for those patients who can be supported at home and review arrangements to support vulnerable individuals in alternative settings, including in the community.”
It also said hospitals needed to begin discussions with local care providers such as care homes and social care companies to ensure they will be able to cope with patients discharged earlier.
Prime minister Boris Johnson outlined the government’s national plan earlier on Tuesday and it is understood ministers are working on a new bill to give them emergency powers which will include giving border force staff the power to detain individuals and require them to take a coronavirus test.
Helen Buckingham, Nuffield Trust director of strategy, said: “The plans set out by NHS England today are a sensible response to the unfolding picture regarding coronavirus. With confirmed cases of the disease likely to grow over the coming weeks, it is absolutely right to ensure that hospitals and community providers are making plans to free up hospital beds and specialist staff for people who need them most.
“This means looking at where patients can be treated remotely, ensuring that hospitals are set up to isolate and treat patients, and ensuring that the most critically ill have access to the specialist help they may need.
“It is concerning that the letter did not include explicit guidance for GPs or social care providers. These services are likely to suffer significantly if staff are unable to get to work due to coronavirus – either through staff being ill themselves or through caring for sick relatives. A holistic approach to planning is the best way to ensure that all parts of the health and social care system are ready to manage a growth in novel coronavirus cases.”
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