‘Confidential’ document warns second covid peak could hit NHS five times harder

In all scenarios presented, covid hospital admissions would remain high for an extended period of many months, even if new lockdown actions were taken. However, putting multiple measures in place could contain them to a peak of less than that seen in the spring, according to the work.

They were included in a document marked “confidential” and included, apparently by accident, in public papers for Thursday’s meeting of Medway Foundation Trust board. Within hours of HSJ asking for more information, they were removed.

They were badged with Kent and Medway Clinical Commissioning Group, the NHS body which oversees services for that area. The forecasts were marked as being “Kent and Medway level”, but were referred to as “regional scenarios”, indicating they may have been produced by regional teams of NHS England and Improvement. The trust’s board papers said its own planning for the coming months would make use of the three scenarios presented in the document.

Some of the details of each scenario were obscured in the copy of the paper HSJ has seen, but the overall picture is clear.

They are:

• A “reasonable worst case scenario” with a peak of hospital admissions five times that seen in April. Introducing all of what are described as “re-tightening” measures within the next two weeks — but remaining short of a full lockdown — would reduce this to about half of April’s peak level. However, there would be several months of heightened admissions under this scenario and covid-19 admissions would only drop back to current levels in April next year.
• A “more likely” case would see admissions rising before Christmas and not declining to current levels until mid-2021. Introducing all the re-tightening measures by mid-November could reduce admissions significantly – to well below April’s peak.
• A “reasonable best case” would still see cases rise close to the levels of April, while new lockdown measures could reduce this. However, even under this path, there would be a higher rate of covid hospital admissions than at present, and this would last for a period of several months. The commentary on the graph suggests that, in this scenario, “ongoing” measures, together with test, trace and isolation “would be enough to suppress the virus until a vaccine is found and no additional measures are needed”.

The “re-tightening measures” which the work models are described as being between the current level of restrictions and a full lockdown. Among those modelled are reduced contacts in the community — which the work suggests is more effective in reducing admissions than school closures.

Other measures include reduced contacts through work. Both the worst case and the more likely scenario assume that all these measures would need to be in place simultaneously, in order to bring the peak of hospital admissions below that seen in April.

The model has some similarities to a national one revealed by the BBC in recent weeks, which also suggested some social distancing measures would need to be introduced by November and could last until spring.

A Kent and Medway CCG spokesman said: “These are assumptions, not predictions, that allow the NHS across Kent to plan to respond to a potential second wave of covid at the same time as restoring core NHS services. This scenario planning will help ensure we continue to meet the needs of our patients and communities.”

James Devine, chief executive of Medway FT, said: “Unfortunately, a chart produced by Kent and Medway Clinical Commissioning Group was shared in error in the trust’s September board papers.

“As soon as we were made aware of this mistake we removed the chart from our board papers. We would like to apologise for any confusion as a result of this error.”

Modelling and challenges

George Batchelor, director of the Edge Health consultancy, suggested changes in public behaviour to be more cautious once hospital admissions were seen to rise could lead to a shorter period of increased admissions than forecast. And he added that any model was very dependent on the accuracy of its underlying assumptions.

Healthcare leaders highlighted how a second peak or wave of the virus would compromise the NHS’ ability to move towards a “normal” service for non-emergency patients.

NHS Providers chief executive Chris Hopson said: “There is significant concern about a prolonged second peak that lasts for a long period of time, particularly if it’s combined with the peak of winter pressures and high levels of winter flu. Such a peak would significantly impact on the NHS’s ability to recover services at the current planned rate of recovery.”

He said planning different scenarios and modelling demand was “essential”.

NHS Confederation chief Niall Dickson warned against “overpromising” what the NHS can achieve, and that it faced ”a formidable challenge”.

Nuffield Trust chief executive Nigel Edwards said: “Large numbers of hospital admissions could mean people going back to the sort of restrictions [in service provision] we saw in the early days of covid. The plans to return to normal are very much premised on trying to contain the infection.”