• Some hospital leaders say some routine electives could restart as soon as next week
  • Tension between NHS hospitals and plans to ask private sector to carry out many more operations
  • New coronavirus cases at hospitals have been dropping for some time, and number in hospitals is gradually falling
  • Unclear how much capacity NHS must keep free for potential future covid-19 peaks

Several acute trust chief executives have told HSJ they are keen to resume more planned operations, as the peak of new coronavirus cases has passed and many hospital beds remain empty.

Some trust leaders said they believed routine elective surgery could be restarted as early as next week. There is also tension between NHS hospitals — some of which are keen to resume their own planned care, especially the more urgent operations — and a desire to use private hospitals, which have been booked out by NHS England.

The government said yesterday the number of people in hospitals with covid-19 has fallen by 10 per cent over the last week. Around 42 per cent of acute beds are now unoccupied, according to figures seen by HSJ. The peak of new infection cases in hospitals was at about 3,000 on 1 April — the number is now about half that figure.

However, there will be fears nationally about the NHS seeking to return to normal and being caught out by ongoing covid-19 pressures, or by a second peak of infections. 

One chief executive running several NHS acute hospitals said regulators had indicated private sector hospitals should be prioritised for returning general elective operations, over NHS sites, but argued against this.

The chief executive said: “The empty beds in my hospitals have been paid for also, as have the staff. I do not agree with the school of thought which suggests that you should push all elective care out to the independent sector as we also need to show patients that it’s safe to use the NHS again for non-covid-19 urgent care.

“The sooner we can show that we are managing the safety issues the better. Otherwise we risk taking years off lives through debilitating conditions which could have been treated.”

David Hare, chief executive of the Independent Healthcare Providers Network, wrote in HSJ this week that some of the “‘buffer capacity’ provided by the independent sector has not yet been needed”, and added: “As more urgent and possibly even routine elective care takes place under the instruction of NHSE, however, then it is clear that many independent hospital facilities can be used as ‘clean’ non-covid sites, ideally placed to help mitigate the inevitable backlog of patients that will build up over this period, guided of course by appropriate clinical guidance.”

Several NHS chief executives said they were considering how to reorganise the split of covid-19 and non-covid-19 areas to enable more normal activity to return.

However, others highlighted that a large amount of NHS capacity would need to be kept free in case of another covid-19 surge, and said guidance from the Department of Health and Social Care or NHS England would be needed on how many beds, including what critical care capacity, needed to be allocated to that.

Bringing back substantial elective care would also need staff such as anaesthetists to be taken off their covid-19 duties, and some equipment, such as ventilators which have been moved from operating theatres.

Several local NHS chief executives sources said consideration was being given to allocating some hospital sites as “hot” or “red” covid-19 sites and others for other care — but this would prove contentious, with most trusts keen to keep their elective work, and potentially public and politicians not wanting their local hospital to be coronavirus-only.

The temporary Nightingale hospitals are likely to have a role in providing some form of coronavirus care, as has already been signalled in London.

Matt Hancock earlier this week appeared to indicate operations could resume soon, but said the NHS needed to wait until it was “safe”.

An NHSE spokesman told HSJ this afternoon: “Next week we will set out guidance to the service on releasing and redeploying some of the treatment capacity that needed to be created while the number of covid-19 patients was rising so sharply.

“A public information campaign beginning this weekend will remind people that the NHS remains open for business, and it is important that non-covid19 patients can also still safely access the appropriate care and treatment they need.”

Updated 4pm to include NHSE comment