North by North West: Bed expansion as leaders fret over winter

The North West is now the worst hit region* in terms of all-cause mortality since March – recording the highest rate of excess deaths per head of population.

Although London saw the highest peak in deaths, it also had a steep descent.

By contrast, the downward curve in the North West has been far more gradual, with the region’s hospitals dealing with significantly higher numbers of covid patients than other regions for several weeks now.

There have also been some worrying signs in the last fortnight, with mortality rates creeping back up in Merseyside in the second half of June, and Liverpool’s public health director issuing a warning on Friday about rising case numbers in the south of the city.

It means the region will be especially cautious in its approach to restoring typical services, and will require high levels of preparedness for any potential second peak.

The main fear is a second covid peak in late autumn or winter coupled with a bad flu season, which could again require a wholesale shift in resources to respiratory care, and further lengthy service suspensions in other areas.

More beds

This is what’s partly behind the move to create what would surely be the biggest ever bed increase in the region.

NHS England’s regional directorate has asked leaders to make plans for 900 community-based beds, to be provided by the end of the autumn months – a hell of a challenge (which we think has been mirrored to some degree in other regions).

The rehabilitation units would be dispersed across multiple localities – in some cases in repurposed wards or care homes, and in others new modular builds. The numbers are unclear, but the idea seems to be in the region of 20 to 30 units.

The basic idea is that these beds can help hospitals discharge covid and even other respiratory patients, more quickly, to prevent hospitals cramming up with potentially infected patients and allowing them to maintain some normal services. Crucially, they could also help ensure hospital patients who may have coronavirus are not discharged to care homes.

You might be thinking, what about the Nightingale facility in Manchester? It was set up to deliver rehabilitation for covid patients and now stands empty.

But as one senior person explained it to me: “A lot of covid patients are really sick and need intensive rehabilitation and support. It takes them a significant amount of time to recover and the Nightingale was absolutely unsuitable for that.”

A few people also mentioned the word “legacy”, suggesting the new units could outlast the pandemic and be part of the solution to the North West’s long-standing struggles with accident and emergency performance.

Besides the practical and financial difficulties in establishing these units so quickly, there is also the question of how to staff them. It’s not yet clear how many additional staff will be needed, to what extent they would be funded, and if it’s even possible to recruit them in time for winter.

We’ll have to see how many of the units come to fruition, but it’s probably safe to say the staffing agencies for nurses and allied health professionals will be busy.

No wonder

There will be multiple reasons for the higher mortality rates in the North West, which researchers at the University of Liverpool have attempted to pin down. They believe age profiles, income deprivation, ethnic communities, overcrowded housing, high care home populations, and perhaps most crucially, the prevalence of chronic conditions make it more vulnerable to the virus.

As Dominic Harrison, the director of public health for Blackburn with Darwen, has pointed out, many North West boroughs have had high mortality rates for many years – similar to some of the most deprived parts of eastern Europe – so it’s no wonder covid should be so dangerous for these already vulnerable populations.

Although the response to the pandemic has required a short-term reaction to the immediate challenge, when the time comes, its terrible impact should force health and care leaders to have a far more serious, and longer term, look at how they can use resources to tackle these underlying causes of ill health.

Best interests

Gary Doherty, the former chief executive of Blackpool Teaching Hospitals, has returned to Lancashire following a punishing few years leading the largest health board in Wales.

Mr Doherty joined Betsi Cadwaladr University Health Board in 2016, tasked with getting the organisation out of special measures.

Four years later, with the organisation still languishing, his departure was facilitated through a secondment deal with Lancashire Teaching Hospitals, where he is now director of strategy.

Betsi’s annual report suggests it is still paying Mr Doherty a pro-rata salary of £180,000, along with the salary of its new CEO. LTH said there is no cost to them.

Betsi says the deal represented “the best interest of the organisation and value for money”, although was accused by some of “rewarding failure”. Others have said the job was always too big for one person to come in and fix.

* If the West Midlands was an NHS region (as opposed to the Midlands), it would be slightly ahead of the North West on excess mortality since mid-March, which compares the number of deaths from all causes to the five year average over the same time period.