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Hospitals in Liverpool are scaling back non-urgent operations to help them cope with Covid-19 patients despite NHS bosses insisting that normal care continues during the second wave.
NHS trusts elsewhere in north-west England, as well as in the north-east and Midlands, are also preparing to cancel routine surgery such as joint replacements and hernia repairs amid a rapid rise in seriously ill coronavirus patients.
A potential second suspension of non-Covid care is looming despite warnings that this may lead to many thousands dying because their cancer, heart problem or other illness is not diagnosed or treated.
Steve Warburton, the chief executive of Liverpool University Hospitals NHS trust, acknowledged that doing less surgery would be “distressing” for patients affected but said the city’s three main acute hospitals had reached a “critical point”.
In a memo to staff seen by the Health Service Journal, Warburton said the trust was “taking a phased approach to reducing our elective programme, while exploring options with other providers to maintain some of this work in alternative locations”.
It is the first trust in England to make clear it cannot provide normal levels of non-Covid care during the second coronavirus surge, even though NHS England has told all hospitals to do so. The decision is likely to lead to other trusts doing the same.
Warburton said: “We will continue to prioritise surgery based in clinical need with a view to maintaining urgent and cancer surgery where possible.” He promised that the trust would continue to provide outpatient appointments “wherever possible” and keep giving patients diagnostic tests such as CT and MRI scans.
“We recognise that this will be distressing for patients whose elective care needs to be rescheduled; however, we must always ensure that the care we provide is safe,” he said.
The Royal Liverpool, Broadgreen and Aintree hospitals are thought to be treating about 250 Covid patients, who between them are taking up about one in seven of the trust’s total stock of beds. However, numbers are increasing quickly.
The trust has begun training staff to work in critical care, including the administration of continuous positive airway pressure (Cpap), where patients who are struggling to breathe receive oxygen but are not on a mechanical ventilator.
Last week the head of NHS England, Sir Simon Stevens, reiterated that hospitals should continue to provide normal care in the months ahead, including by using “Covid-free hubs” to do elective surgery.
However, well-placed NHS sources in Manchester, Birmingham and north-east England said trusts there were reluctantly considering again cancelling planned operations.
One hospital boss in the Midlands told the Guardian: “The decision about whether or not to turn off elective care will be taken soon. It won’t go down very well with NHS England bosses in London. But they don’t understand how difficult it is to [offer both Covid and normal care] while keeping people safe.”
A senior doctor in Manchester said: “There’s already a discussion going on at the moment about calling off elective surgery. However, understandably the intention is to resist that for as long as possible because we know that [services not being available in the spring during the lockdown] and people’s reluctance to come into hospital meant some people with cancer and heart failure, who would’ve been detected in normal times, weren’t detected because they didn’t present, and some of those people were no longer salvageable by the time they did present for care.”
Dr Jane Eddleston, the medical lead for Greater Manchester, told the Downing Street briefing by senior doctors on Monday: “The north-west has about 40% of all Covid cases at the moment and this is proving very challenging for us. The situation at the moment is that 30% of our critical care beds are taken up with patients with Covid and this is starting to impact on the services we provide for other patients.”
On Sunday Dr Jonathan Van-Tam, England’s deputy chief medical officer, said: “If cases rise dramatically, the NHS will need to focus more on dealing with the life-threatening situations immediately in front of them; this can mean freeing up staff and space by postponing other non-urgent procedures and treatments.”
Source: The Guardian
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