(Bloomberg) -- As the coronavirus pandemic takes hold of Europe, Britain’s already-stretched health system is preparing for the biggest threat it’s faced since it began caring for patients in 1948.
Regarded worldwide as a model of free health care for all, the National Health Service has already grappled with staffing shortages and tight budgets. Now there are questions about whether it has enough beds, life-saving equipment and workers to tackle a feared spike in infections.
“The NHS has a long track record of rising to huge challenges, but this is probably the hugest challenge it has faced in its 70 years,” said Helen Buckingham, the director of strategy at the Nuffield Trust think tank who spent 25 years at the NHS. “I’m not going to pretend it’s going to be easy.”
Britain isn’t alone. Hospitals around the world are scrambling to avoid the dire scenario playing out in Italy, where the epidemic has outstripped supplies of beds, personnel and equipment. That country has reported about 31,000 known coronavirus infections and more than 2,100 deaths, behind only China.
The NHS has its own set of hurdles. About 100,000 positions in a workforce of more than 1 million went unfilled in the latest quarter, almost 40% of them nursing roles, according to London-based Nuffield. Thousands from overseas quit after the Brexit vote amid uncertainty about their immigration status. On top of that, almost nine out of 10 beds are already occupied.
Bracing for an onslaught, the NHS is suspending elective procedures that aren’t urgent for at least three months and seeking to free up as many as a third of its 100,000 beds for coronavirus patients, Simon Stevens, its chief executive officer, said Tuesday in a parliamentary hearing.
The number of ventilators, used to help the sickest patients breathe, is set to increase to about 12,000 over the next several weeks; the NHS says it wants even more. Government officials are also seeking help from private hospitals, Stevens said.
The London branch of the Mayo Clinic, the private Rochester, Minnesota-based hospital chain, is willing to help test people for the virus or take patients with other illnesses, said medical director Kevin Fleming. Some regulations will have to be waived for the collaboration to work, he said.
Prime Minister Boris Johnson Monday urged the public to avoid all “non-essential” contact with others amid warnings that the country could see hundreds of thousands die from the illness caused by the infection, Covid-19. Without months of adherence to drastic measures, the infection rate could double every five or six days, he said. Britain so far has confirmed about 2,000 cases and 55 deaths.
Taking radical steps to suppress the epidemic is the only viable strategy to respond to the looming emergency, according to research from Imperial College London released Monday. A less aggressive approach to slowing the virus’s spread -- even in an optimistic scenario -- would lead to inundated health systems, with the U.K. death toll rising as high as 250,000. An insufficient approach in the U.S. would result in more than 1 million deaths, the researchers estimated.
The goal of intervention is to keep the increase in cases steady, rather than a “short, sharp surge” that could upend the system, according to Buckingham. Private hospitals may be able to alleviate the pressure by handling planned procedures or setting aside extra space for the public system, she said. The NHS could also bring back recently retired workers and fast-track medical students close to finishing their studies, she said.
“The NHS is putting in place all the preparations it can do,” she said, “but the onus is on the public to do everything we can do to help slow the spread of coronavirus, so we minimize the gap between demand and capacity.”
Misdiagnosis Risk
The country has 193 independent hospitals with about 8,500 beds. There are 1,000 more beds in so-called NHS private patient units, according to a Laing Buisson report. In central London, an estimated 8% of the beds in private hospitals are for the highest level of intensive care.
As the NHS focuses all its resources on fighting the coronavirus, it’s possible other conditions will be missed or misdiagnosed. The same thing happened during the 2009 swine flu pandemic, when an 8-year-old boy diagnosed with the disease died because he actually had diabetes.
“Health professionals can become blinkered so they don’t spot what the other possibilities are when presented with symptoms consistent with Covid-19,” said Dorothy Flower, a lawyer at RPC in London. “I wouldn’t be surprised if that led to a number of lawsuits further down the line.”
Another issue that needs attention is that laptop computers that NHS doctors need to work remotely and teleconference are in short supply, said David Wrigley, a general practitioner in North Lancashire who’s deputy chairman of the British Medical Association.
“There’s been no real national guidance on this or advice about how to set up this new way of working,” he said.
After World War II, the NHS grew out of the idea that returning soldiers should be cared for no matter their financial position, and the program to provide universal health care was soon extended to the general population. In recent years, the system has encountered increasing threats to its mission, staffing and annual budget, and its fate was a key issue when Britons went to the polls in December.
The government measures introduced this week are crucial in reducing infection rates and peak pressure on the system, according to Stevens of the NHS.
“This is an unprecedented global health threat,” he said. “Unmitigated, there’s no health service in the world that would be able to cope if the virus let rip.”
©2020 Bloomberg L.P.
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