Table 2.
Overview of hospital provision interventions implemented in England
| Intervention | Description | Effect on CC resources | Effect on G&A resources | Source |
|---|---|---|---|---|
| Interventions managing admissions | ||||
| Cancellation of elective surgery | Cancelling elective surgery reduces the number of beds occupied, and thereby also reduces the number of staff and ventilators required on a daily basis. | • Beds: Reduce occupancy by 30% | • Beds: Reduce occupancy by 41% | NHS Hospital Episode Statistics; Redaniel and Savovic [26, 27] |
| Interventions increasing supply | ||||
| Set-up of field hospitalsa, b | Non-hospital sites are temporarily turned into hospitals. This increases bed numbers, but with no additional staff. In England, no details were provided about any increases in ventilator numbers solely through this intervention. | • Beds: Increase total by 500 (12%) | • Beds: Increase total by 8000 (8%) | NHS England news (03/04/20) [28], Health systems response monitor [25] |
| Deployment of newly qualified/final year medicine and nursing studentsa,b | Final-year medical and nursing students have their qualification process accelerated to enable them to start working immediately. They are allocated as G&A nurses and G&A junior doctors respectively. | – |
• Nurses: Increase FTEs by 16,456 (51%) • Junior doctors: Increase FTEs by 4840 (47%) |
BBC news (24/03/20) [29] |
| Return of former healthcare staffa | Individuals who recently worked in the health system are asked to return. This is predominantly staff who retired within the previous 3 years, but also includes individuals who left for other professions. In order to account for this fact, and also the fact that some senior staff may not wish to take on clinical decision-making responsibilities, staff are allocated across all six categories. The figures here are only for those estimated to have returned as opposed to all eligible. |
• Nurses: Increase FTEs by 587 (15%) • Junior doctors: Increase FTEs by 64 (10%) • Senior doctors: Increase FTEs by 92 (10%) |
• Nurses: Increase FTEs by 4822 (15%) • Junior doctors: Increase FTEs by 979 (10%) • Senior doctors: Increase FTEs by 1206 (10%) |
BBC news (24/03/20) [29] |
| Use of private hospitalsa | National health systems temporarily use private healthcare resources to provide public care. This increases the number of beds, ventilators and all staff categories. |
• Beds: Increase total by 317 (8%) • Nurses: Increase FTEs by 955 (24%) • Junior doctors: Increase FTEs by 17 (3%) • Senior doctors: Increase FTEs by 24 (3%) • Ventilators: Increase by 1200 (15%) |
• Beds: Increase total by 7683 (8%) • Nurses: Increase FTEs by 7845 (24%) • Junior doctors: Increase FTEs by 258 (3%) • Senior doctors: Increase FTEs by 317 (3%) |
NHS England news (21/03/20) [30] |
Note: CC: critical care; G&A: general and acute. Baseline proportions of CC and G&A were applied to data that were found to be aggregated in data sources. Staff increases account for staff sickness rates. Although further interventions involving reallocation of resources, such as conversion of operating theatres and G&A resources into CC wards and changes in staffing ratios, were also approved on a national level, these are implemented at a hospital level. As a result, their effect could not be quantified nationally and thus were not included in the analysis
aFull supply-side intervention package [4]
bSupply-side interventions deemed most sustainable in medium run [4]