Published 29 April 2020
Many patients recovering from Covid-19 will require substantial rehabilitation. This rehab may be provided in step-down care so that hospitals have the capacity for other demands, but it will put pressure on community beds. Pressure in the community has not yet been visible as:
Longer stays in acute settings, where occupancy rates are low
The offsetting impact of reductions in non-Covid demand
Temporary expansion in the bed base, including use of care home and independent sector beds
As the focus in the acute sector shifts towards restoration and recovery, the factors that have been protecting community beds will reverse. Emergency and elective non-Covid activity will come back.
As we enter the “new normal” of ongoing Covid-19 demand, the squeeze on community beds could become much more substantial. Yesterday, 16,000 patients were in hospitals with Covid-19. Even if we assume that this drops by 50% in the coming months and only 30% of these patients need a step-down bed for 20 days, 3,200 community beds would be needed for Covid-19 rehabilitation - nearly 1 in 4 of all community beds. On top of this, non-Covid demand will return to previous levels and potentially exceed this as acute trusts try to get through the backlog of delayed demand.*
There is a risk that the experience of the last six weeks creates a false sense of security regarding the ability of out of hospital services to handle the increase in demand. But the recovery of acute activity could create a bottleneck in community care. As plans for restoration and recovery are created, it is vital that these plan for pressures throughout the healthcare system and not just for getting activity through acute hospitals. Read about our work on this and more broadly here: https://www.edgehealth.co.uk/covid19. * The estimated community bed baseline was calculated from a previous audit. We have assumed that the community bed-base has shrunk in line with the acute bed base (as reported by the King's Fund).