Published 14 May 2020
Many of the hospitals where we have worked tell me that Christmas day is wonderfully quiet. It tends to bear out in the data with occupied beds dropping a few days before the 25th. There are a few reasons for this pattern, although the main point is that in January the demand returns with a vengeance. This returning demand tends to build up somewhat slowly, but long lengths of stay mean that it causes ongoing operational issues for the weeks, if not months, that follow.
Like Christmas, Covid-19 has caused a drop in A&E attendances and emergency admissions. But the drop due to Covid-19 has been larger and longer - the chart below summarises this for NHS STP regions (bars show reduced attendances, dots show reduced admissions).
This shows that type 1 A&E attendances (the most severe) dropped by an average of 50%. Emergency admissions fell by 40% - slightly less, which is expected if those attending were more acutely ill. Some areas saw much higher drops than others - notably London, where the number of people infected with Covid-19 was scarily high, but also Cornwall where cases have been quite low.
A good friend tells me that the drop in A&E attendances in March felt like the moment before a storm, so it was a welcome relief and gave them time to prepare for Covid-19. The problem is that, like Christmas, many of the people that avoided hospitals during the peak of the pandemic still have health needs. Some may have recovered. Some of these people may have gotten more acutely ill or worse.
Working with one hospital, we estimated that 25%-50% of their "lost" activity from March and April might return in the next three months. If 80% of hospital beds are non-elective, an increase of 25% would mean 20% more occupied beds even before you consider Covid-19 demands. That might mean removing all the space that would typically be used for planned operations - this will worsen waiting times. So as the NHS looks at its recovery and restoration, it is important to understand the patterns of demand and how these may present over the coming weeks.