NHS pressure: hospitals in England dangerously busy - as staff race to free up beds for Omicron patients

More than two-thirds of English hospital trusts had potentially dangerously busy wards in the week to Boxing Day despite efforts to free up beds in anticipation of a surge in severe Omicron cases.

Hospitals are considered to be too busy if more than 85% of their available general and acute beds are occupied by patients. After this, patient care is thought to be compromised.

General and acute beds are for people admitted from A&E, by their GP, or who are recovering post surgery. It excludes beds in intensive care, maternity, and mental health wards.

Analysis by NationalWorld of NHS England’s weekly winter pressure reports reveals 94 out of 134 acute hospital trusts had an average occupancy rate of more than 85% during the week to 26 December - more than two-thirds.

The British Medical Association, responding to the figures, said the NHS was facing “the most precarious time ever”.

It comes as the health system puts itself on a “war footing” to prepare for a possible rising tide in patients infected by Omicron over recent days and weeks – particularly older people.

Omicron initially spread most widely among younger age groups, who are less likely to be hospitalised.

Across England, an average of 87.4% of adult general and acute beds were occupied during the latest week. Occupancy rates peaked on 22 and 23 December at 91.2%.

During the seven-day period, nine out of 10 trusts recorded occupancy levels of 85% or more on at least one day.

Four out of five saw rates hit 90% at least once, while almost half hit 95%. The current NHS plan states trusts should reduce bed occupancy to a maximum of 92%

The latest week’s figures – the fourth installment in NHS England’s weekly winter pressure reports – were an improvement on the previous.

In the week to 19 December, average weekly occupancy was at 93.3%. In the week to 12 December, it was at 94.3%, and in the week to 5 December it was 93.8%.

There were an average of 77,901 beds occupied over the latest week, a significant drop on the 84,544 recorded the week before.

But more recent data from the government Covid dashboard shows a significant uptick in Covid patients in the days after Christmas – whether those admitted due to Covid, those who caught it after being admitted, or people who tested positive when being admitted for something else.

As of 8am on 30 December there were 11,452 such patients, up from 7,536 on Boxing Day, meaning the health service is likely to be facing increased pressure since the end of the period the winter pressure report covers.

Because of enhanced infection control measures and the need to treat Covid and non-Covid patients separately, hospitals are also likely to feel the strain at lower occupancy levels than previous years, NHS England said.

NHS England and NHS Improvement have previously suggested 92% should be considered the recommended safe limit for bed occupancy in winter. However, the Royal College of Emergency Medicine endorses the 85% threshold.

High bed occupancy rates can lead to bed shortages and make it difficult to find the optimum bed for a patient’s needs, contributing to waiting time backlogs and delays in A&E.

There is also evidence it can lead to an increase in hospital acquired infections and other “avoidable adverse events”, according to a review by the National Institute for Clinical Excellence (NICE).

The latest NHS England report also reveals a big increase in the number of staff off sick with Covid.

In the week to 19 December there was a daily average of 17,836 acute trust staff absent due to Covid sickness or self isolation. In the week to 26 December that rose to 25,273.

Dr Vishal Sharma, British Medical Association consultants committee chair, said the considerable drop in staffing levels “threatens the ability of services to give people the treatment they need” – even as the NHS prepares Nightingale sites to increase bed capacity.

“The [UK] NHS went into the pandemic with proportionately far fewer hospital beds than its comparable neighbours, which meant, even before the arrival of Covid-19, hospitals were regularly surpassing safe occupancy levels,” he said.

“Hospitals have in recent winters consistently struggled with unsafe capacity, but with rising numbers of patients being treated with Covid – now the highest since early March – and a record-high backlog in other care, we’re currently experiencing what many doctors feel is the most precarious time ever for the health service, its staff and the patients they treat.”

Dr Sharma called for more investment in ventilation and other NHS infrastructure to ease crowding, and more targeted health measures for the public to be introduced.

NHS national medical director Professor Stephen Powis said the NHS is doing everything possible to free up beds to prepare for the impact of Omicron on the health service – the full scale of which is still unknown.

“In the last week hundreds more beds were freed up each day compared to the week before,” he said.

“On top of the incredible efforts made by staff to get people out of hospital safely, we are also making every possible preparation for the uncertain challenges of omicron, including setting up new Nightingale surge hubs at hospitals across the country and recruiting thousands of nurses and reservists.

“The NHS is on a war footing. Keeping as many colleagues as possible at work on the frontline and minimising absence will be essential in the next few weeks.”

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