NHS backlog would not be as bad if No 10 had agreed beds funding, inquiry told

The NHS’s backlog of care would not be as bad if the government had given it permission to expand the number of hospital beds in the middle of the Covid-19 pandemic, the head of the health service has suggested.

In July 2020 the NHS sought 10,000 “non-temporary” hospital beds to deal with recovery from the first wave of the crisis and the future surges in case numbers.

But the request was denied by the Treasury and Number 10.

Giving evidence to the UK Covid-19 Public Inquiry, NHS England chief executive Amanda Pritchard said that the decision was “disappointing” and that the nation “could be in a different position” when it comes to the backlog of pre-planned hospital care.

If we had had that capacity, we could certainly have treated thousands more patients if we had had that additional headroom, as well as being more resilient going into the second wave and into winter more generally

According to the latest data from NHS England, an estimated 7.64 million treatments were waiting to be carried out at the end of August, relating to 6.42 million patients.

The list hit a record high in September 2023 with 7.77 million treatments and 6.50 million patients.

The inquiry also heard that going into the pandemic, hospital bed capacity in England was lower than many comparable countries around the world.

Counsel to the inquiry Jacqueline Carey KC, said: “In July of 2020, NHS England sought 10,000 non-temporary beds to deal with recovery and the potential future surges … the funding for those beds was not approved by Her Majesty’s Treasury.”

Ms Pritchard said: “We had done some modelling work over that summer to looking at from a best estimate, what it would take to be able to run with a sort of constant number of patients in the service who were Covid positive, create the necessary headroom then to respond to normal winter pressures, but crucially also to have the space to do the, not just urgent, but also non-urgent, non-Covid work, so that we would be able to do that recovery work that we’d begun to start in the summer.”

Ms Carey said: “I think the Prime Minister’s private office was involved in the decision to refuse and said, effectively, they wanted more use to be made of Nightingales, the independent sector, to go back to discharging patients if necessary, using flu vaccinations to hopefully deal with any flu upsurge there would be, and that there would be capacity looked at in the Spending Review… What were the consequences of that 10,000 bed requests being refused, from your perspective?”

Ms Pritchard replied: “It was, as you say, very disappointing, because what it meant in practice is that where we could now be in, I think, a very different position on elective recovery.

“If we had had that capacity, we could certainly have treated thousands more patients if we had had that additional headroom, as well as being more resilient going into the second wave and into winter more generally.

“So subsequent to the pandemic, there have been some steps taken to increase core bed capacity, but clearly we could have done with that capacity at the time, and I think we’d be in a quite different position now.”

The pandemic probe also heard about the extreme pressures on the service during January 2021, including how patients were sent from Cumbria to Newcastle and from Kent to Oxford for care.

She said that the second wave was “completely terrifying at times” and how some hospitals were “right on the edge” of “crit con four” at times.

“I was talking to people who were in hospitals, in intensive care units, who were describing some of the same things you’ve heard from witness testimony … and we were very close, at times, very close.”

Ms Carey asked: “When you say we were ‘very close’ or ‘right on the edge’, to use your words, does that mean running out of beds in any particular hospital and indeed region?”

Ms Pritchard replied: “Yes.”

Ms Carey added: “If I suggested to you we were on the brink at times in January 2021, would you disagree?”

Ms Pritchard replied: “No.”

The inquiry heard that Ms Pritchard’s statement “made clear” that there were three occasions when she was concerned critical care would exceed capacity – March 2020, winter 2020 to 2021, and winter 2021 to 2022.

Ms Carey said the statement also highlighted that “there clearly were some spare beds available throughout most of the pandemic”, but as other witnesses have said “it’s not just about the bed, it’s about the quality and the detail of care that is provided”.

In all of the conversations we were having with government, we were really clear about what people were actually experiencing

She asked if Ms Pritchard thought “there was an overreliance on the data, presenting a rosier picture”.

Ms Pritchard disagreed, replying: “I’m confident in saying there wasn’t for us.

“And in all of the conversations we were having with government, we were really clear about what people were actually experiencing, and certainly colleagues of mine were inviting in, making arrangements for journalists to film in our critical care units and in our hospitals to try and help the public understand what extraordinary length staff were going to.”

The inquiry was shown a document outlining the costs of the temporary Nightingale hospitals which were set up at seven locations in response to the crisis.

The probe was shown a document detailing the costs of the programme.

Ms Carey said: “If one takes London as a starting point, it was approved on March 23. It went operational on April 3. But during wave one, 57 patients were admitted.

“It was open for admissions from April to May 2020, then on standby. And during wave two, it was not used to admit Covid-19 patients, but 71 non-Covid 19 patients were treated.

“And we can see there that from January 11 2021 it was used as a mass Covid-19 vaccination centre until late June 2021.

“Set up £77 million, £9 million to run, just over £5 million to decommission. Total cost £132 million.”

Ms Carey highlighted that the programme cost more than £358 million, and asked Ms Pritchard if she thought “that was a useful resource that was available to the NHS, albeit one that was very little used to treat Covid-19 patients”.

Ms Pritchard replied: Yes is a simple answer. Because, when we were at the beginning of this process, making decisions about opening these unprecedented field hospitals, because that’s what we’re talking about, we went into this expecting to need them.

“We didn’t have community prevalence data, we only had the data, which was the rear view mirror about patients who were in hospital at the time.

“So it was much more uncertain than it became later on, when we could predict much more accurately what was likely to happen.

“But the doubling rates looked like we were going to be in a situation where we would hit a maximum operational, even with the surge that we’ve talked about, capacity.

“And if we had not had this kind of facility available at that time, this inquiry would be having a very different kind of conversation if we had ended up in that kind of scenario where we would have been unable to treat, potentially many, many thousands of patients.”

Asked what the NHS could do to ensure there is more critical care capacity in the event of a respiratory pandemic such as Covid-19, Ms Pritchard said: “A bed is not a bed, a bed is a physical space yes, but it’s got staff, it’s got medicines, it’s got equipment.

“And all of those things are part of what I think forms that future resilience narrative, and that future resilience ask, which clearly, I’ve already said we didn’t have headroom going into the pandemic, and that has not materially changed as we stand now.”