UK | 7,934,936 cases, 136,986 deaths (as at 5 October 2021)

Historical governance and cultural connections mean that there are applicable lessons from the UK experience

The UK’s struggle to control and contain COVID-19 has made global news on occasion, but the National Health Service (NHS) has so far withstood three ‘waves’ of pandemic patients. There is also widespread agreement from the UK Government, and from within the health system, to continue certain aspects of pandemic preparedness and response.


Initial increase in capacity

NHS Providers identified that the NHS undertook five separate processes to prepare the health system:

  • Discharging medically fit patients – this enabled NHS hospitals to increase their capacity substantially, as usually 20-30 per cent of patients are ready to go home.
  • Postponing/diverting planned care – this involved the cancellation of elective surgeries and moving care, where possible, to community locations.
  • Creating extra critical care capacity – infrastructure was added and redesigned to accommodate the anticipated surge in patients. In 2020, 33,000 extra beds were created in less than a month, adding a level of capacity which was the equivalent of 53 more, average-sized, district general hospitals across the country. This included a 4,000-bed field hospital created in the ExCel Centre in London for emergency use.
  • Emergency training staff to support COVID-19 patients – trusts rapidly expanded the number of staff who can look after critically-ill coronavirus patients. This included working with anaesthetists and theatre recovery staff to grow the number of specialists who can operate ventilators and moving staff into new roles to support care. At the same time, trusts have also been training and incorporating the 36,000 nurses and doctors who have volunteered to return to the NHS after recent retirement.
  • Incorporating private sector capacity into the NHS – the NHS struck a comprehensive deal with the independent hospital sector to use their capacity to both treat COVID-19 patients and help the NHS deliver other urgent operations and cancer treatments.

The five steps occurred concurrently and enabled the health system to withstand the initial pandemic pressure in 2020. This was a huge, but beneficial, undertaking.


Enabling approach

A key feature of the NHS’s preparations for the pandemic were that trusts were enabled to take the steps necessary to prepare their service, with a relaxation of financial and governance restrictions. Previous financial constraints were temporarily lifted, allowing investments and partnerships to be created without worrying around who the ‘payer’ was. National and local regulatory controls were also loosened, and governance arrangements were pared down which helped to speed up decision-making.

This enabled quick and revolutionary changes. One trust fitted an entire building with new oxygen piping and ducting within a week to ensure every bed in the building could now use a ventilator.

Trusts were also given the information necessary so that they knew which changes to make. Trusts were supported by national modelling, analysis and intelligence, to estimate what the likely local pattern of increased demand would be, which was roughly accurate.


Continuing early success

While its preparations have, overall, been seen as successful, the NHS has struggled to handle the demand on its services stemming from the pandemic, with an increased burden stretching infrastructure and the workforce. However, the attempts to remedy this demand has followed on from the initial readiness steps. In particular, there has been an ongoing focus on trying to ensure that patients who no longer require complex medical care are rapidly discharged from hospitals into alternative settings – this recently includes a £594m investment to speed up discharge for the first half of 2021/22 to continue a process that took place throughout the pandemic. There is widespread agreement that a lot of the steps taken to ready the NHS need to be continued post-pandemic, while building on the inequalities and fragilities that were exposed.


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