Roderick Crawford edited Parliamentary Brief 1992-2012 and currently works in conflict resolution.
Chris Whitty, the Chief Medical Officer for England, told the Health Select Committee recently that 50 per cent of the cases of Covid-19 are likely to be concentrated within a three-week period, putting a huge strain on the NHS if it goes to the top end of the expected range of infection.
The NHS currently has about 142,000 beds available for patient use across all its estate in England. Average occupancy is around 90 per cent, peaking at around 95 per cent in winter, but with some trusts at even higher levels of occupancy.
Even if all elective operations were cancelled for many months – which would mean risking complications for patients and creating a huge backlog, as well as underutilising specialist skills — the number of beds freed up could still be far short of what is needed for coping with critically-ill patients infected with Covid-19.
It might not be wise to use all hospitals; cross-infection to already ill and highly vulnerable patients has to be avoided and would be almost impossible to prevent with shared facilities for cooking and cleaning, restrooms and cafeterias as well as entrances, lifts and corridors.
Patients in need of continuing cancer treatment, accident and emergency and maternity care, as well as patients with severe mental health conditions have to be treated and kept safe from infection — and so away from those hospitalised by Covid-19 as well as their visitors.
If demand for beds is forecast to rise above what can be safely provided for by the NHS within its current facilities, then additional facilities will need to be found outside of the NHS estate and preparations made for making those facilities available to the NHS at short notice.
One source of tens of thousands of extra beds is the hotel sector. Hotels have beds, bathrooms, lifts, catering, laundry, parking and drop off areas. There are plenty of hotels located in or near urban areas or near transport links and hubs. There will be many hotels near hospitals, allowing existing resources to be utilised more effectively. Not all accommodation within a hotel would need to be suitable for patients – excess rooms will be needed for storage, staff rooms and offices.
The 200,000 hotel rooms run by the main hotel chains alone in the UK provide sufficient additional capacity to draw upon both locally and nationally. My local hospital in North Durham has 523 beds in total; the Raddison Blu Hotel is about half a mile away with 207 beds – and rather more comfortable too. Taking over the local hotel would increase bed capacity here by 40 per cent.
Cross-infection to other patients would be reduced by allocating an entire building for treating patients with COVID-19 away from other patients who are likely to be highly vulnerable — and the staff that care for them and the facilities they use.
Designated hotels could also provide quarantine centres for people who cannot access their own homes, either because of risk to a vulnerable person there, a lack of care, or because they are travelling and cannot travel home. Hotels can also provide staff accommodation for NHS staff brought in from other trusts to support overwhelmed health services: the impact of the virus is unlikely to be uniform.
Should an epidemic break out in London, for instance, (or any other population centre) then NHS staff can be brought in from Trusts outside to staff these extra beds. London hospitals would be hard pressed to cope if it becomes an epidemic hotspot, but London has the largest concentration of hotels in the UK, thus giving London the facilities it needs to cope if demand for beds overwhelms current supply.
An epidemic on a national scale would reduce the ability to move staff between trusts, so additional trained personnel to supplement existing NHS staff would have to be found, and much comment has already been made on how this might be done.
With demand for beds and staffing possibly spiking beyond the current capacity of the NHS’s existing facilities and staff levels, these measures would allow for a fast and flexible bed-expansion programme that would provide better options than treating patients at home who need inpatient care, not least for quality of care and efficient use of staff. It would also give hospital managers and clinicians wider choices when allocating in-hospital beds in the face of a spike in demand for staffed beds, especially if it was only for a few weeks.
Identifying the most suitable hotel facilities that could be taken over, as well as the contractual arrangements for so doing, would ensure that the NHS was ready to expand its bed provision in facilities dedicated to treating those suffering severe effects of Covid-19.
Doing that now would make sense. Whether the government would want the power to takeover properties, with the Secretary of State for Health authorising health trusts to do so, is something government might need to consider. Without preparation in place, that might become necessary, which makes the argument for early preparation all the stronger.
Once the crisis is past, hotels can be deep-cleaned, bed linen replaced and the properties returned to use as hotels. In the event of an epidemic, the hotel sector would benefit from NHS rental income to compensate for loss of business, so it would benefit both health and the hospitality sectors.
This solution would provide flexible bed space and essential facilities at short notice where and when needed, preventing the ugly scenes of widespread treatment in hospital corridors and provide suitable accommodation for those recovering from the worst effects of the virus as well as providing resources for more flexible use of staff.