NHS hospital capacity during covid-19: overstretched staff, space, systems, and stuff

Kevin Fong, Charlotte Summers, and Tim Cook unpick arguments that the NHS was not overwhelmed by covid-19, highlighting its legacy effects on healthcare and lessons for future health crises

During the UK’s covid-19 inquiry we have heard that “there was an inbuilt reluctance to accept that it was possible to get to a point where the NHS was overwhelmed” and that NHS capacity was regarded as “elastic.”1 The question of whether the NHS was overwhelmed during the covid-19 pandemic has become an important point of debate. Some commentators continue to suggest that the NHS prepared for a surge in admissions that did not threaten NHS capacity and unnecessarily suspended services.234

These comments either misunderstand or misrepresent the nature of the threat, the NHS response to covid-19, and the concept of capacity in healthcare services. NHS capacity is a complex property of a complex sociotechnical system; it cannot be described through simple numerical counts of bed spaces, occupancy rates, equipment, and staff. In particular, the workforce comprises the social component of this system and capacity cannot be assessed without reference to their experience.

The challenge of planning within this framework is described in shorthand as the four S’s: space, staff, systems, and stuff.5 The NHS entered the pandemic after a long period of substantial financial constraint, resulting in eroded operational resilience. Analysis of the four S’s shows this contributed to many intensive care units (ICUs) in the UK experiencing overwhelming pressure during the pandemic, creating harms for both patients and staff.

ICUs provide specialist care to patients with immediate life threatening illness or injury leading to single or multiple organ dysfunction. The term “intensive care bed” does not describe an item of furniture but rather a specialised location, a suite of technology, and the specialist staff …

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