Hospitals across the UK now have the mountainous task of addressing a backlog in elective care, the likes of which not seen before, while simultaneously holding capacity to deal with threat of Covid-19.

As the number of Covid-19 cases fall, hospitals and GP surgeries have begun preparing to resume routine appointments and planned procedures, such as elective surgery, endoscopy, diagnostic tests and scans. However, things remain a long way from ‘business as usual’.

While the worst of the immediate crisis may have passed, many hospitals continue to care for a large number of Covid-19 patients, with reports stating around 25 per cent of intensive care unit beds still needs to be retained for this purpose. A second wave is also still a very real threat, which – according to a number of experts, including England’s chief medical officer, Professor Chris Whitty – has the potential to be even more deadly than the first.

At the same time, waiting lists for elective procedures are increasing and will continue to do so even after planned surgery is reintroduced, since hospitals will be limited to the extent to which they can safely be able to return to pre-Covid activity level. Some reports suggest that waiting lists for elective procedures could top 10 million by the end of this year. As a result, hospitals are under increasing pressure to resume service as soon as possible.

The term ‘elective procedure’ can be misleading, often implying that patients have a choice of whether or not to go ahead with an operation. The reality is that many of those patients will be experiencing increasingly chronic pain and impairment to their lives, and the majority will not consider their procedure a choice, but an increasing necessity.

Hospitals now face a serious challenge, they must prepare to resume elective care while keeping both patients and staff safe from the risks of exposure to Covid-19. Many of the patients requiring surgery or treatment are more vulnerable to illness due to their underlying health conditions. There is also the risk that patients or visitors from outside will bring the virus into clean zones of the hospital, as could clinicians who need to travel between sites.

Access to tests for staff and patients prior to procedures taking place will be important, but the long turnaround times currently experienced for analysing tests could further add to waiting times and risk surgery being cancelled if the results are not back on time.

Due to the continued need to adhere to social distancing measures, there is significant pressure on managing physical space. In many cases, hospital facilities have been completely repurposed or redesigned to deal with the crisis, and internal space may be divided up into ‘green’ and ‘red’ zones, which will need to remain fixed for some time. This, coupled with the increased time required to change PPE, and to undertake full cleaning of procedure rooms between operations, will significantly reduce capacity in those hospitals that do restart elective procedures.

For many hospitals, it is the reduction in physical capacity and the continued logistical disruption posed by Covid-19 that will pose the greatest challenge in returning to ‘normal’ service. Where will this additional capacity come from, and how will the patient journey for elective surgery impact on existing staff and patient flows?

Flexible infrastructure

One potential solution could be flexible healthcare infrastructure. A mobile operating theatre could upscale hospitals’ green zones by providing a safe space away from Covid-19 red zones within the hospital itself. Combined with a mobile or modular ward, which could also house staff areas, this could provide a complete stand-alone green zone where procedures can be undertaken safely.

Dr Hans Kluge, Director for the WHO European region, said recently in an interview with The Daily Telegraph that now is the, “time for preparation, not celebration”. He stressed that, though the number of cases of Covid-19 in countries such as the UK, France and Italy was beginning to fall, it did not mean the pandemic was coming to an end, and that countries should use this time to start to build capacity in hospitals, primary care and intensive care units.

Since the pandemic and the resulting backlogs have brought a need for temporary additional capacity, it makes sense to consider flexible healthcare options that allow hospitals to upscale based on their needs. Mobile and modular facilities can be used either on a temporary or semi-permanent basis, as required.

Vanguard Healthcare Solutions provides temporary facilities to support healthcare providers when additional capacity is needed to cut waiting lists, to decant an existing theatre or in response to a crisis situation, and has been a trusted partner to the NHS for over 20 years.