United Kingdom

NHS used HALF as many ICU beds during Covid-19 crisis in the spring as France

The NHS used half as many intensive care beds as France, Belgium and other badly-hit European nations during the Covid-19 crisis in the spring, according to figures that come amid shock claims the health service denied care to older patients to stop it becoming overwhelmed. 

At most, there were the equivalent of 50 infected patients hooked up to ventilators for every million people in mid-April, the peak of the pandemic when Britons were told to stay at home to 'protect the NHS'. 

In Belgium, which at the time was seeing Covid-19 deaths at a similar rate to the UK, the figure stood at around 111 per million people. France was treating 104 people per million in intensive care during the same week. While in the Netherlands, which suffered a similar amount of coronavirus cases as the UK, the figure reached a high of 74. 

The numbers come amid disputed claims the NHS was rationing beds and denying older coronavirus patients intensive care treatment during the height of the Covid-19 pandemic, even though hospitals were nowhere near being overrun. 

Those aged over 80, and some over 60s, were not given potentially life-saving treatment because health officials were concerned the NHS would be overwhelmed, according to reports. It is claimed documents called a 'triage tool', drawn up at the request of England's chief medical officer Professor Chris Whitty, were used in preventing elderly Covid-19 patients from receiving ventilation in intensive care.

As part of an investigation, the Sunday Times says the tool was used to create a 'score' for patients based on their age, frailty, and illness. Under the original system, over-80s were automatically excluded from ICU treatment due to their age. Even over-60s considered frail and with pre-existing health conditions, such as heart disease, could have been over the intensive care threshold.

The tool was never formally published, nor was it official NHS policy. But the newspaper, which carries claims by doctors who say the tool was used in their hospitals, said the documents were widely circulated among health care professionals.

NHS chiefs hit back at the accusations and said they were false, while 'deeply offensive to NHS doctors, nurses and paramedics'. Officials say that while early work on an intensive care national 'triage tool' did take place, it was 'not completed' and never issued.

The figures come amid claims the NHS was rationing beds and denying older coronavirus patients intensive care treatment during the height of the Covid-19 pandemic, even though hospitals were not overrun. The Sunday Times investigation cites data which shows the over 70s and 80s groups made up the smallest percentage of ICU patients, despite having the highest number of deaths. Pictured: A graph showing the percentage of intensive care hospital admissions versus the the number of hospital deaths in different age categories

A graph showing the number of intensive care admissions of patients over the age of 60. The graph shows that while the admissions soared, the percentage of elderly admissions declined

HOW BUSY WERE ICUS IN THE UK, ITALY, FRANCE, BELGIUM AND THE NETHERLANDS DURING THE PEAK OF THE CRISIS?

UNITED KINGDOM

Busiest day: April 12

How many patients were in ICU? 3,301 Covid-19 patients were hooked up to mechanical ventilators 

What does that equate to per million people? 49.53 

ITALY 

Busiest day: April 3

How many patients were in ICU? 4,068 Covid-19 patients were in intensive care 

What does that equate to per million people? 67.40 

FRANCE 

Busiest day: April 8

How many patients were in ICU? 7,019 Covid-19 patients were in intensive care

What does that equate to per million people? 104.78 

BELGIUM 

Busiest day: April 8

How many patients were in ICU? 1,285 Covid-19 patients were in intensive care 

What does that equate to per million people? 112.13 

THE NETHERLANDS  

Busiest day: April 7

How many patients were in ICU? 1,315 Covid-19 patients were in intensive care

What does that equate to per million people? 76.10

The figures on ICU bed occupancy comes from the European Centre for Disease Prevention and Control and Public Health England. 

Europe saw the coronavirus crisis peak in mid-April with cases and hospital admissions surging at similar rates. But the UK, Belgium, Italy, Spain and France led the way. 

Britain's outbreak was most comparable to epidemics in France and the Netherlands because both countries recorded case numbers within a similar rate per population during March and April. 

Belgium and Italy had slightly higher infections, and their peaks occurred at different times.

However, data shows there were half as many people being treated in intensive care beds in the UK, compared to France and the Netherlands.

On April 12, there were 3,301 infected patients hooked up to ventilators in the NHS, the equivalent of around 50 people per million. 

On the same day, France was treating double that, at 100.22 people per million (6,714), and the Netherlands 71 people per million (1,231).

A week earlier, on April 3, Italy had seen an intensive care occupancy rate of 67.4 per million, and days later, on April 8, Belgium recorded 112.13 per million — more than double the UK.

Although the data alone suggests the UK was treating less people than its European neighbours, the healthcare infrastructure of each nation has not been taken into consideration and therefore it is difficult to make direct international comparisons. 

The UK has fewer hospital beds than other European countries with 2.7 hospital beds per 1,000 people, compared with an EU average of 5.2, according to 2018 figures. 

The UK also has one of the lowest numbers of practising doctors per population, including hospital doctors, in the EU. 

Despite the number of nurses being around the EU average, it is lower than comparable countries like France, Germany and the Netherlands. 

But statistics show despite fears the NHS would be overwhelmed with coronavirus patients, it never reached full capacity. 

Less than two-thirds of critical care beds were taken up by Covid-19 patients even at the worst part of the crisis, Government data shows. 

In the second week of April, England was recording occupancy levels of 55 per cent, the highest of any of the four nations in the whole pandemic. 

At the peak of the crisis in Britain, only a quarter of all hospital beds were occupied by virus patients, data shows.

On April 7, 26.5 per cent of the 67,206 people in England's hospitals were being treated for coronavirus — the highest proportion on record.

At the moment, although hospital admissions have been rising, Covid-19 cases are occupying seven per cent of all of NHS England's beds — thought to be around 110,000 in total.

At the peak of the pandemic, this figure was around a quarter - although capacity was freed up when the NHS told hospitals to scrap as many operations as possible and turf out patients on their wards to make way for an influx of Covid-19 patients.

The UK's outbreak was most comparative to France and the Netherlands because each country recorded case numbers within a similar region over March and April. Belgium and Italy had slightly higher cases and an their peaks occurred at different times. However data shows there were half as many people being treated in intensive care beds in the UK, which was measured as how many people were on a ventilator, compared to France and the Netherlands.

A graph from a report by the Cabinet Office Briefing Rooms (COBR), showing the percentage of critical care beds being taken up by Covid-19 patients in the UK between March and May

At the peak of the crisis in Britain, only a quarter of all beds were occupied by virus patients. On April 7, 26.5 per cent of the 67,206 people in England's hospitals were being treated for coronavirus — the highest proportion on record

What NHS chiefs say to the Sunday Times article

 • The NHS hospitals did not run out of intensive care beds, so there was never a need to refuse anyone treatment on the basis of NHS capacity.

• Clinicians make decisions about the best course of treatment for their individual patient, based on that person’s specific needs, and wherever possible with relatives, carers or next of kin. That is what happened throughout this pandemic; there was categorically NO blanket national decision to refuse care to any group of people, including on the basis of their age.

• The optimal therapy for most hospitalised Covid-19 patients has turned out to be oxygen therapy, which can be given in a general ward, rather than the patient being sedated on a mechanical ventilator in intensive care, and latest data show that of all Covid-19 patients receiving any form of oxygen therapy, the majority of them were indeed aged 65 or older.

• Older people were not denied admission to ICU during the first wave; actually they comprised the majority of patients admitted to ICU with Covid-19, throughout. This has remained true irrespective of the overall number of patients of any age in England’s ICUs being treated for Covid-19.

The move was successful and 33,000 beds were made available, meaning hospitals were not overwhelmed by the effects of the virus. But it left hospitals with thousands of extra empty beds than normal for months, meaning that millions of people missed out on treatment for cancer and other diseases.

Meanwhile the temporary Nightingale hospitals — rapidly set up across the UK to cope with the predicted wave of seriously sick Covid-19 patients — sat almost entirely empty.

ExCeL London was the first field hospital to open, with 500 beds and the capacity of 4,000 to cope with Covid-19 patients from the capital.  It opened on April 3 and was in use for only a month, treating a total of 54 patients.  

The NHS has now come under fire for reportedly limiting its intensive care beds for those who were most likely to survive the coronavirus — claims the health service vehemently denies.  

A three-month investigation by the Sunday Times, which spoke to more than 50 witnesses, including doctors, bereaved families, care home workers, politicians and government advisers, concluded that the NHS was denying elderly and frail patients a bed in ICU based on the assumption they would be less likely to beat the virus. 

It cited data which shows the over 70s and 80s groups made up the smallest percentage of ICU patients, despite having the highest number of deaths in hospital.  

As part of the investigation, the paper claims some GPs were asked to identify frail and elderly patients who would be left at home, even if they needed hospital treatment due to complications from Covid-19.

It also claims NHS England issued guidance about groups of patients who should not ordinarily be taken to hospital without the green light from a senior doctor. These groups include all care home residents.

Meanwhile, paramedics were told to be more selective about who they take into hospital, the paper added.

The paper also claims the controversial triage tool, which was first discussed by the UK's Moral and Ethical Advisory Group (MEAG) at the start of the pandemic in March, was used in hospitals in Manchester, Liverpool, London, the Midlands and the southeast.

The tool was to be used to give a score to patients using their age, frailty and pre-existing health conditions. That score would then be used work out if a patient should be selected for critical care, should they need it, with 'eight' being the cut-off point.

Under the tool, those over the age of 80 would score nine on their age alone, meaning they would automatically be excluded, while over 75s were marked close to eight to begin with. Even those aged over 60 could be at risk of missing out on treatment on the triage tool, if they had an underlying health condition and were considered frail.  

According to the Sunday Times, a second version was later produced, lowering the score for age, but still advising those over 80 who were not in peak physical health should be denied treatment.

This graph shows the number of UK hospital admissions in different parts of the UK as the coronavirus pandemic began to take hold, from March to the beginning of April

This graph shows the number of Covid-19 patients in UK hospitals in critical care as the coronavirus pandemic took hold, between March and the start of April

NHS chiefs hit back at the reports, denying older patients were refused treatment. Officials say that while early work on an intensive care national 'triage tool' did take place, it was 'not completed' and never issued.

They also denied critical care units were ever at capacity - backed up by ministers spending £220million on seven Nightingale field hospitals that were barely used in the first wave. Meanwhile, NHS chiefs say that even at the height of the pandemic, only 42 per cent of NHS's ventilator beds were being used.

An NHS spokesperson added that two thirds of the 110,000 treated Covid-19 hospital patients so far were aged over 65.

NHS chiefs say the service has never adopted, published or relied on any such tool and its logo has not been authorised for use on any such tool.

However, the Sunday Times claims that it was distributed to the some doctors during the consultation period, while NHS Highland in Scotland also is said to have posted a version on its website - before later saying it was published 'in error'.

Dr Chaand Nagpaul, chairman of the British Medical Association, told the Sunday Times 'large numbers of patients' did 'not receive the care they needed' and this was down to the health service' not having the resources'. 

Meanwhile, Conservative MP David Davis told the paper: 'The policy appears to have given the least care to those who needed it most.

'It is profoundly wrong that the government did not come clean to the public about this tragedy.' 

However, the decision to review a triage tool has been defended by health chiefs, who said the process was talked about at the start of the pandemic, when it was estimated around two-million people could be put in hospital by Covid-19.

An NHS spokesperson said: 'No intensive care national triage tool was issued by the NHS.

'Early work on a triage tool was commissioned when modelling suggested two million people here could require hospital treatment and hospitals in northern Italy and Spain were being overwhelmed.

'This was not completed let alone issued because it became clear that, thanks to the efforts of the public in following Government guidance, the number of patients would be kept within NHS capacity.'

Co-chair of MEAG, Professor Sir Jonathan Montgomery, said: 'We were asked to look at the issue of a Covid-19 triage tool, however, it wasn’t needed. 

'Clinicians have been focused throughout the pandemic on assessing the individual needs of their patients and then providing the care that will benefit them best.

'The rapid expansion of critical care capacity ensured that our initial concern that the NHS might be unable to meet all its patients’ needs proved unfounded.'  

Meanwhile, Dr Alison Pittard, Dean of the Faculty of Intensive Care Medicine, said: 'Throughout the first wave of Covid-19 the NHS did not run out of critical care capacity, which remained available to everybody who would benefit from it.

'As we learned more about Covid-19 treatment changed as it became clear that oxygen therapy, that can be delivered on general wards, is often more beneficial than being on a ventilator.

'The Faculty of Intensive Care Medicine has been clear throughout that doctors should make decisions about patients’ treatment just as they normally would.' 


The NHS has denied critical care units were ever at capacity, saying that even at the height of the pandemic, only 42 per cent of NHS's ventilator beds were being used. Pictured: A Nightingale Hospital in Sunderland

Conservative MP David Davis (left) told the Sunday Times: 'The policy appears to have given the least care to those who needed it most.' Dr Chaand Nagpaul (right), chairman of the British Medical Association, told the paper: 'It is manifestly the case that large numbers of patients did not receive the care that they needed

It comes as other reports suggest that the largest Nightingale Hospital, at London's ExCel centre, will need to undergo work before it can be used once more.

The field hospital, one of seven built across the UK to deal with an influx of Covid patients during the first wave, contained 500 intensive care beds, but cared for 51 patients.

It was put into 'standby' in May after hospital admissions began to drop. But the government has stated the field hospitals will now start to reopen, with Manchester already reopened, as case numbers begin to rise again.

However, according to the Telegraph, the NHS has admitted no work has been done on London's Nightingale Hospital since it was put on standby.

Dr Rinesh Parmar, a specialist registrar in anaesthetics who chairs the Doctors' Association, accused the government of 'sitting on their hands'.

He said: 'You tend to have more patients that are not intubated and ventilated than are using other therapies. From a staffing point of view, it would also make sense to have it as a step down facility so you're not then required to staff it with intensive care doctors and nurses who are already in short supply.' 

Some 19,790 people tested positive for coronavirus in the UK yesterday, marking a rise of just 16.5 per cent on the 16,982 cases reported last Sunday 

Britain has recorded a further 151 Covid-19 deaths yesterday - more than double last Sunday's total 

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