New guidelines from the UK Health Security Agency (UKHSA) – one of the bodies taking over from Public Health England – recommend halving from 2 metres to 1 metre the “physical distancing” to be maintained in healthcare facilities to protect against transmission of the Covid-19 virus.
The new proposals do not apply to emergency departments where patient access and movement is harder to control, but have been read as meaning that NHS hospital beds can be moved closer together – restoring some of the capacity that was lost in 2020 as the pandemic set in.
The UKHSA guidance, which also removes the need for a negative PCR and 3 days self-isolation before selected elective procedures, and allows NHS providers to revert to standard rather than enhanced cleaning of buildings leaves decisions on how to implement this new regime to local management.
However it’s not at all clear that the new 1 metre distancing rule is intended to apply to hospital beds, or even practical to apply, since the gaps between beds were larger than this even before the pandemic.
In June 2020 NHS Providers, warning that greater distancing between beds would inevitably reduce the numbers of beds in use, stated that the normal average space between beds was 1.6 metres in older buildings and 1.8m in newer hospitals.
This is a significant reduction from the 2000 guidelines for the building of University College Hospital London, which allowed 2.7 metres between beds, while subsequent increased space was recommended in Hospital Building Notes based on ergonomic studies which established that “most activities carried out at the bedside could be accommodated within the dimensions 3.6m (width) × 3.7m (depth).”
The minimum size of these gaps is dictated among other things by the need for access for cleaning staff and, when necessary, for monitors, drips and emergency equipment, as well as ensuring visitors to one patient do not impinge on the space for neighbouring patients.
Some hospitals during the peak of the pandemic were unable to space out the beds to the full 2m, and resorted to hanging clear flexible screens to provide a physical barrier between bed spaces to provide additional protection.
In July 2020 NHS England’s director of estates discussed the need to commandeer some of the spaces allocated to offices and non-clinical services in order to maximise the area available for beds with enhanced distancing.
But with backlog maintenance bills for NHS trusts totalling £9 billion at last count and rising rapidly, and plans for the 40 or 48 new hospitals likely to be scaled back to fit the constrained availability of capital for any kind of investment, it’s clear there has been a lack of funds for the reorganisation needed to get bed numbers and capacity back to anything like pre-Covid levels.
At the end of September 4916 beds in England were filled with Covid patients, acting as a further limit on capacity to treat the normal caseload. The latest bed availability and occupancy figures (up to end of June 2021) show a loss of 4,567 front line general and acute beds since the equivalent quarter pre-Covid – and a much bigger drop in numbers of beds occupied – down by almost 10% (8,906).
In January the HSJ concluded that up to half of the apparently “unoccupied” acute beds in hospitals were in fact not available for use by non-Covid patients – in addition to the beds closed as a result of the pandemic. There’s a very long way to go before the NHS comes anywhere near to restoring the capacity it had prior to Covid-19.
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