Addenbrooke's prepares worst case scenario plans

Addenbrooke’s Hospital has revealed it has three scenarios for this winter’s Covid-19 peak and claims they are well prepared even if their worst predictions are realised.

Chief operating officer Nicola Ayton spoke with the Cambridge Independent about what measures they are putting in place now to manage any surge in patient numbers.

And she warned that if wards have to be switched to dealing with coronavirus patients then some less urgent surgery and treatments, including knee and hip operations, will be further delayed.

Ms Ayton said: “We have been learning from our experience of caring for patients during that first peak as well as working over summer putting a range of measure in place to make sure we are as prepared as possible for both an increase in in the number of Covid patients over the winter but also our ability to meet the needs of patients as we would in any normal situation.

“Particularly for those whose treatments were delayed in the first wave, we have worked over the summer to rebuild that capacity. It is a really careful balancing act for hospitals around the country to make sure we continue to meet the needs of our patients with or without Covid ”

The model they are working on was prepared jointly with Cambridge University and the hospital’s infectious disease teams based on evidence from the first peak in March and April this year.

Ms Ayton explains: “In the lowest scenario we would probably only need around 15 medical beds for our Covid patients and up to five critical care beds. That is not the scenario we are planning for .

“We are planning for three scenarios at the moment the most likely to occur would be around 50 to 60 medical beds and around 20 critical care beds on top as that. That assumes roughly and equivalent peak to what we saw in March and April and no higher.

“But of course we also have plans to enable us to meet the needs of patients should the epak be higher than we saw earlier in the year in which case we could be able to create capacity between 130 and 150 medical beds plus another 45 critical care beds after that.”

As revealed in last week’s Cambridge Independent, the hospital is also preparing extra capacity to be available by January next year that can be used by patients from across the region. This will be built on car park space on the campus.

“It's not on the scale of the nightingales in Manchester and London but the principle of using the capacity to support Covid care and create right pathways and support patients to be cared for closer to home that is similar to why those nightingale facilities were created,” Ms Ayton explained.

At the moment there are just ten Covid positive patients in the hospital and none in critical care. In total, 127 patients have died with Covid-19 at the hospital since the outbreak began.

Ms Ayton said: “We are currently seeing between one and two covid positive patients a day. We are not seeing that exponential growth, that doubling in numbers, that we saw in the first peak yet. We will keep an eye on the Covid infection rate and that will inform us when we will need to increase capacity within the hospital.”

Plans are in place to keep Covid-19 patients separate from other parts of the hospital, as well as separate areas for patients with the flu or norovirus.

Ms Ayton praised the local population for sticking to rules that help prevent the spread of the virus. She said: “At the moment thankfully and I'm really grateful to the local population because people really are following public health guidance because we have seen lower levels of Covid prevalence in this community than in other areas of the country.”

She warned that some patients may experience delays for treatment that is non-urgent if more wards and staff are needed to care for coronavirus patients.

“Our mode;l does assume you convert a lot of your capacity into Covid capacity and therefore you are less able to treat patients who don't have covid 19. So we do not envisage running out of capacity of beds for covid patients.

When it comes to surgery we will do everything we can to keep that capacity ringfenced. So we can continue to provide urgent elective surgery including cancer surgery over the winter.

“There are still patients waiting and they are waiting longer than they would have done because the waiting lists have got bigger but that does mean we have focused on being able to treat as many patients as possible with urgent and complex needs in advance of a second peak.

“With medical capacity it's about prioritising patients who are the sickest with the most pressing clinical needs. That is a big challenge for hospitals and trying to get that balance right for those who need emergency treatment and urgent elective treatment and Covid patients is a big challenge.

“The types of patients already waiting longer are routine orthopaedic surgery knee and hip replacements for instance. There are patients who are in pain and need treatment but we are considering when harm may occur and that may be a longer period of time before the harm occurs. That's the way in which the clinical prioritisation categories have been developed . But just because you can wait I'm still acutely aware that it is a person in pain and it's really important we monitor the impact of that very closely and we continue to assess whether harm is occurring.”

She added that they have sufficient numbers of ventilators to cope with a peak like that seen in March and April and understand how best to use available PPE.

The next worry on the horizon is Brexit in December, however Ms Ayton said: “Because it has been coming for a long time we have factored it into procurement, supply chain and our recruitment plans. I think with the plans we have got I anticipate we should be in a good place to continue to provide continuity of care during that period. I'm not planning for major service disruption at the moment but clearly over the longer term we continue to focus on how we recruit staff and it does add complexity to that.”