Adapting hospital capacity to meet changing demands during the COVID-19 pandemic

Ruth McCabe, Nora Schmit, Paula Christen, Josh C. D’Aeth, Alessandra Løchen, Dheeya Rizmie, Shevanthi Nayagam, Marisa Miraldo, Paul Aylin, Alex Bottle, Pablo N. Perez-Guzman, Azra C. Ghani, Neil M. Ferguson, Peter J. White, Katharina Hauck*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)


Background: To calculate hospital surge capacity, achieved via hospital provision interventions implemented for the emergency treatment of coronavirus disease 2019 (COVID-19) and other patients through March to May 2020; to evaluate the conditions for admitting patients for elective surgery under varying admission levels of COVID-19 patients. Methods: We analysed National Health Service (NHS) datasets and literature reviews to estimate hospital care capacity before the pandemic (pre-pandemic baseline) and to quantify the impact of interventions (cancellation of elective surgery, field hospitals, use of private hospitals, deployment of former medical staff and deployment of newly qualified medical staff) for treatment of adult COVID-19 patients, focusing on general and acute (G&A) and critical care (CC) beds, staff and ventilators. Results: NHS England would not have had sufficient capacity to treat all COVID-19 and other patients in March and April 2020 without the hospital provision interventions, which alleviated significant shortfalls in CC nurses, CC and G&A beds and CC junior doctors. All elective surgery can be conducted at normal pre-pandemic levels provided the other interventions are sustained, but only if the daily number of COVID-19 patients occupying CC beds is not greater than 1550 in the whole of England. If the other interventions are not maintained, then elective surgery can only be conducted if the number of COVID-19 patients occupying CC beds is not greater than 320. However, there is greater national capacity to treat G&A patients: without interventions, it takes almost 10,000 G&A COVID-19 patients before any G&A elective patients would be unable to be accommodated. Conclusions: Unless COVID-19 hospitalisations drop to low levels, there is a continued need to enhance critical care capacity in England with field hospitals, use of private hospitals or deployment of former and newly qualified medical staff to allow some or all elective surgery to take place.

Original languageEnglish
Article number329
JournalBMC Medicine
Issue number1
Publication statusPublished - 1 Dec 2020

Bibliographical note

Funding Information:
The following authors were part of the Imperial College London Hospital Capacity Planning Group: Ruth McCabe, Nora Schmit, Paula Christen, Josh C. D?Aeth, Alessandra L?chen, Dheeya Rizmie.

Funding Information:
PC, JCD, AL, RM, NS, SN, PNG, ACG, NMF, PJW and KH acknowledge the MRC Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth and Development Office (FCDO), under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the European Union. PC, RM, MM, PNG, NMF and KH also acknowledge the Abdul Latif Jameel Institute for Disease and Emergency Analytics, funded by the Abdul Latif Jameel Foundation. NMF and KH were also supported by the National Institute for Health Research (NIHR) HPRU in Modelling and Health Economics, a partnership between Public Health England (PHE), Imperial College London and LSHTM (grant code NIHR200908). JCD also acknowledges funding from the Wellcome Trust (215193/Z/19/Z). NS also acknowledges funding from the Imperial College MRC Doctoral Training Partnership. PA is partially funded through a research grant from Dr. Foster Intelligence (a wholly owned subsidiary of Telstra Health) and through the NIHR PSTRC. PA also acknowledges support from the NIHR under the Applied Health Research (ARC) programme for North West London, and the Imperial NIHR Biomedical Research Centre. ACG and NMF acknowledge additional COVID-19 funding from the Wellcome Trust and FCDO. DR acknowledges funding from Imperial College Business School. SN is also partially supported by NIHR Imperial Biomedical Research Centre funding.

Publisher Copyright:
© 2020, The Author(s).


  • COVID-19
  • Critical care
  • Elective surgery
  • General & acute
  • Hospital capacity
  • Interventions


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