1/18 Lots of continuing comment on ventilator numbers so thought it might be helpful to do one of my threads. Usual basis – we are not Government, we are not @NHSEngland, we are the voice of NHS trusts. See detail of basis of our coronavirus comment here: nhsproviders.org/news-blogs/pre…
2/18 Start with basics, remembering we are not clinicians. Broadly two different types of ventilation support: non invasive and full mechanical ventilation. The type required depends on patient symptoms. For some patients, non invasive ventilation support will be sufficient.
3/18 Non invasive (e.g. CPAP) means patient continues to do breathing but with help of a machine / mask / oxygen. Full mechanical ventilation means the machine does the breathing for the patient because they can’t do it by themselves.
4/18 There seems to be a sole focus in much of the public comment on full mechanical ventilation when, in reality, we need to maximise supplies of both types of ventilation support because different sets of patients benefit from each type.
5/18 Central NHS team and trusts working incredibly hard with Government to boost supply of both types of ventilation equipment. Being done in a number of different ways – buy on international market, manufacture from scratch, borrow from private sector etc.
6/18 From where we sit, strong focus on single number for mechanical ventilator capacity (e.g. we have 8,000, we’ve secured x,000 more, we need 30,000 in total) seems simplistic. It ignores lots of factors. It ignores fact that we need more of both types of ventilation support…
7/18 It ignores time - supply will grow over time. It ignores delivery and manufacturing timescale – ordering something is not the same as it being in use on the ground. EG We know of a trust expecting ventilators from abroad that has now had export blocked by host country….
8/18 EG2 We know that manufacturing something from scratch, getting regulatory approval (even if expedited), testing and getting into service are all bound to take some time. It’s very difficult to predict in advance how long this will take.
9/18 It ignores demand pattern – whilst ventilators are mobile, to a degree, and we understand NHS will hold a central strategic reserve, adequacy of supply will depend on actual demand. By definition, if demand is staggered by time and geography, it wil be easier to meet.
10/18 From where we sit, the following seem true. In the face of these variables, trying to calculate a single precise number and say “it will definitely be enough” is too simplistic. We can have a ball park idea, dependent on a lot of variables, but that’s all.
11/18 National leaders tell us they have a model of expected demand & supply, over time, by region and that this shows there will be sufficient mechanical ventilation capacity. But this obviously can’t confirm there will always be enough capacity in every place at every point.
12/18 This is a marathon, not a sprint. It’s clear that extra capacity will be coming on stream later on in the race and that will be really helpful. But for the first few miles, now, and the immediate peak in mid April, there will be pressure on ventilation support.
13/18 All the trust CEOs we speak to are telling us, for example, that they would like more machines of both types. But they’re obviously making best use of what they have got on the basis that if problems and gaps open up, their job is to do the best they can.
14/18 It would be helpful if Government, national NHS leaders, and media could be clearer about these nuances as we don’t think that “we’re miles short of 30,000, let’s panic” or “we’ve just ordered 10,000 new ventilators from x, it’ll be fine” are particularly useful.
15/18 Trust leaders think it would be helpful for Government and NHS leaders to share more of the detail of why they are confident there is sufficient capacity, what the immediate constraints for the next few weeks look like, and how any capacity shortage will be managed.
16/18 Trust leaders tell us that they want the public to know four things. First, that they will do everything they can to maximise ventilation support capacity so that as many patients as possible who can benefit from it will be able to do so.
17/18 Second, as part of being a trust in the NHS, they will do everything they can to support their neighbours in “mutual aid” and share capacity where needed. That's what our members are used to and plan for. It's a key advantage of having a National Health Service.
18/18 Third, if there is insufficient capacity, they will prioritise access on well-established basis of who would gain most clinical benefit. Fourth, they will do everything they can to ensure that those unable to get access receive the best possible appropriate care & support.
19/18 Worth unpacking tweet 18 a bit. Trusts will always ensure everyone gets best possible care. If there is insufficient capacity (something NHS is planning and seeking to avoid) nationally agreed clinical guidelines will be used to prioritise access to ventilators.
20/18 Those guidlines operate on the well-established basis of who would gain most clinical benefit. Everyone will continue to receive care.
