ANOTHER DAY: ANOTHER MAD CONSPIRACY THEORY TO SLAY:
Today's theme?....."EMPTY HOSPITAL BEDS SHOW THE GOVERNMENT ARE LYING ABOUT CORONAVIRUS AND DOING A BIT OF EUGENICS AND VACCINE PROPAGANDA ON THE SIDE

Why were beds running at 95% plus bed occupancy right up until the pandemic, with growing waiting times and overcrowding?
a) Already had just about smallest beds/1000 in entire OECD after sustained reductions over decades
b) Rising urgent care demand (nearly doubled in 15 yrs)

c) Many beds effectively taken out of commission due to growing numbers of "delayed transfers of care" (sometimes called "bed blocking (ugh!) partly due to flow and processes within hospital but largely due to cuts/insufficient capacity in community health services/social care

d) So the people (who have no interest In listening to reason) who say things to me like "I came to the hospital/brought my mum there last year and we were stuck in a corridor - now all the empty beds mean there is a plot to deceive the public/crash the economy etc"
Nope..

e) Things changed when pandemic hit - largely driven at local level by local clinicians and operational managers exercising leadership and initiative and working with local community partners. But also backed by NHSEngland and some permissions in Coronavirus Act. What things?

f) Most elective, planned work was postponed or cancelled (not to minimise effects on people who were/are waiting for that) and bed bases repurposed to cope with acute surge
g) wards were split into "hot" and "cold" areas to try and keep possible/probable Covid-19 cases separate

g) Hospital emergency front door streams were separated in similar way
h) Staff redeployed from other areas to beef up rotas& senior opinions access to tests and 7 day round clock working
I) Intensive Care Units tripled in size (an extraordinary feat) filled w/Covid-19 patients

j) Big focus on ambulatory emergency care so that patients assessed away from A&E if possible and triaged to be supported and monitored at home where possible
k) Primary care, community nursing teams also changed their working models - more remote consulting, some "hot hubs" etc

l) partly due to joined up local working and thinking, partly due to permissions in the Coronavirus act and from NHS England, great joined up local work to prevent beds being taken up by delayed transfers or leaving patients exposed to risk of hospital

m) So people who might previously have waited days to access community intermediate care rehab/discharge to assess/home based crisis response, social care, now able to access far more quickly and those beds all now freed up for first time in years

n) Members of public - partly due to "protect the NHS" messages and sense of civic duty and partly due to fear of catching Covid-19 in hospital staying away e.g. A&E attendances massively down. Often staying away *despite* drs encouraging them to come in cos they were sick

o) Not to minimise this because we still don't know what medium and long term effects will be on those people who might usually have presented to hospital, just as with the normal outpatient work and planned procedures, tests, operations. There will for sure be opportunity costs

p) The reason why Nightingale hospitals (despite all the slavish attention from the media - cos of News Values and PR) stayed empty was because of this extraordinary effort by the whole frontline NHS - largely free of help from politicians or "the centre" and often in spite of it

q) eg lack of testing, lack of PPE, lack of pandemic preparedness despite ample warnings, slow response in Feb/March, complacent public policy
r) Staff have put their own health and wellbeing on the line every day for 2 months now and the peak in acute care has passed

s) It is a bit bloody insulting to suppose that all those staff (some of whom have died or are still on ICU) colluded I a big government led CONSPIRACY to exaggerate scale of the Covid-19 problem
t) Remember Italy? Spain? New York? We thought we might be next and so did modellers

u) Now we are gradually putting "usual" services for "usual" patients back together again but have to be cautious. we don't need a return to 95% bed occupancy, overcrowding in A&E for obvious reasons (Pandemic 2nd peak, anyone)?
x) None of this is to minimise care home crisis

y) None of it is to minimise broader socioeconomic effects of lock down, distancing and shielding which we all realise are very significant

z) But there is NO BLOODY CONSPIRACY. Have I spelled that out enough for you? Jeez!