Anaesthesia and Critical Care COVID-19 Activity Tracking Survey
ACCC-Track Round 2 December 2020 Round 2: Summary response rate
Number of responses: 194 Excluded: 40 Independent: 13 Duplicates: 22 Incomplete submissions: 5 Round 2: NHS response rate
Total number of responses Responses by Responses by included: 154 Local Coordinator: 56% hospitals: 54% Round 2: Return rate –NHS hospitals by region
100% 79% 80% 65% 59% 56% 56% 55% 55% 60% 53% 50% 44% 40% 40% 37% 35%
20%
0%
East Midlands East of England West Midlands Northern Ireland South West NorthEngland West England South East England North East England National average (mean) Yorkshire and the Humber Space, staff, stuff (equipment) and systems for restarting elective surgery Space Round 2: Space
Proportion of respondents Scotland (n=14) South West England (n=15) West Midlands (n=11) East of England (n=11) London (n=25) Wales (n=7) South East England (n=14) North West England (n=20) Yorkshire and the Humber (n=16) North East England (n=5) East Midlands (n=10) Northern Ireland (n=5) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
RED AMBER GREEN Staff Round 2: Staff Proportion of respondents Scotland (n=14) London (n=25) West Midlands (n=11) South East England (n=14) East of England (n=11) South West England (n=15) Yorkshire and the Humber (n=16) North West England (n=21) Wales (n=7) North East England (n=5) East Midlands (n=10) Northern Ireland (n=5) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% RED AMBER GREEN Stuff Round 2: Stuff
Proportion of respondents
Wales (n=7) Scotland (n=14) South East England (n=14) South West England (n=15) London (n=25) West Midlands (n=11) East of England (n=11) Northern Ireland (n=5) North West England (n=21) Yorkshire and the Humber (n=16) East Midlands (n=10) North East England (n=5) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% RED AMBER GREEN Systems Round 2: Systems
Proportion of respondents Scotland (n=14) West Midlands (n=11) North East England (n=5) South West England (n=15) London (n=25) South East England (n=14) East of England (n=11) Yorkshire and the Humber (n=16) North West England (n=21) Northern Ireland (n=5) East Midlands (n=10) Wales (n=7) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% RED AMBER GREEN State of the nation – December 2020
SPACE, STAFF, STUFF, SYSTEMS 26% 42% 32%
0% 20% 40% 60% 80% 100% At least one red No red, at least one amber All green Round 2: State of the nation – Space, Staff, Stuff, Systems December 2020 vs October 2020
Round 1 (October) 17% 37% 46%
Round 2 (December) 26% 42% 32%
0% 20% 40% 60% 80% 100% At least one red No red, at least one amber All green ICU Staged Resurgence Plan (SRP) Round 2: UK – ICU Staged Resurgence Plan (n=143)
ICU resurgence plan 14% 41% 30% 7% 8%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% SRP1 SRP2 SRP3 SRP4 SRP5 Opinion – perioperative care delivery Early December 2020 (round 2) compared to October 2020 (round 1) Round 2: UK - Delivery of perioperative care December 2020 vs October 2020
50%
41% 40%
31% 30%
20% 18%
Proportion of hospitals of Proportion 10% 8% 3% 0% Much worse Worse About the same Better Much better Round 2: Proportion of theatres* closed
60% 55%
50%
40% 36%
30% 30% 24% 24% 19% 20% 17% 16% 15% 14% 12% 10% 10% 7% Proportion of theatres closed of theatres Proportion
0% UK Northern Wales East Yorkshire North South Scotland West North South London East of average Ireland Midlands and the West East Midlands East West England (mean) Humber England England England England *excluding non-theatre sites Round 2: Proportion of theatres* closed December 2020 vs October 2020
60% 55%
50% October 2020 42% 40% 36% December 2020 30%30% 30% 26% 24% 24%23% 19% 20% 20% 20% 16% 17% 16% 15% 15% 14% 12% 10% 8% 10% 6% 7% Proportion of theatres closed theatres of Proportion 4% 4% 5%
0% UK Northern Wales East Yorkshire North South Scotland West North South London East of average Ireland Midlands and the West East Midlands East West England (mean) Humber England England England England *excluding non-theatre sites Use of other locations for surgery e.g. independent sector, external sites Round 2: Theatre capacity increase* at other locations
20% 18%
16%
15% 14% 13% 12% 11% 11% 10% 10% 10% 10% 9%
5% 4%
2%
Proportion of theatres open at other sites sites other at open theatres of Proportion 0% UK Wales NorthernYorkshire East of London East North South South West North Scotland average Ireland and the England Midlands West East West Midlands East (mean) Humber England England England England *compared to theatres open in 2019 Round 2: Theatre capacity increase* at other locations December 2020 vs October 2020
20% 18% Dec-20 Oct-20 16% 15% 15% 14% 14% 13% 13% 12% 12% 12% 11% 11% 10% 10%10% 10%10% 10% 10% 9% 9% 8% 7% 6% 5% 5% 4% 2%
0% Proportion of theatres open at other sites sites other at open theatres of Proportion UK Wales Northern Yorkshire East of London East North South South West North Scotland average Ireland and the England Midlands West East West Midlands East (mean) Humber England England England England
*compared to theatres open in 2019 Round 2: Designated ‘low risk’ COVID-19 theatre area December 2020 vs October 2020
Dec-20 Oct-20 40% 37% 37%
30% 28% 25% 24%
20% 17% 18% 13% 10% Proportion of hospitals Proportion
0% Yes - on-site & external Yes - external site only Yes - on site only No Presence of a ‘low/lower risk’ COVID-19 theatre area Round 2: Designated ‘low risk’ COVID-19 theatre area
Proportion of hospitals Scotland (n=14) Northern Ireland (n=5) London (n=25) North West England (n=21) Yorkshire and the Humber (n=16) South East England (n=14) West Midlands (n=11) South West England (n=15) East Midlands (n=9) East of England (n=11) Wales (n=7) North East England (n=5) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Yes - on-site & external Yes - external site only Yes - on site only No Round 2: Theatre productivity in open theatres December 2020 vs October 2020
Dec-20 Oct-20 60% 48% 50% 45% 41% 40% 38%
30%
20% 9% 8% 10% 5%
Proportion of hospitals Proportion 4% 2% 1% 0% <25% 25-50% 50-75% 75-100% >100% Proportion of cases completed in each theatre compared to corresponding months in 2019 Anaesthesia activity: December 2020 vs 2019
• Comparative data added from round 1 (October 2020 vs 2019) Round 2: Non-cancer elective operations December 2020 vs 2019
100% 87% 80% 75% 74% 64% 66% 65% 64% 60% 58% 60% 52% 51% 47% 40% 26% 20%
Proportion of hospitals Proportion 0%
Wales London Scotland
East Midlands East of England West Midlands Northern Ireland UK average (mean) North East England South East EnglandSouth West EnglandNorth West England
Yorkshire and the Humber Round 2: Non-cancer elective operations
December 2020 vs 2019 October 2020 vs 2019 100% 87% 79% 82% 75% 74% 80% 71% 70% 67% 66% 65% 64% 61% 64% 57% 60% 60% 58% 60% 60% 58% 60% 52% 51% 47% 40% 36% 26% 29% 20%
Proportion of hospitals Proportion 0%
Wales London Scotland
East Midlands East of England West Midlands Northern Ireland UK average (mean) North East England South East EnglandSouth West EnglandNorth West England
Yorkshire and the Humber Round 2: Paediatric surgery December 2020 vs 2019
100% 88% 85% 84% 81% 78% 80% 65% 68% 58% 60% 55% 46% 45% 35% 40% 30% 20%
Proportion of hospitals Proportion 0%
Wales London Scotland
East Midlands East of England West Midlands Northern Ireland UK average (mean) South East England South West England North East NorthEngland West England
Yorkshire and the Humber Round 2: Paediatric surgery
100% December 2020 vs 2019 88% 85% 84% 81% 82% 81% October 2020 vs 2019 80% 78% 68% 65% 65% 61% 63% 62% 63% 58% 60% 58% 55% 60% 53% 51% 46% 45% 40% 35% 36% 31% 30%
20% Proportion of hospitals Proportion 0%
Wales London Scotland
East Midlands East of England West Midlands Northern Ireland UK average (mean) South East England South West England North East EnglandNorth West England
Yorkshire and the Humber Round 2: Cancer operations December 2020 vs 2019
100% 85% 83% 79% 78% 77% 80% 75% 75% 75% 74% 72% 66% 59% 60% 55%
40%
20%
Proportion of hospitals Proportion 0%
Wales London Scotland
East Midlands East of EnglandWest Midlands Northern Ireland UK averageSouth (mean) West England North West England South East England North East England
Yorkshire and the Humber Round 2: Cancer operations
December 2020 vs 2019 October 2020 vs 2019 100% 85% 83% 79% 79% 81% 78% 81% 80% 75% 74% 75% 77% 75% 75% 74% 77% 77% 80% 70% 72% 72% 70% 66% 66% 66% 59% 60% 55%
40%
20%
Proportion of hospitals Proportion 0%
Wales London Scotland
East Midlands East of EnglandWest Midlands Northern Ireland UK average South(mean) West England North West England South East England North East England
Yorkshire and the Humber Round 2: Emergency surgery December 2020 vs 2019
100% 96% 96% 95% 94% 91% 90% 89% 89% 87% 86% 85% 83% 81% 80%
60%
40%
20%
Proportion of hospitals Proportion 0%
Wales Scotland London
East Midlands East of EnglandWest Midlands Northern Ireland UK average (mean) South West England North West England South East England North East England
Yorkshire and the Humber Round 2: Emergency surgery
December 2020 vs 2019 October 2020 vs 2019 100% 96% 94% 96% 95% 94% 94% 90% 92% 91% 89% 91% 89% 87% 86% 86% 87% 85% 86% 85% 87% 85% 80% 82% 83% 81% 80% 78%
60%
40%
20% Proportion of hospitals Proportion 0%
Wales Scotland London
East Midlands East of EnglandWest Midlands Northern Ireland UK average (mean) South West England North West England South East England North East England
Yorkshire and the Humber Round 2: UK activity 2020 vs 2019
63% Non-cancer elective operations 62% Oct-20 65% Paediatric surgery 61%
75% Cancer operations 75%
90% Emergency surgery 87%
0% 20% 40% 60% 80% 100% Percentage of 2019 activity The total number of operations completed in all theatre locations over 24 hours Excluding non-theatre environments. Round 2: Estimated loss of surgical activity over 24 hours
28% loss of surgery compared to December 2019 28% 2615 operations lost each day in 136 responding hospitals
Estimated 5503 each day in all UK hospitals
72% UK staffing – anaesthesia / critical care
Impact on staffing of anaesthetists/intensivists • re-deployed to non-patient facing roles • off work with sickness as a result of COVID-19 • shielding • self-isolating/in quarantine • re-deployed to ICU work Round 1: UK staffing - anaesthesia/critical care
October
1000 919 900 Data corrected for all hospitals across UK: 800 ≈ 14% depletion of anaesthesia workforce 700 600 ≈ 45% increase in ICU workforce 547 500 400 300 200 151 80 100 70 71 0 At home shielding Redeployed to Off work with At home due to Redeployed Total non-patient facing sickness as a self-isolating within Number of anaesthetists / intensivists Number of anaesthetists roles result of COVID- and/or department to 19 quarantine ICU Round 2: UK staffing - anaesthesia/critical care
December 1400 Data corrected for all hospitals across UK: 1172 1200 ≈ 18% depletion of anaesthesia workforce 1000 ≈ 60% increase in ICU workforce 800 730 600 400 177 200 72 73 120 0 At home shielding Redeployed to Off work with At home due to Redeployed Total non-patient facing sickness as a self-isolating within Number of anaesthetists / intensivists Number of anaesthetists roles result of COVID- and/or department to 19 quarantine ICU Round 2: UK staffing - anaesthesia/critical care December 2020 vs October 2020
December October 1400 1172 1200 1000 919 800 730 600 547 400 177 151 200 72 80 73 70 120 71 0 At home shielding Redeployed to Off work with At home due to Redeployed Total non-patient facing sickness as a self-isolating within Number of anaesthetists / intensivists Number of anaesthetists roles result of COVID- and/or department to 19 quarantine ICU Elective adult surgery ‘green/low risk’ pathway December 2020 vs October 2020 • patient PCR testing/self-isolating/COVID-19 symptom screening Round 2: Elective adult surgery – change in green/low risk pathway compared to October 2020 80% 69% 70% 60% 50% 40% 30% 19% 20%
Proportion of hospitals of Proportion 10% 6% 1% 1% 2% 2% 0% Yes - increased Yes - other Yes - removed Yes - reduced Yes – increased Yes - reinstated No change time of PCR pre- (reduced fallow green pathway self-isolation self-isolation (extra PPE for op theatre times, completely period period AGPs, extra reduced PCR fallow theatre tests from 2 to times) 1) Thank you All local co-ordinators, anaesthetic and critical care staff completing this survey. Next round starts February 8th 2021 Authors: Emira Kursumovic, Tim Cook, Jasmeet Soar, Andrew Kane, Richard Armstrong, Jose Lourtie, Owen Waite, Karen Williams
Health Service Research Centre