National chiefs: Ventilators will follow ‘most immediate need’

Many are expecting demand for ventilated beds to outstrip what they have as the number of patients seriously ill with covid-19 ramps up.

Trust leaders yesterday told HSJ they were growing increasingly worried about the lack of information over when the machines would be sent to their trusts. Some are worried London, and other regions which see their demand spike first, will get more supply.

A letter from NHS England and Improvement to trust chiefs late on Wednesday told them that as “extra ventilators become available we will coordinate distribution via regional teams who will work with local health systems”.

It continued: “We will deploy the devices to areas with the most immediate need, on a fair share basis relative to patient ventilation need. We will aim to ensure that there is an equal distribution of both conventional and specifically made devices.” It comes as several firms are scrambling to produce non-conventional but effective ventilators speedily.

The proposed approach indicates trusts in London could be prioritised, as the capital is thought to be one to two weeks ahead of the country in terms of covid-19 pressure.

It is in contrast with a potential alternative method of distributing them per capita of population, an approach which some outside of the current surge zones have called for.

It comes as the health service awaits the arrival of 8,000 ventilators ordered by the government ahead of an expected surge of covid-19 patients in the next month. 

One trust, Epsom and St Helier University Hospitals Trust, told HSJ it was planning to have 75 critical care beds during levels of “super surge”, but needs another 40 ventilators to achieve this.

However, many trusts outside London also need ventilators to meet the demand predicted by experts.

University Hospital Southampton Foundation Trust has increased ventilated critical care capacity from 55 to 150, but a spokesman told HSJ the trust still plans to add another 50 machines to its stock.

Last week trusts were told that ventilators would be procured nationally, but some trusts are continuing to attempt to buy machines themselves, according to NHSE/I.

In its letter the regulator said it “discourages” this to avoid the NHS competing for the same machines amid such “globally competitive procurements”.

Meanwhile, NHS Supply Chain is ramping up orders for equipment and consumables required alongside ventilators in intensive care units.

This will enable the centre to provide “starter packs” of consumables with each bundle of ventilators and monitors.

“This is intended to enable the devices to be used immediately and allow time for trusts to assess and secure their specific consumable requirements,” the letter said.

National chiefs hope the number of different types of machines provided can be “minimised” to reduce training requirements for staff. Last Sunday trusts were warned of the increased fire risks associated with more ventilators being used on wards. 

The national chiefs said they would attempt to ensure continuity for trusts which use specific manufacturers, but only where this does not “delay or skew” the distribution of machines.

HSJ has asked the Department of Health and Social Care how decisions will be made if multiple trusts require ventilators at the same time, and have to be prioritised, but had not received a response at the time of publication. 

The letter was signed by Professor Keith Willett, NHSE/I’s strategic incident director; Emily Lawson, NHSE/I’s chief commercial officer; and Mark Brandreth, chief executive of the Robert Jones and Agnes Hunt Orthopaedic Hospital FT and lead for ventilation supply.