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How should we configure acute medical services to meet the needs of patients during peaks of COVID-19 infections and more generally during periods of intense acute care activity in the NHS?

COVID-19 has had a profound impact on the organisation and delivery of acute healthcare. Prior to the rapid increase in COVID-19 admissions, acute trusts and acute community providers had opportunities to re-engineer acute care through new care platforms (e.g. changes in processes of care, re-deployment of staff and rota changes). These changes are designed to provide a rapid increase in capacity across a system of care, not just for intensive care and ventilators, but also for general care of patients with COVID-19 who have become too unwell to stay in their usual place of residence.

We are seeking to understand the impact of these changes and to learn which approaches are more likely to be associated with ‘COVID Resilience’ – the ability to meet the healthcare needs of the population during COVID. The challenge for health and social care is not only to support patients with COVID, but also to ensure that patients with acute illness not due to COVID can also get access to timely treatment, alongside detecting and treating important conditions such as cancer.

We will study NHS Digital data and analyse the national audit survey of acute medicine units. We will use this information to map patient flows and clinical outcomes for COVID-19 and non-COVID acute diseases at hospital level, cross-mapped to national audit survey and NHS Digital workforce data, and examine outcomes in settings with novel care pathways. The learning from the variations in rapid re-design of acute care is essential in preparedness for further peaks of COVID and planning the rapid and sustainable recovery of non-COVID pathways. Importantly, we should identify positive changes (such as reduced crowding in emergency departments) and seek to understand how to maintain such improvements.