£45m: Huge initial coronavirus cost to NHS in Gwent

The eye-watering figure for the April-July period comprises the cost of opening and manning almost 750 extra hospital beds - amongst total revenue spending of more than £30m - to deal with an influx of Covid-19 patients, along with almost £14.5m of capital spending.

More than half of the latter figure (£7.5m) has been taken up with completing a section of the otherwise unfinished Grange University Hospital at Llanfrechfa, to enable it to house 384 of those extra beds.

Though the overall revenue spending figure may be reduced - fewer extra beds have been planned subsequently, and those at the Grange have not yet been required - the numbers are an indication of the financial toll exacted by the necessity for Aneurin Bevan University Health Board to respond quickly to a disease that, says one of several reports on the impact of coronavirus to go before board members today, struck the area "at scale and pace".

Part of the Grange University Hospital at Llanfrechfa has been completed ahead of schedule to house 384 beds as part of extra capacity to cope with the coronavirus threat. Picture: Aneurin Bevan University Health Board

It is a price however, that has enabled the NHS in Gwent and partner organisations such as councils and the third sector, to cope with an unprecedented situation that threatened to overwhelm key services.

There have to date been 430 deaths attributed to coronavirus in Gwent, and 2,401 confirmed cases - the true figure is doubtless higher - and the report, which includes the health board's Covid-19 Plan, details the extent to which the health service here has been stretched, especially during March and early April.

So concerned were health board bosses as they put together a plan to try to meet the emerging threat, that the new International Conference Centre (ICC) at the Celtic Manor Resort in Newport was earmarked as a potential site for caring for patients.

That did not come to pass, though the option remains part of contingency plans should a second wave of coronavirus develop.

The peak of infection has now passed, says the report, and as lockdown measures begin to be eased, so the health board has begun planning for the resumption of some of the services put on hold several weeks ago - such as non-urgent, or elective, surgery.

But such planning is being done with the knowledge that coronavirus continues to represent a significant threat of unknown duration.

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Another report lays bare the stark scenarios the NHS in Gwent faced as the full impact of coronavirus began to be felt in the UK, in terms of the beds and ventilators it might require.

Issued on March 13, prior to the introduction even of social distancing measures, the first Covid-19 modelling for Gwent was based on two assumptions - no mitigating measures, and limited mitigating measures based on assumed changes in people's behaviour. Four different levels of impact were factored into each, giving eight estimates of bed and ventilated bed need.

The results, even in retrospect, are enough to chill the blood. With no mitigating measures and 100 per cent disease impact, it was estimated that 9,170 hospital beds and 883 ventilated beds would have been needed in Gwent at peak occupancy, with daily patient admissions hitting 1,222 at their peak.

Even with limited mitigating measures and the lowest impact that was modelled, it was estimated that 779 beds and 75 ventilated beds would be needed at peak for Covid-19 patients, with 104 daily admissions.

Given that during normal times Gwent hospitals have a combined total of 1,554 beds and 25 ventilated beds, the "extraordinary" increases in demand "even at the lower estimates, had the potential to overwhelm health board baseline capacity" states the report.

It is worth remembering that no measures resembling the social distancing and subsequent lockdown restrictions had been announced on March 13, leaving the health board, its counterparts in Wales, and NHS bodies throughout the UK, staring into the abyss.

The potential for social distancing and other restrictions to significantly reduce the incidence of infection were instrumental in persuading the UK Government to introduce the lockdown rules that kicked in on March 23.

Subsequent hospital bed and ventilator capacity models for Gwent reflected this potential, and included factors such as social distancing compliance levels and later still, personal protective equipment and staffing availability.

In Gwent hospitals, actual weekly peaks in demand - of cases requiring oxygen (300), requiring ventilation (47), total hospital coronavirus cases (334), and weekly admissions of such cases (258) - occurred during the three weeks beginning March 25.

The NHS in Gwent's response to the coronavirus threat has helped save the lives of many, including Scott Howell, 48, of Blackwood - the first Covid-19 patient in the Royal Gwent's intensive care unit - pictured with nurses ahead of his discharge last month, after a remarkable recovery. Picture: Aneurin Bevan University Health Board

Given that the first hospital cases were seen around March 11, the timescales give an idea of how quickly coronavirus impacted upon the area's health services.

The peaks were earlier and represented an extremely challenging situation for staff but were, thanks to their unstinting efforts and to the work going behind the scenes to boost capacity, nowhere near those the system could have faced towards the end of April when, if restrictions had not been introduced, the modelling indicates it would have been overrun by demand.

Another of the reports hails the "exceptional" response of staff and teams across the health board, whose efforts have "enabled us to meet this initial phase of demand and prepare for future phases of response with greater insight and experience".

Restarting the rest of the NHS - and the backlog that awaits

PLANS are being made for the gradual reintroduction of NHS services put on hold in Gwent by the impact of coronavirus and the need to keep people safe while diverting resources - doctors, nurses, equipment, facilities - to deal with its threat.

The frightening speed with which the pandemic began to leave its mark on these shores from late February, meant that within weeks, routine operations and other procedures were cancelled in hospitals across the UK.

And when they resume, there will be a huge backlog of cases, alongside the likelihood of a surge in demand from patients who have put off seeking treatment these past couple of months.

No details are available yet on how and when services will resume - but an indication of the effect of cancellations can be seen in treatment waiting times figures for Aneurin Bevan University Health Board in March.

It had been estimated that around 850 patients would have been waiting more than 36 weeks for treatment by March 31 - but with cancellations kicking in early that month, the actual figure was 1,622.

Testing suffered too. The health board had hoped to wipe out waits of more than eight weeks for tests by March 31, but almost 1,500 patients had been waiting beyond time limit by the end of the month.