Ventilation has been a core component for the treatment of patients as a result of the coronavirus infection. In its CPAP form, ventilation has been identified as an effective treatment for a high proportion of patients across countries, thus reducing the need for more invasive forms of ventilation.
Overall, ventilation has been less of a challenge during the crisis than initially feared, and every patient that has required ventilation has been able to be provided with access.
However, questions have still been raised across our membership and in the media about the availability of ventilators, their distribution across regions, the availability of their associated consumables and the ability of NHS organisations to support their use.
This page highlights the key issues raised across the system since the start of the pandemic, the emerging issues and our ongoing and previous asks of the government.
Consumable supply and use
In previous weeks, the available supply of oxygen to hospitals developed as a key issue for a number of NHS trusts as a result of dated supply architecture that meant that the demand of oxygen required to support overall ventilator usage was surpassing the piping systems supply ability.
This resulted in NHSEI sharing guidance with clinical and engineering teams on how to limit the demand for oxygen when using a range of ventilation devices.
As the NHS returns to delivering business as usual services, the demand for ventilators and their consumables has also increased. This increased demand has the potential to place a strain on the delivery of both COVID-19 and business as usual services and has resulted in a number of ventilator consumables being placed on a suspension list that restricts their order.
We have asked NHSEI and the Department of Health and Social Care how they will balance the demands for ventilator consumables required for both COVID-19 and BAU services, ensuring that they can be provided in sufficient quantities so as not to impact upon the delivery of care to either population group.
Availability and distribution
The forecast number of ventilators to meet peak demand has changed as the pandemic has developed across the UK, the initial predication of 30,000 was revised down to 18,000 by the health secretary on 5 April. However, this still left the NHS short of ventilator capacity despite new orders from existing international supplier, the private sector deal and UK Ventilator Challenge.
Members have raised concerns about how the real-time modelling of ventilator need will be responded to. We have asked for greater clarity on the redistribution between organisations to meet need. This was delivered in clarified guidance from DHSC on the process used to determine the distribution of available ventilator capacity from central stocks and between organisations.
Despite this, there is still concern among members about changes in forecast in some instances leaving them with a deficit of ventilator capacity.
We have been clear that in order to ease anxiety among NHS trusts, especially in those regions that where yet to see a speak in cases, it should be ensured that adequate supply will not be affected by real time changes in modelled need.
On 29 April, the government granted indemnity to the manufactures of rapidly developed ventilators for any personal injury or death resulting from defects in their equipment. NHS organisations have been instructed to use their traditional ventilators in the first instance.
We have asked the government where this indemnity will leave responsibility for claims resulting from ventilator defects, and if there will be potential liability and protection for NHS organisations required to decide who will and will not get access to traditional ventilators over rapidly produced models should demand mean that this decision has to be made.
Despite government assurances in the available supply of oxygen, mental health trusts have struggled to receive the supplies of oxygen needed to ventilate the growing number of patients in their facilities that require some form of ventilation but cannot be moved to other facilities for treatment.