Recommendation COVID-M3.6: Scale Up Hospital Capacity

6.1 The Welsh Government agrees with the Inquiry that it is important that hospitals must be able and ready to increase capacity quickly when needed. The Welsh Government will build on the arrangements established during the Covid‑19 pandemic, and use the lessons learned since then to improve future planning. 6.2 The Welsh Government recognises that hospital capacity is not just about the number of beds available. It is also about having trained staff, equipment, medicines, supplies, suitable spaces, oxygen and ventilation, digital systems, infection prevention and control measures and the ability to keep essential services. 6.3 The NHS in Wales already has national guidance to guide health boards to increase critical care capacity during a sudden rise in demand. The All‑Wales Critical Care Escalation Guidance for the Management of Large Unplanned Increases in Demand was updated in 2023 to reflect learning from the Covid‑19 pandemic. It asks health boards to plan for increased critical care capacity for adults, children and babies (neonates), with capacity including trained staff, beds, and equipment. 6.4 Mutual aid arrangements are also in place between health boards in Wales and the NHS in England so they can support each other when services are under pressure. 6.5 Health boards are required to review critical care capacity plans and local surge plans at least annually and have senior executive sign off. This helps the NHS in Wales learn and improve, keep organisations ready, and provide assurance that services can respond to a future pandemic or other major emergency. 6.6 The ability to increase adult critical care capacity was tested in 2024, and the ability to increase children’s critical care capacity was tested in 2025 as part of Exercise Pegasus. Exercise Pegasus also provided an opportunity to test planning assumptions for wider pandemic capacity, including highly communicable infectious disease capacity and general hospital capacity.

6.7 Recent public health outbreaks, including Mpox in 2025 and Hantavirus in 2026 also led to a review of the clinical pathways and actions cards. These are documents that help staff know what to do during an outbreak for new and emerging infections. As a result, the NHS in Wales retested its capacity to care for patients with serious infectious diseases. A readiness assessment has also been commissioned and will be carried out by the NHS Wales Shared Services Partnership. 6.8 The next phase of work will focus on developing plans to increase general hospital capacity. These plans will be developed on an ‘all‑threat’ basis, meaning that they are ready to respond to a range of risks and scenarios, including future pandemics. 6.9 Guidance will be issued to NHS organisations in Wales to support surge planning. This will recognise that plans to surge capacity must be supported by underpinning workforce plans. 6.10 This work will also include reviewing and updating the Essential Services Framework. This Framework provides guidance to organisations on which services must continue during an emergency response such as a pandemic.

The Scottish Government accepts both recommendations 5 and 6 in principle, and recognises the central role of all NHS Boards in ensuring that robust, practical and regularly reviewed arrangements are in place to respond to future pandemics or public health emergencies.

The Scottish Government has already begun taking steps to address these two recommendations, including:

The Scottish Government has commissioned all NHS Boards (this includes territorial health boards and special boards such as NHS 24 and Scottish Ambulance Service (SAS)), to review and assure their arrangements in terms of current capacity and the ability to scale up when required, while also contributing to the development of a consistent national approach to preparedness and resilience

While capacity can fluctuate, work by the Scottish Intensive Care Society Audit Group has shown increases in critical care capacity in Scotland since the pandemic

A review of critical care equipment has been undertaken. All NHS Boards are holding and maintaining on site ICU equipment to double capacity

Work is underway to confirm the approach to maintaining this capacity (as equipment will require replacement in five years’ time)

PSD Scotland is working in partnership with NHS Boards to deliver a national Medical Equipment Management System, to provide the Scottish Government with national oversight of Board medical equipment

Further initial steps proposed are as follows:

The Scottish Government has commissioned work to ensure there is a clear overview of health boards' capacity.

Health Boards have been asked to review existing plans and arrangements for managing significant increases in urgent and emergency care demand, including:

Workforce arrangements

Staffing models

Training and competency

Mutual aid

Governance and escalation

Risks and gaps

Health Boards are also undertaking a review of current plans for expanding hospital and critical care capacity. The Scottish Government has asked that this includes:

Additional bed capacity

Critical care expansion capability

Availability of equipment, supplies and consumables

Workforce

Infrastructure requirements

Command, control and decision-making arrangements

The government agrees with the Inquiry that it is important to continue to prepare to scale up hospital capacity and to regularly test this ability, ensuring that the system can respond effectively during a pandemic.