London hospital trust turns away coronavirus patients
As the situation for the NHS deteriorates in the capital, the Government works to free up resources
A LONDON hospital trust has become the first to admit it is turning away coronavirus patients, as NHS chiefs warned services in the capital are on the brink of being overwhelmed.
Lewisham and Greenwich NHS Trust said it has transferred Covid-19 patients to neighbouring hospitals, as demand for life-saving treatment surges.
A senior clinician at the trust revealed that at one stage on Tuesday only one patient had been admitted to intensive care out of an eligible group of five, although the trust insists all who have required ventilation have so far received it.
It came as the death toll from the disease rose most sharply in London, with 16 of the total 29 new fatalities in England coming from the capital. There were three deaths at Lewisham and Greenwich, more than nearby larger trusts.
In the UK, 144 patients are now known to have died from the disease.
Last night, senior medical leaders warned that smaller hospitals would find it hard to cope and were already transferring patients to larger teaching counterparts.
Dr Simon Walsh, the British Medical Association for emergency care lead, said: “Most hospitals have already managed to double their critical care capacity but the worrying thing I am hearing is that some units around London are already filled to capacity and some are exceeding capacity.” Becoming the latest senior medic to bemoan the lack of staff testing for Covid-19, he said he was aware of paediatric emergency departments where between 25 and 30 per cent of the doctors were already selfisolating.
Meanwhile, a government source said: “In London, the situation is already looking like one of the worst winters we could remember – elderly people needing ventilators and there are just not enough of them to go round. We were already under pressure, the situation is deteriorating pretty fast.”
Yesterday’s fresh coronavirus fatalities put the acceleration in deaths in the UK higher than that of Italy.
Speaking on condition of anonymity, a clinical staff member centrally involved in the coronavirus response at Lewisham and Greenwich said the trust’s A&E departments now resemble “Covid-19 waiting rooms”. “We’re running out of beds and running out of space,” he said. “Some patients with Covid-19 are being shipped to other trusts. Managers are off sick with stress.”
At the daily Downing Street press conference, Prof Chris Whitty, the Chief Medical Officer for England, acknowledged the deteriorating situation in London. He said that intensive care units would be the first to experience “real pressure”, adding that there would be a “lag” before the public’s efforts to stem the spread of Covid-19 would result in a slowing of case numbers. One London hospital trust has less than seven days’ worth of protective equipment left and has a store room that has been broken into, with masks and other protection stolen, sources told The Daily Telegraph.
A spokesman for Lewisham and Greenwich NHS Trust said claims that Covid-19 patients had not been properly ventilated were “categorically not true”. “We have provided intensive care treatment to all Covid-19 patients who have needed it,” he said.
He also said all A&E services had not been disrupted.
Last night, ministers announced that £2.9billion already allocated for emergency spending on the virus would be used to free up more than 15,000 beds by helping patients no longer in need of treatment to return home and for social care services.
‘Some patients with Covid-19 are being shipped to other trusts. Managers are off sick with stress’
‘Very, very difficult choices are having to be made … five new people are being intubated every 12 hours, but not all Covid patients are getting access’
IN NORMAL times, it might seem a nobrainer.
All five patients being reviewed for potential admission to the intensive care unit – with its precious ventilators – are experiencing difficulty breathing.
Having failed to fight off Covid-19 naturally, their immune systems are now beginning to overreact, heralding the possibility of dangerous respiratory complications such as pneumonia, which, if they can’t be controlled, could lead to multiple organ failure.
According to one witness, however, on that occasion only one patient was selected.
The basis for the alleged decision at Lewisham and Greenwich NHS Trust is not known, and bosses insist that all Covid-19 patients who required a ventilator and intensive care have received it.
But such are the harrowing decisions now allegedly being faced by the staff as coronavirus spreads around the capital.
In common with others across London, what, only a handful of days ago was a normal acute trust, is increasingly resembling a field hospital in the war against the disease.
“Very, very difficult choices are having to be made,” said one clinician, a veteran of many NHS winter crises.
“Sometimes five new people are being intubated every 12 hours, but not all Covid-19 patients are getting access.”
The management strongly disputes that patients with Covid-19 have so far been denied access to ventilators.
This view from the front line comes in the week NHS leaders revealed they are embarked on a frantic drive to boost their capacity of the lifepreserving kits – currently at 8,175 – by nearly 50 per cent.
Despite this “war footing effort”, as
Boris Johnson phrased it, on Tuesday NHS England chief executive Sir Simon Stevens stopped short of guaranteeing the extra machines would be sufficient to cope with a surge of cases.
“We are running out of beds and running out of space,” the staff member said. “It’s got so bad that we’ve had to ship Covid patients out to other trusts.
“The A&E department is increasingly resembling a Covid waiting room, so patients with normal emergency problems are being sent to minor injuries.”
The problem is not just an apparent lack of space.
Boris Johnson’s announcement on Monday that anyone living with a person displaying symptoms of Covid-19 should self-isolate for 14 days is having a dramatic impact on staff numbers.
“The moment the announcement was made we started losing more people – they just went home,” said the clinician.
“That’s why the fact that we can’t get tested for the disease is so devastating, because we’ve got doctors and nurses who are totally fit and well sitting at home where they can’t help anyone.”
Those Covid-19 patients not immediately selected for intensive care treatment are sent to other hastily created isolation zones within the Lewisham and Woolwich hospitals that comprise the trust, where medics try to control their symptoms using drugs and simple oxygen masks.
The pattern allegedly starting to emerge in south-east London was chillingly presaged last week, when the Intensive Care Society revealed it was drawing up new guidelines giving doctors greater flexibility to ration life-saving care to those with the best chance of survival.
This was amplified on Tuesday by Prof Stephen Powis, the medical director for NHS England, who indicated that he would be prepared to issue new guidance to doctors giving them extra cover in crisis situations such as being suffered in northern Italy. As if the responsibility of making these potentially life-and-death decisions were not a heavy enough burden, the staff at Lewisham and Greenwich say they are fighting coronavirus without appropriate protection from Covid-19.
“We don’t feel protected at all,” the clinician said.
“Lots and lots of staff don’t have access to the proper FFP3 face masks that are actually fitted, we feel extremely vulnerable and rotas are being hit with people coming down with symptoms.”
The experience was echoed yesterday by one of the most senior doctors in the capital, the London director of major trauma, Prof Karim Brohi.
“Not a single one of us working in the NHS isn’t a bit scared to go to work,” he said.
Although many doctors and nurses at Greenwich and Lewisham are deeply worried about their own safety and their capacity to cope with the tide of patients, some were yesterday trying to stay upbeat.
Annie Anderson, a critical care sister posted a picture of staff in protective gear, saying: “This is today’s team this morning just before they entered the isolation zone.
“These guys are so amazing and I am so lucky to be part of such an amazing team.
“This is real. It’s happening. We don’t know what the next few months will bring but we know we are the best people for the job.”
She added: “Follow the advice, stay at home.”
Others staff were keen to promote
‘The fact we can’t get tested for the disease is so devastating … we’ve got doctors and nurses who are totally fit and well sitting at home where they can’t help anyone’
the Government’s social distancing strategy – for delaying the peak of cases and allowing the NHS to cope.
They tweeted pictures of themselves holding cards reading: “I stayed at work for you. Please stay at home for me!”
The stress of adapting hospitals from their day-to-day roles to a pandemic crisis centre is not only taking its toll on clinical staff.
It is understood that more than one manager at Lewisham and Greenwich has called in sick with stress in recent days.
“The situation is placing extraordinary demands on people,” the staff member said.
Last night, the nation’s medical leaders began to acknowledge the pressure faced by London.
Prof Chris Whitty, the Chief Medical Officer, told reporters: “At the moment London from the coronavirus is under pressure but indirectly, but that’s going to go up,” he said.
“The first thing that will get under the greatest pressure will be intensive care and respiratory care system, that’s the first point of real pressure on the NHS that’s going to be happen.”
“And to be clear: even if everybody does all the things we hope and really, really would ask that they will do, the numbers will continue to go up over the next two weeks because there’s a lag until things start to improve.”
A spokesman for Lewisham and Greenwich NHS Trust told The Telegraph that Covid-19 patients who required a ventilator and intensive care had received it.