Nurses sent to Lon­don as cap­i­tal faces ‘tsunami’ of virus pa­tients

NHS also to ask doc­tors work­ing at new hos­pi­tal to sleep on site for weeks

The Guardian - - Front Page - Denis Camp­bell Rowena Ma­son Chris Hop­son

Nurses will be trans­ferred to Lon­don from other parts of Eng­land un­der NHS plans to help hos­pi­tals in the cap­i­tal fac­ing a “tsunami” of Covid-19 pa­tients within days, the Guardian has learned.

In an un­prece­dented pack­age of mea­sures, the NHS will also ask doc­tors to sleep on site for six weeks at the new Nightin­gale hos­pi­tal, scrap lim­its on the num­ber of pa­tients nurses can look af­ter in in­ten­sive care wards, and ex­plore whether ven­ti­la­tors intended for one per­son can be used for two.

NHS Eng­land has also asked its net­work of re­gional chief nurses if they can spare any of their staff, es­pe­cially those ex­pert in in­ten­sive care, to work in the cap­i­tal dur­ing the peak of the pandemic, which is ex­pected to start early next month.

The moves emerged as the to­tal num­ber of re­ported deaths in the UK rose to 578. One of­fi­cial said the NHS faced an “ex­treme surge” of se­ri­ously ill pa­tients early next month. The plans are part of a se­ries of mea­sures drawn up in re­cent days by se­nior of­fi­cials from NHS Eng­land’s Lon­don re­gion, which were dis­closed to the Guardian.

NHS Providers, which rep­re­sents hos­pi­tal trusts, has warned that some hos­pi­tals in Lon­don are fill­ing up so fast with peo­ple left se­ri­ously un­well doc­tors to in­tu­bate them so they could be put on a ven­ti­la­tor.

Of­fi­cials in­volved in the NHS’s emer­gency pre­pared­ness ef­fort in Lon­don have re­vealed that:

• A lack of ven­ti­la­tors has forced NHS plan­ners to ex­plore whether one ma­chine could be used to keep two pa­tients alive, dras­ti­cally in­creas­ing ca­pac­ity at a stroke.

• Lon­don will have 7,500 crit­i­cal care beds by the end of next week – 27 times more than the 275 beds it had be­fore the epi­demic be­gan in Jan­uary.

‘Hos­pi­tal trusts are strug­gling with the ex­plo­sion of de­mand’

• There are fears that a lack of oxy­gen could ham­per the drive to save lives through the mas­sive ex­pan­sion of crit­i­cal care ca­pac­ity. Hos­pi­tals will need daily de­liv­er­ies to ser­vice the ex­tra ven­ti­la­tors.

• Doc­tors at the new Nightin­gale hos­pi­tal at Lon­don’s Ex­CeL cen­tre look­ing af­ter thou­sands of pa­tients re­ceiv­ing life-or-death care will stay there for at least six weeks, work­ing five days in a row be­fore hav­ing a break – and will sleep on site.

• The huge num­ber of pa­tients fall­ing ill will mean the usual staffing ra­tios in in­ten­sive care units are scrapped tem­po­rar­ily so that one in­ten­sive care nurse can look af­ter six pa­tients rather than one – in what doc­tors pri­vately warned was an “un­be­liev­able” re­lax­ation that would hit care stan­dards.

Chris Hop­son, NHS Providers’ chief ex­ec­u­tive, said hos­pi­tals in Lon­don had ex­panded crit­i­cal care ca­pac­ity be­tween five- and seven-fold in the past weeks, but bosses at those hos­pi­tals have been alarmed by the speed at which beds are fill­ing up in the cap­i­tal.

He said the prob­lems had been ex­ac­er­bated by med­i­cal staff be­ing off sick with sus­pected coro­n­avirus or in vul­ner­a­ble groups, with 30% to 50% not at work in some trusts. He did not name the trust where 50% of staff were off sick or self-iso­lat­ing be­cause some­one in their house­hold had symp­toms, but it is a Lon­don trust.

NHS chiefs are con­cerned that the Lon­don am­bu­lance ser­vice is al­ready so stretched it will strug­gle to cope with the 100 ex­tra pa­tients a day, all with Covid-19, that they are ex­pected to take to hos­pi­tal. It plans to meet that chal­lenge by us­ing 20-25 ve­hi­cles usually used to trans­port pa­tients to non-ur­gent ap­point­ments, which have few med­i­cal facilities on board, and hire taxis and dial-a-ride ser­vices for peo­ple de­nied their usual trans­port.

Pri­vate hos­pi­tals in Lon­don have of­fered to pro­vide 111 crit­i­cal care beds to help the NHS, as well as 1,300 “step­down” beds for pa­tients leav­ing NHS hos­pi­tals. They will also sup­ply staff and equip­ment.

In a sign of the huge num­ber of peo­ple ex­pected to need crit­i­cal care when ill­ness rates in the rest of Eng­land be­come as high as in Lon­don, the NHS also plans to open two fur­ther “field hos­pi­tals” for Covid-19 pa­tients, modelled on the trans­for­ma­tion of the Ex­Cel cen­tre, in Manch­ester and Birm­ing­ham. Of­fi­cials are look­ing at the Na­tional Ex­hi­bi­tion Cen­tre near Birm­ing­ham air­port as a likely venue.

In ad­di­tion, the army – which is play­ing a key role de­liv­er­ing sup­plies of per­sonal pro­tec­tive equip­ment to hos­pi­tals and GP surg­eries – is build­ing a new ward for se­ri­ously un­well pa­tients in the car park at Wi­gan hos­pi­tal.

Ex­perts be­lieve that the north of Eng­land will start ex­pe­ri­enc­ing rates of Covid-19 ill­ness com­pa­ra­ble to those in Lon­don in about two weeks.

Speak­ing to BBC Ra­dio 4’s To­day pro­gramme, Hop­son said: “They [Lon­don trusts] are strug­gling with the ex­plo­sion of de­mand in se­ri­ously ill pa­tients. They are say­ing it’s the num­ber ar­riv­ing and the speed with which they are ar­riv­ing and how ill they are. They talk about wave af­ter wave af­ter wave.

“The words that are used to me are that it’s a con­tin­u­ous tsunami. As one said to me, it’s much big­ger and large num­bers with a greater de­gree of stretch than you can ever have pos­si­bly imag­ined.

“The CEOs are con­cerned that all that ex­tra ca­pac­ity is now be­ing used up very, very quickly. We’ve got the surge ca­pac­ity at the Ex­CeL cen­tre but this is fill­ing up very quickly.”

Con­cern over whether min­is­ters could have bet­ter pre­pared for the pandemic will prob­a­bly be height­ened by re­marks from Sir David King, a for­mer chief sci­en­tific ad­viser to the gov­ern­ment. He told jour­nal­ists that the gov­ern­ment was warned of the dan­gers of epi­demics sweep­ing the UK four years ago.

“In 2016 there was a re­port that in­di­cated our hos­pi­tals would not be ready for an epi­demic of this kind but it has not been made pub­lic,” he said.

NHS Eng­land was ap­proached for comment.

‘We have got the surge ca­pac­ity at the Ex­CeL cen­tre but this is fill­ing up very quickly’ Chris Hop­son NHS Providers

PHO­TO­GRAPHS: IAN FORSYTH/GETTY; DAVID ROGERS/GETTY; PHIL NOBLE/REUTERS

▲ seven-year-old Alice Wilkin­son joins her mother in Manch­ester to ‘Clap For Our Car­ers’ Clockwise from main im­age: a woman dances out­side her house in Salt­burn-by-theSea, res­i­dents in Northamp­ton ap­plaud, and

PHO­TO­GRAPHS: IAIN WATTS/MER­CURY PRESS; DAVID DAVIES/ PA; JEFF MOORE

▼ Clockwise from main im­age: staff at the Royal Liver­pool Univer­sity hos­pi­tal re­act as peo­ple across the na­tion, in­clud­ing two house­holds in east Lon­don, par­tic­i­pate in ‘Clap for Our Car­ers’ in trib­ute to NHS staff

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