Hospital workers want to keep all NHS beds

Mayor Sadiq Khan told the BBC evening news on March 30th that despite the new ‘NHS Nightingale hospital’ potentially providing space for 4,000 beds, double the number of intensive care unit (ICU) beds would actually be needed in London.

The new temporary NHS Nightingale Hospital situated at the Excel conference centre in Docklands, is being rapidly kitted out with beds, oxygen pipes, ventilators, electricity supplies etc. to house 500 patients to start with, expanding eventually to care for 4,000.

Khan said that London needed to double that number to 8,000 beds. As there are just 800 intensive care beds in London at the moment, hospitals need to increase that number ten-fold!

The reason for the crash campaign to kit out not just the conference centre in London, but others in Birmingham, Manchester, Glasgow and Cardiff, is because the so called ‘surge’ or ‘peak’ of coronavirus cases is expected to present to UK hospitals in the next week.

Already 9,000 coronavirus patients are occupying one in ten hospital beds. The numbers are increasing by 1,000 per day in England and will continue to increase.

Sir Patrick Vallance, the government’s Chief Scientific Adviser, says the rate of acceleration of the pace has slowed because of the social distancing measures reducing people contact in the last week. But this does not alter the fact that more patients are surging into hospitals every day, reflecting the rapid rise in the contagion from three weeks ago.

Half the current hospital admissions for coronavirus are in London. How are London hospitals to find all this extra capacity for extra intensive care beds?

Sadiq Khan looked worried.

The UK has 6.6 ICU beds per 100,000 population. Germany has 29 ICU beds per 100,000 population. (WHO regional office for Europe 2009 )

On 17th march the Chief Executive of NHS England, Sir Simon Stevens, produced clearly thought-out plans to free up 30,000 beds in NHS hospitals for coronavirus patients.

15,000 ‘medically fit’ patients were to be discharged from hospital by March 27th.

£1.3bn of the Chancellor’s extra £5bn cash for the NHS was allocated for a speeded-up ‘enhanced NHS discharge process’. Community providers were to ‘take full responsibility’ for all patients on acute trust discharge lists.

Stevens’ view has always been that there are far too many older or complex patients in NHS hospitals, and that they should be cared for in the ‘community’, either in their own homes, or in care homes. (See ‘NHS Long Term Plan’ 7.1.19)

Local Authorities have been given £1.7bn to commission capacity to receive these discharged patients.

Another 15,000 beds will be acquired by stopping NHS acute trusts from performing routine surgery from 15th April. In addition, NHSE will pay private hospitals for block bookings for coronavirus patients.

A host of new deregulations and changes to the employment of staff and other provisions are listed in a final diktat in a letter from NHSE dated 17th March. One senior official is reported as saying that the guidance basically amounted to orders which say ‘whatever it costs, get people out of hospital. Don’t worry about the rules, just do it.’

Suggestions of postponement of cancer operations, curtailment of chemotherapy, and cancellation of cancer-screening programmes in Scotland have been made. Thousands of hospital outpatient appointments have been postponed.

Acute hospital trusts all across England are now engaged in a flurry of closures of services and reconfigurations of wards to comply with these instructions.

Local councils are devoting all their energy to trying to find places to put discharged patients.

But they have hit some obstacles.

Care homes are insisting that they will only take patients who have had an antigen test to prove they are coronavirus negative.

These fears are well justified. Recent weeks have seen care homes in Spain and France turning into clusters of deaths.

Already, the massive killing potential of this new virus Covid-19 has been expressed in the finding of multiple dead bodies in some of these homes.

Once the virus gets into the home, the contagion is unstoppable and multiple deaths ensue.

Care home staff in England have inadequate personal protective equipment, PPE, i.e. gowns and masks and gloves, and put themselves at risk. Already two doctors have died in the UK. The care homes don’t want the risk.

It has not been so easy to find the extra 30,000 beds.

40 years of constant NHS bed closures, accelerated since 2000s with closure of scores of District General Hospitals has left just 90,000 hospital beds compared to 450,000 beds in 1948 at the NHS’s foundation.

Stevens’ NHSE emergency plan is to temporarily commandeer large already-built conference centres, get the army in and set up ‘field hospitals’.

A rush is on to involve sundry businesses to design and produce another 8,000 ventilators of different levels of complexity.

No one can be sure where the ICU-trained doctors and nurses are to come from in these new giant field hospitals. Stevens boasts how medical students, volunteers from St John’s Ambulance, paramedics, doctors coming out of retirement, and cabin crew from closed-down airlines will all muscle in to do the job.

Professor Hugh Montgomery from University College Hospital said: ‘We’ve had to expand ICU beds. We will have to provide care in a different way and train rapidly inducted staff. It will not be one ICU nurse to one patient. One nurse will supervise three to six beds now. We are used to dealing with “Rolls Royce”-style ventilators. We will have to use simpler ventilation machines. The nature of the work has changed dramatically … Whereas patients wearing hoods or masks on positive pressure machines used to be nursed in ICU, now they will be on general wards … This had to be done as conventional beds are exhausted.’

Without proper, full ICU training for many staff, and without proper PPE and viral antigen tests available at scale, how safe is this care going to be?

Dr Jess Potter, locum doctor interviewed on BBC evening news, said the doctors did not know their terms and conditions, whether there would be PPE and sick pay.

NHSE is using the catastrophe of the coronavirus pandemic to break up traditional high standards of patient care, downgrade hospitals and staff expertise and hand contracts to the private sector. The giant field hospitals will be handed back to the private owners, leaving the NHS weakened and bereft of beds and ICU facilities.