There were 50,000 positive cases reported across the UK for the second day running on Wednesday, with figures showing London – now the centre of the crisis – with 5,524 patients in hospital, more than its first-wave peak in April.
Critically ill patients are being “evacuated” from the south of England to hospitals hundreds of miles away as NHS bosses in London revealed data showing the capital is set to run out of critical care beds within a week.
In response to the worsening crisis in London, The Independent has learnt NHS England will announce plans on Thursday to reopen the Nightingale Hospital, at the east London Excel conference centre, on 4 January – initially with around 60 beds for patients who are almost ready to leave hospital.
Several patients from across Kent have been taken to Plymouth, Southampton, Bristol and Leeds in recent days as the southeast of England has run out of beds as the numbers of coronavirus patients continues to rise.
Across England critical care networks have been told to keep some beds free for possible transfers from the south as the surge in patients accelerates and staff sickness undercuts the ability to staff the beds with enough nurses.
One critical care consultant said: “We have no choice but to evacuate the patients to other parts of the country. This is about as serious as it gets. You don’t transfer a critically ill patient unless you really have to.”
In London the city is at 116 per cent for critical care beds. Senior sources said many NHS trusts were at or near the “absolute maximum” level of beds they could open due to staff shortages but were being told to do more by NHS England.
On Tuesday evening, a message to hospitals across London from Sir David Sloman, the capital’s regional director, had “requested that each sector should progress to opening and staffing the identified critical care beds, in order to meet the projected demand of 1,553 beds by 4 January 2021.”
A table showing each hospital in London and its critical care bed numbers showed the city currently had 1,171 critical care beds on 28 December – 382 short of what will be needed.
Under so-called surge plans – where hospitals create new makeshift intensive care units, the capital’s hospitals believe they could manage to have 1,488 beds by 4 January – 65 short of what could be needed.
It’s possible hospitals could open 1,757 beds under so-called super-surge plans that are being discussed at the highest levels and would see children’s intensive care wards turned into units for adults, with seriously ill children from across London transferred to Great Ormond Street Hospital.
Many hospitals feel the super-surge plans are unrealistic. One NHS source said: “Staffing is the issue. Most units haven’t been able to open what they said they could.”
Another senior NHS figure said staffing was the “rate-limiting factor” both for the Nightingale and extra capacity in hospitals.
NHS England has agreed to relax nurse to patient ratios in intensive care to one nurse to three patients – normally the safe ratio is one to one for the sickest patients.
The Nightingale will open with 60 beds but could expand to hundreds over coming weeks if the NHS can find enough staff to run the service. During the first wave when the field hospital was being used for ventilated patients it treated only 54 patients in total because many hospitals were unwilling to send patients or staff amid concerns over safety.
Sickness levels and staff forced to self-isolate because of coronavirus are responsible for 40 per cent of absences from work in London.
In the southeast region, in Kent in particular, hospitals have exceeded their capacity for critical care patients with no spare beds for several days.
A number of patients have been transferred by land ambulance to hospitals hundreds of miles away.
One clinician with knowledge of the transfers told The Independent: “There are no ICU beds in Kent on Wednesday. Nearest are in Bristol and the Midlands. We transferred one critically ill patient to Bristol from Medway and another one from Kent to the Midlands.”
They added: “Staff and hospitals are overwhelmed. We have opened all our surge ICU beds and cancelled all surgery and we cannot open anymore beds. The patients in hospitals with Covid are going up and up.”
They said two patients were transferred from the William Harvey Hospital in Ashford to Plymouth on Monday with others from the Queen Elizabeth Hospital in Margate to Southampton hospital. On Tuesday one patient went to Oxford with two to Bristol.
The NHS worker added: “It’s really getting bad. Staff are on their knees, there is just not enough staff with critical care expertise.”
In a leaked message to the southeast region’s hospitals and NHS chiefs on Monday, seen by The Independent, Anne Eden, NHS England’s regional director for the southeast, said it was clear the “rapidly increasing numbers of patients” meant more critical care beds were needed. Plans on Monday would deliver an extra 63 beds in the southeast, she said, with junior doctors and other staff redeployed from areas where other activity has been stopped.
She added the region’s critical care services were now being overseen on a 24-hour basis with a daily call to assess where hospitals needed to carry out critical care transfers on what she described as an “inter-regional” basis.
An NHS spokesperson: “Hospitals in London are coming under significant pressure from high COVID-19 infection rates and while staff are going the extra mile and the NHS in London is opening more beds in NHS hospitals across the capital to care for the most unwell patients, it is crucial that people do everything they can to reduce transmission of the virus.
“In anticipation of pressures rising from the spread of the new variant infection, NHS London were asked to ensure the London Nightingale was reactivated and ready to admit patients as needed, and that process is underway.”