Coronavirus: London hospitals cancel operations to free up staffing as critical care beds fill up

NHS staff warn ‘January will be a nightmare’ as the capital sees surge in Covid cases

The Royal London hospital has had to cancel operations and redeploy staff as coronavirus cases surge (PA)

London’s hospitals are already beginning to run out of critical care beds ahead of the Christmas relaxation of rules – which is expected to increase cases further, a leaked NHS briefing has warned.

The update on the situation in the capital comes as major hospitals have already started to cancel operations for other patients in order to find enough staff to deal with the rise in patients as NHS trusts open up extra surge capacity.

More operations are expected to be cancelled in hospitals across London, with staff warned they could be redeployed at short notice.

On Wednesday, there were a total of 2,289 coronavirus patients in London hospitals, an increase of 2 per cent on the day before.

But the numbers of coronavirus patients in critical care beds jumped 8.6 per cent in a single day, increasing from 302 to 345 patients on Wednesday, while an additional 900 people who have tested positive were receiving oxygen.

Across London, there were just 49 adult critical care beds available on Wednesday. In total there were 904 beds occupied, 328 by patients with Covid-19. This meant the capital’s total critical care bed occupancy rate was almost 95 per cent.

The report, seen by The Independent, warned: “Over the last seven days there has been an average daily increase of 3.6 per cent in the number of Covid-19 patients in adult critical care. If this trend continues we forecast in three weeks there will be 1,241 occupied adult critical care beds of which 665 will be Covid-19 patients.”

Although the number of patients is much lower than it was the first wave, many hospitals are still treating routine and non-Covid patients – meaning they are struggling to staff critical wards and keep other services running.

A briefing for NHS managers warned them: “A reduction of elective [routine] activity is likely to be needed in line with increasing acute activity.”

It added managers “need to ready themselves for reactive cancellations” and “the need for redeployment is likely to be greater than previously anticipated due to the rapidly changing environment, other demands such as vaccination and the rising sickness rate.”

It also suggested annual leave over the festive period be reviewed.

The Independent has been told by multiple doctors, nurses and NHS managers across the capital that staffing is the major risk as Christmas approaches and restrictions on household movement are relaxed.

Rolling seven day case rate for coronavirus cases across NHS London areas (NHS briefing)

London has seen the largest increase in Covid cases in the last week with infection rates reaching 319 per 100,000 people, compared to just under 200 in the previous week. The increase in cases in the southeast and London has been linked to a new variant of Covid-19 which is now being analysed by Public Health England experts

The worst affected areas in London are the southeast and northwest areas, with Barts Health Trust the worst hit for Covid patients. It had 51 Covid patients on Wednesday, with 120 in critical care.  

The trust told The Independent it was cancelling some operations to redeploy staff and open up extra beds but said this would not affect cancer patients.

At the trust’s Royal London Hospital four operating theatres for elective, or routine, surgery have been closed this week. One doctor said the key issue was staffing: “Staff sickness overall is increasing. We’re already having trouble covering shifts due to contact isolation for staff, more than actual sickness in staff themselves. Track and trace and the app is keeping lots of people home when they wouldn’t have had to do that in March.”

The staffing problem means that while the trust opened up a new intensive care floor at the Royal London hospital after a £24m refurb, it cannot staff the 176 extra beds without taking staff from elsewhere.

In most hospitals, the normal ratio of one nurse to one patient in intensive care has been relaxed.

At the weekend, Whipps Cross Hospital, near Walthamstow, declared an critical incident because it did not have enough beds for patients. It was forced to divert ambulances to other hospitals and cancel some operations.  

One ICU doctor said: “I am worried mainly over ICU nursing. We’ve already stretched the ratios, and it’s a really finite resource. We’re not at full capacity and teetering on the edge. More admissions will tip us over. I think January is going to be really really difficult.”

One NHS source said there was a “sombre mood” among senior managers adding: “We are expecting the curve to rise more, that translates to hospital admissions and that leads to critical care. Patients going into critical care are sick and can stay for 30 days plus.

“January will be a nightmare.”

Operations have also been cancelled at Hammersmith Hospital, North Middlesex Hospital and Hillingdon Hospital.

A spokesperson for Barts Health NHS Trust said: “We are treating high numbers of patients with Covid-19, and in line with our winter escalation plan we have moved into a ‘high pressure’ phase and are taking steps to keep our patients safe.  

“These include deferring some routine procedures over the coming days so we can redeploy staff and increase the number of critical care and general beds available.”  

NHS England was approached for comment.