Coronavirus: Is the NHS ready for its toughest seven days ever?

‘We are doing everything we possibly can, but we simply do not have enough intensive care nurses. We are going to have to accept we can’t save everyone’

The next seven days will test the National Health Service like never before, as the number of coronavirus patients needing life-saving treatment begins to approach unsustainable levels – with predictions that patient numbers could double every few days.

Across the country hospitals are hoping the 33,000 extra beds in makeshift wards that have been fashioned out of old clinic spaces, offices and surgical theatres will give the NHS the capacity it needs.

The number of UK deaths has passed 1,000, with 260 further victims of the epidemic. The increase, from 759 to 1,019, was by far the biggest day-on-day rise in fatalities since the outbreak began.

NHS chief Stephen Powis told a Downing Street press conference that while every death is a tragedy, less than 20,000 would be a good outcome for the UK. “We shouldn’t be complacent about that,” he added. “Although that would be a good result, it will only happen if we stop the transmission of the virus.”

There is mounting concern among NHS leaders and senior nurses, who have told The Independent there is a major risk over safely staffing the extra beds and treating patients who need help to breathe, alongside concerns that large numbers of staff could become sick themselves.

One chief nurse at a hospital in the midlands told The Independent what was now being considered for intensive care “would have been unthinkable in normal times. This is going to push staff who aren’t used to this sort of acute care of patients to the limits.”

Nicki Credland, chair of the British Association of Critical Care Nurses (BACCN), added: “We are doing everything we possibly can, but we simply do not have enough intensive care nurses. We are going to have to accept we can’t save everyone.”

London is expected to be the worst hit during the next 10 days with the rest of the country following behind within the first few weeks of April.

On Friday NHS England confirmed there were 6,300 Covid-19 patients in hospital, with at least half thought to be hospitalised in London. Cabinet minister Michael Gove said on Friday that the number of cases was doubling every two to three days, suggesting London would be overwhelmed without the additional 4,000 beds which have been opened at London’s ExCel centre.

But an email to NHS staff from one London hospital, seen by The Independent, made clear staff who volunteered to work at the newly named NHS Nightingale Hospital would be expected to effectively live on site. It said staff volunteering to work in the hospital would need to be prepared “to live-in for the period the field hospital is open”.

St John Ambulance volunteers are also being asked to help staff the hospital, but some are thought to be having only a few days of training ahead of the hospital opening in the coming days.

More field hospitals are expected to be opened, at the Birmingham NEC and Manchester Central conference centre, in the next few weeks to try and relieve pressure on local hospitals.

But as the numbers of patients inexorably rise, the plans hastily put in place by NHS bosses in recent weeks will be forced to take the strain of what will rapidly become a national emergency.

NHS guidance issued on Thursday to hospitals made clear that staff from across hospitals, including non-nurses such as care assistants, therapists and pharmacists may have to be used to care for patients with intensive care nurses expected to oversee “teams of carers” across several patients.

Normally intensive care wards operate on a ratio of one nurse to one patient.

The documents said the NHS was heading into the crisis with 10 per cent of posts vacant, with normal business maintained thanks to the use of agency nurses. It said: “Opening additional beds in surge is therefore a challenge to staffing capacity.”

It said normal rules on training for nurses would need to be relaxed “to preserve life using every available resource”.

The document added: “It is acknowledged that a period of pandemic such as coronavirus will place pressures on and challenges to providing safe, effective, quality care to the critically ill patient.”

Ms Credland from the BACCN, who helped agree the guidelines, said: “What we have needed to do is to think about how we deploy staff who don’t traditionally work in intensive care such as theatre and outpatient nurses.

“It is not going to be perfect. We are going to try and do the absolute best we can for the most people we can possibly do it for.

“The situation in London is awful and we know we will start to see that disseminate through the rest of the country and you can’t just teach people to be a critical care nurse in a matter of days and weeks.”

She warned nurses and other staff could suffer serious mental health impacts from the next few months: “Staff are going to see a lot of patients die in one shift and they won’t have been able to deliver the level of care they are used to. The risk of post-traumatic stress is absolutely astronomical.”

Nursing is only one aspect of staffing levels for critical care beds. One doctor at the Royal London Hospital, in Whitechapel, explained: “It’s all very well making extra space and extra ventilators, but will we have enough staff for those areas? We will need physios, runners like healthcare support workers, pharmacists, admin staff, security, cleaners.”

The added: “Every Covid area, a four-bed bay and each side room, must have a runner outside. Usually ITU [intensive treatment unit] nurses would pop out to a storeroom a billion times per shift to get bits and pieces and new drug infusions and find the doctors to ask questions or get a prescription. Now it will all have to be done by runners. We won’t have enough phones to keep doctors in contact.”

They also said a team of at least five would be needed to lie patients prone, on their stomachs, which can actually help their lungs to cope with the infection.

Researchers and clinicians from King’s College London and South London and Maudsley NHS Trust have also warned NHS staff face what they described as a “moral injury” from the decisions made during the crisis.

Professor Neil Greenberg said the psychological distress can result from actions, or lack of them, which violate someone’s moral or ethical code. In an article for the British Medical Journal, he wrote: “During the Covid-19 outbreak many healthcare workers will encounter situations where they cannot say to a grieving relative, ‘We did all we could,’ but only, ‘We did the best we could with the staff and resources available, it wasn’t enough.’ That is the seed of a moral injury. It will hurt, and perhaps hurt for a long time, unless we now start to prepare and support our staff who will have to face this challenge.”

Professor Alison Leary, chair of healthcare and workforce modelling at London South Bank University, said the NHS needed to “employ the principle of a slow-moving major incident” and consider how it would cope during the second and third wave as well as the initial crisis.

She added: “We need to understand many staff will be working beyond their scope and competency. We have to accept we are working well beyond our risk envelope that we would normally accept as health professionals and as a society.”

She said the longer-term mental health of staff and patients from the pandemic was likely to last for years to come.

Helen Buckingham, director of strategy at the Nuffield Trust, said that there also needed to be consideration of the social care and nursing homes that could undermine the NHS response if they had to send patients to hospital or could not receive new patients. “We should remember there are more staff working in social care than there are in the NHS, around 1.5 million people,” she said.

But Ms Buckingham said the NHS was “as ready as it can be in the circumstances”, adding: “It is clear from the modelling that we are going to see the numbers rise significantly in the next few days. We will only really know with hindsight if that is enough.”