A very pressured ‘calm before the storm’ in London

Will the “vaccine wall” hold?

Hospital leaders work on the basis of a two-week delay between community transmission of Omicron and cases coming in large numbers to their front doors.

“So basically Christmas Day,” as one put it to London Eye, is when the resulting pressure may land in ernest.

This wave is spreading fast nationally but for acute trusts in the capital it feels a bit different (it is England’s Omicron capital, and has the fastest increasing rates overall). And as ever, it’s being felt unevenly across the city.

While at least one trust is having to re-model parts of its estate to build in isolation bays and extra beds, others still have the headroom to focus on virtual wards instead (ie support for the discharged).

One large trust’s ICU is still mainly full of non-covid patients, while another has had to cancel operations because the post-op beds were already filled with the unvaccinated unwell.

But the better news first.

“Maybe the vaccine wall will hold?” said one hospital boss. As this piece went to press we were nowhere near the first or second wave in terms of covid pressure in hospitals. There aren’t the anguished calls for the declaration of a health emergency like we saw last December. The Mayor took the initiative and declared one in early January.

Many leaders in London had called for it to come sooner, and from the NHS itself.

But everyone has stressed that no one really knows how Omicron will land yet. If it is “the calm before the storm” for some leaders, it’s a very high-pressured calm for others.

Because in less good news, even if Omicron doesn’t drive admissions, the urgent and emergency care picture is bad and will soon get worse.

“The front door pressure is off the scale,” said one hospital boss not given to hyperbole.

Once again large numbers of staff are at home with covid. One contact described how the staffing position meant not only did you lose that member of staff, but workers on staff banks were increasingly turning down shifts which they know will be extra onerous because of the shortages. A vicious circle harried systems could do without.

This is before you get into how “fed up”/less-polite-term staff are generally. What can you offer them at this point?

It’s not the ideal time to be having redeployment/sacking conversations with unvaccinated staff.

So even if the impact is only half of the last wave, it might feel harder for all the reasons above.

P2s in peril again?

Some parts of the city’s system are really struggling with P2 electives (people who need treatment within a month), others not yet.

It might not even take an Omicron hospital wave to force the re-opening of cancer surgery hubs, the heavy non-covid pressure could do it on its own, some figures have warned.

If we do get an Omicron hospitalisation surge then it will take a little time for the bulge of pressure to work through from initial admissions, to inpatients requiring non-invasive ventilation. It is this critical point, with the need to surge intensive care capacity, which draws theatre staff and anaesthetists away from the elective lists — resulting in much more widespread cancellations.

Sourcing private hospital capacity has been left to integrated care systems recently but might revert to something more formal and national if covid admissions become an issue the way staffing is currently an issue. This week’s letter from NHSE did call for IS use to be “significantly step[ped] up”.

Systems have surge plans ready, and are revisiting them in nervous anticipation of omicron, but less so the staff.

There have been reports of operations cancelled because bank staff would rather work on a vax site for better pay than do a normal shift, but it isn’t clear how widespread that is.

Sources in and out of the capital tell London Eye the centre’s refusal so far to signal what it they should let slip – with insistence that every IPC guideline is followed and all current targets pursued — is a frustrating denial of reality.

This is perhaps something London regional director and soon to be NHS England chief operating officer Sir David Sloman can raise at the top.

Meanwhile, good luck to interim replacement Andrew Ridley, a well-respected figure across the capital and further afield.