HSJ Weekly Catch Up: Nightingales, PPE problems and local knowledge

A Nightingale sang

Over the last week, there has been lots of debate about what model of care should be provided at east London’s Nightingale Hospital.

Initially, a huge intensive care barn was being planned, taking the sickest patients from around the capital.

But it’s understood there was significant kick back against that idea from critical care departments, who doubted the logic of having lots of frail patients with comorbidities sent to the Nightingale, where none of the normal multispecialty support would be on hand.

These sorts of concerns appear to have been to the fore in Manchester and Birmingham too, which are working on hospitals that will focus on step down care, rather than ICU.

A draft clinical model for the London facility, seen by HSJ, suggests a compromise was reached, whereby it will still have up to 2,900 intensive care beds, but will be largely focussed on younger/fitter patients requiring ventilation. It will also have around 700 step down beds for those being readied for discharge.

Moving away from London, University Hospitals of Birmingham Foundation Trust has suspended non-urgent cancer surgery, saying it was following latest national guidance, which advises how trusts can prioritise patients with cancer and related services.

Meanwhile, hospitals outside of covid-19 hotspots have told HSJ they are being denied vital information to help them prepare due to a lack of national data sharing.

Hospital chiefs are calling the lack of national data, such as critical care occupancy, a “black hole”, with daily figures only shared across regions.

Leading the field

Temporary hospitals are beginning to spring up across England as the NHS prepares for a crucial month in the fight against coronavirus.

Field hospitals are being set up in Harrogate Convention Centre and leisure centres throughout Cumbria.

A range of other venues around the country are also being considered, such as Gatwick and Heathrow airports.

Meanwhile, the government has sent an email to local resilience forum planners, asking them to urgently share stock levels and daily consumption rates of personal protective equipment, body bags, swabs and infection control products at ambulance and acute trusts, and in primary care and other services.

The request — which was sent on Monday and asked for a response by 9pm on Tuesday — came from a Ministry of Defence planner at the resilience and emergencies division of the Ministry of Housing, Communities and Local Government.

Regional variation

The photos and footage keep coming of the Nightingale hospital at the Excel centre in London and the UK epicentre of covid-19 infection remains in the capital.

Yet away from England’s biggest urban centres, there is concern other regions are in danger of missing out on such additional surge resource; and having less robust planning in place for if/when they are hit.

The regional issues raise strategic tensions about how the service should respond too — are huge field hospitals in urban centres the wisest first move, or should resource flow out to smaller hospitals? Can kit be ferried around the country, or does it need to be divided out equally? Can patients even be shunted around England to where hospitals have capacity?

On Tuesday afternoon, HSJ analysis showed deaths in the East of England — a region with plenty of rural and coastal patches — are higher than London was at the same point since its 10^th recorded death. It is not possible to read much into the whys and wherefores of that yet; but it may be one more reason to consider the options.

Moving further up north, the fragility of the emergency department at Chorley and South Ribble Hospital has been well documented for several years.

Lancashire Teaching Hospitals was forced to temporarily downgrade the department in 2016 after national caps on agency spending made staffing the unit more difficult.

Although it later reopened as a 12-hour service, there is general consensus among medical experts that even the reduced service is unviable in the medium to longer term.

Preparatory work to consult on a major reconfiguration was underway before the coronavirus outbreak, but the trust has now moved to close it temporarily amid the current pressures.

Losing the will

Procurement teams continue to battle with critical personal protective equipment shortages, in spite of a raft of new efforts from the centre.

Sources told HSJ that even major trusts like Barts Health in London ran out of gowns last week and, according to the Health Care Supply Association, the products simply weren’t included in national pandemic influenza preparedness preparations. As HCSA chief officer Alan Hoskins put it in a now deleted tweet: “Losing the will to live, god help us all.”

NHS Supply Chain — which has reportedly been shipping its pre-Brexit stockpiles out to trusts — said it is expecting to get more gowns on Monday.