London Eye: ‘Better but still horrible’

How long is this plateau?

There might be efforts later in the year to say London wasn’t overwhelmed by this peak.

Anyone working through it in the service or even seeing the TV reports from inside the intensive care units will know that isn’t true.

Anyone looking at how many cancer surgeries got cancelled will know that’s not true as well.

Lots of the grim options outlined in London medical director Vin Diwaker’s presentation to leaders a fortnight ago have come to pass: mass cancellations of surgery and other planned work, transfers out of area to Yorkshire, the West Midlands and beyond.

And of course, beds and staff stretched like never before.

There is jolly talk of plateaus and things getting better but as one hospital leader told London Eye: “The plateau has definitely extended”.

The pressure on general and acute beds has flattened but ICU beds under the capital still face growing demand.

Another hospital leader said the workload was “not growing but not falling yet — which is better but still horrible”.

The maths of the situation are horrible. Running triple the number of ICU beds means you are looking at an ICU nurse:patient ratio of 1:3 before you get into their having to sleep etc. And we know the rate has been as bad as 1:6 at some places in the capital at times.

So, as another senior leader put it: “It is a very high plateau which is the problem.”

Another, more bluntly: “To quote my COO — it may feel better but it’s still bloody sh*t out there”.

Nationally one in 10 nurses is off sick with covid and at least one hospital in London is working to a bank and agency usage of 22 per cent. The new variant is clearly taking a toll here and, in some parts of the capital, nurses are more likely to live among the (heavily infected) communities they serve.

Overseas nurses (on which the NHS has long depended) often live together as well, creating a further infection risk.

Staff are exhausted and this still seems underrecognised at the highest levels.

But the steady increase of the past month is starting to abate.

Some are even optimistic enough to say they see “signs that we might be starting to see the end of it”.

At some emergency departments, the balance of patients is starting to tip back towards non-covid (most EDs have been running a covid and non-covid accident and emergency for some time now).

Another hospital leader said their A&E volumes in minors were low “so I hope the 111 pilots are working because otherwise it’s going to be like the first wave where lots of people who should have come and got treated didn’t and then present later much worse”.

Figures out today indicate this might already be the case.

What next?

The service might feel quite different after the covid peaks have gone. The incredible work of everyone involved will have to be recognised: the volunteers, everything. People won’t forget the work across silos. And they’ll need more than just a rest.

But now the NHS is showing up Test and Trace on how to deliver a national programme, delivering apparently variation-resistant vaccinations for all, will people say there never was a crisis, never a collapse?

Another chief executive: “Cancelling cancer surgery, massive numbers of deaths, huge ambulance waits and staff burnout is pretty much the service collapsing. I don’t know what worse would really look like.

“But now we’ll pull it back from the brink. The public will be desperate for life to feel normal from April.

“Many NHS staff will still be hugely traumatised and won’t want to move on. They will need support.”

They better get it.