London Eye: How are hospital bosses feeling? Surprisingly upbeat

Still too early to say but…

It’s not just workforce planning that’s difficult, it’s also forecasting the demand from Omicron and (still out there) Delta.

In a London where it can feel like everyone has tested positive, how are NHS leaders feeling about how it’s going?

Surprisingly upbeat, compared to some of the dire forecasts.

While there are still difficult decisions being made every day on safe staffing, hospital sources say we’ve not yet seen anything like the numbers hitting ICU as did in January.

Yes, admissions continue to grow but the rate of increase has slowed.

While ICUs are busy, data from last week in the capital showed about a fifth of those beds were covid patients. This week, that is more or less unchanged.

Interestingly and, anecdotally, some clinical staff report more covid inpatients than before being admitted for something else and then being discovered to have covid. Those incidental cases are inevitable when there’s huge prevalence, but those on the ground say they seem to be playing a bigger role — so far — this time. Maybe a heavily vaccinated population with a lot of antibodies is not going to translate into ICU transfers like they did in previous waves?

If they do, and they certainly still might, then we are looking at the “London overwhelmed in 2-3 weeks” scenario.

One consultant told London Eye on Monday: “It feels on a knife edge. Lots of admissions, currently just about balanced out by high turnover (mostly discharges, but sadly some deaths and some transfers to ICU), but feels like something’s about to give and could then escalate rapidly. Next few weeks will be critical.”

One hospital leader said on Wednesday the general acuity of covid patients, and the proportion requiring oxygen, had also not escalated so far. So, fingers crossed.

Another said: “My sense is that we should be OK from a capacity point of view so long as we can get enough staff in to keep the flow and discharges going.”

But as ever, it’s a mixed picture. A different trust director said: ”It’s all about frantically getting ready for a storm, hoping for something less severe, but not knowing at all. Predictions vary substantially day by day, whilst the covid impact remains troublesome and rising gradually.

”Much of it is asymptomatic and unrelated to admission, but still causes significant care issues. Workforce absences are continuing, hundreds of staff isolating. Lots of anxiety about the weeks to come.”

While there’s talk of super-surge planning and field hospitals in other parts of England, that sort of armageddon-planning doesn’t seem to be something London is focussed on (indeed, the region seems highly focussed on vaccination numbers. London still has the lowest overall rates in England).

However, everything is far from OK

Of course, there are many notes of caution to be sounded too. Accident and emergency and cancelled operations particularly, but the main problem people mention is staffing, with covid absences rocketing up everywhere.

NHS Providers chief executive Chris Hopson said he had spoken to one hospital chief executive worried they wouldn’t be able to run their maternity unit because so many midwives would not take the vaccine. He didn’t say which trust but it wouldn’t surprise anyone if it was inside the M25.

There’s a limit to how many people can be redeployed into non patient-facing roles. And while the deadline is April, first doses must be given by early February and the planning, and difficult conversations with staff, have to happen now.

With calls to re-open the cancer surgery hubs earlier this week, these and elective services might face the same problems for different reasons to the ones expected.

A big wave into ICU and more acute covid patients in general beds would mean the redeployment of anaesthetists and theatre staff and more cancelled operations.

But if that doesn’t happen and instead there are high numbers of lower acuity patients being monitored on virtual wards (ie over video conferencing) you could still end up with a significantly reduced hospital workforce. This is something the planning document on covid virtual wards explicitly warned about and offered no reassurance for. There are concerns that the staffing model for these patients does not have enough nurse input in it as it is. The meeting of NHS England London’s clinical executive group on this is today.

London’s loss

Congratulations to Tracey Fletcher on taking the East Kent job. There is a trust which has had major challenges but the Homerton boss’s track record is excellent. It’s not the only measure, but while other trusts come and go at the top of the A&E performance table, the Homerton has been in the top two or three for a long, long time, so kudos to her and her team. Kingston Hospital FT has also had strong performance and former Homerton finance director Jo Farrar was exported there in 2015. Perhaps London’s DGHs are starting to get the recognition they deserve.