• Medical director says trusts “hanging on by their fingernails”
  • Warns of “inexorably” rising numbers of covid-19 inpatients at neighbouring trust

Hospital chiefs in the South West have warned the region will not avoid the extreme pressures felt by other parts of the NHS amid rapidly rising numbers of covid-19 inpatients.

The region was the least affected area of England during the pandemic’s first wave, but the medical director of two acute trusts yesterday predicted a “tidal wave” of covid-19 coming to the West Country.

Adrian Harris, medical director at Royal Devon and Exeter Foundation Trust and Northern Devon Healthcare Trust, said the region faced an “absolute crisis” and individual trusts would be “hanging on by their fingernails”.

His comments, made at NDHT’s board meeting, came on the same day HSJ revealed the South West region now has the fastest growth in covid-19 inpatients.

Although the region is England’s least densely populated, it also has the lowest hospital capacity per capita in the country.

Dr Harris said: “We hope and we pray that the lockdown has come in time for Devon.

“My personal view — and of my colleagues around the country — is that there’s a tidal wave of covid-19 coming to the West Country.

“We are preparing to be hit as hard as the East of England. If we are hit as hard, we will be hanging on by our fingernails and we are planning accordingly.”

Although NDHT only has 12 covid-19 inpatients, Dr Harris pointed to the “inexorably” rising numbers of covid-19 inpatients at nearby Royal Cornwall Hospitals Trust.

At RCHT, the number has gone from four covid inpatients in early December to 56 in early January. The trust’s chief executive, Kate Shields, told her board today the organisation was “starting to see one of the most challenging times in its history”.

A source told HSJ the trust is opening a fourth “red” ward to treat covid-19 patients, and is forecasting up to 200 such inpatients by the end of the month. In the first wave, the trust’s covid-19 occupancy peaked at around 20 patients.

University Hospitals Plymouth Trust is believed to now have more than 50 covid-19 inpatients, although this is lower than its peak during the first wave (around 110).

Speaking to the joint boards at RD&E and NDHT, Dr Harris added: “I fully believe the situation we’re seeing in the East of England, with the problems around beds and oxygen supplies, will come to the West Country…

“Normally we’re able to make some fairly robust predictions about where we’re going to be. But I have to say the accuracy of where we’re going to be is probably the least we’ve had since the beginning of the pandemic.

“We will face absolutely extraordinary times.”

He confirmed the region was taking patients transferred from hospitals in the South East of England, and said many hospitals there are “in excess of” 60 per cent of their bed base occupied by covid-19 patients.

Dr Harris also said Devon had analysed 192 covid-19 cases last month, of which eight were found to be the mutated form which has caused more pressures on hospitals in London and the South East.

He said: “I don’t believe we will dodge the bullet. I think the next board meeting we hold we will be talking about numbers of covid-19 we have not seen before.”

East Midlands system ‘going to be in trouble’ if beds not emptied

Alan Burns, group chair for Kettering and Northampton General Hospital trusts, told HSJ that unless space was created in the next week or so, his local system would buckle.

He said: “It seems clear that unless we can find a way to discharge and empty some 80 beds or so within the next week, we’re going to be in trouble.

“It’s the same problem that’s been reported in various places today. We’re still doing a certain amount of elective work and cancer work — we’re not where London is in terms of cancelling urgent operations — but, in order to keep a reasonable service, we are going to have to be able to create some space to allow the hospitals to function.

“We have got nearly 200 covid patients in Northampton, we’ve got a bit over a hundred in Kettering with nearly 20 [intensive care unit] cases between them. It’s that sort of number [and] that’s a lot when you add to some of the normal winter stuff… We don’t need much to go wrong for the system to be struggling.”

Mr Burns said there had been “helpful but, as of yet, not very productive conversations” to create extra acute space.

He added: “The nursing homes fear liabilities and exposing themselves and their residents to covid. [There’s] the fact that the vaccination programme hasn’t made quite as much progress in nursing homes as we might have hoped because of the difficulties with the Pfizer vaccine — it’s going to get easier now with the Astrazeneca [vaccine]. It’s just difficult to find ways and places to discharge your patients in this uncertain time.”

Rebecca Brown, acting chief executive at University Hospitals of Leicester Foundation Trust, also highlighted the challenge in the East Midlands in her trust’s board meeting yesterday.

She said: “As you know, we are currently at 24 per cent of our bed base [occupied] with covid patients, that’s around 320 to 330 at any one time.

“This is significantly higher than our first wave but we also know this is going to get a lot worse because of the new variant and we need to be prepared for that.

“What we don’t know is the impact of the new variant will have on Leicester, Leicestershire and Rutland because of course we’ve been in a situation where we’ve had a lockdown for much longer than lots of other areas and also we’ve had very high rates. We’re dealing with a lot of unknowns when it comes to covid as we have throughout the last year as well.

“What we have got is looking and observing what is happening across the country and we need to be ready for the pressure that we’re seeing in London and the East of England.”

UHL said it was planning to increase its ICU capacity to 150 per cent and wanted to get its bed capacity up to 50 per cent, in part through the postponement of electives, focusing predominantly instead on urgent electives and urgent cancer procedures only. This would continue for the next four to six weeks, with weekly review.