Nurses will be transferred to London from other parts of England under NHS plans to help hospitals in the capital facing a “tsunami” of Covid-19 patients within days, the Guardian has learned.
What do the restrictions involve?
People in the UK will only be allowed to leave their home for the following purposes:
- Shopping for basic necessities, as infrequently as possible
- One form of exercise a day – for example a run, walk, or cycle – alone or with members of your household
- Any medical need, to provide care or to help a vulnerable person
- Travelling to and from work, but only where this is absolutely necessary and cannot be done from home
Police will have the powers to enforce the rules, including through fines and dispersing gatherings. To ensure compliance with the instruction to stay at home, the government will:
- Close all shops selling non-essential goods, including clothing and electronic stores and other premises including libraries, playgrounds and outdoor gyms, and places of worship
- Stop all gatherings of more than two people in public – excluding people you live with
- Stop all social events, including weddings, baptisms and other ceremonies, but excluding funerals
Parks will remain open for exercise, but gatherings will be dispersed.
In an unprecedented package of measures, the NHS will also ask doctors to sleep on site for six weeks at the newly-built Nightingale hospital, scrap limits on the number of patients nurses can look after in intensive care wards, and explore whether ventilators intended for one person can be used for two.
NHS England has also asked its network of regional chief nurses if they can spare any of their staff, especially those specialising in intensive care, to work in London during the peak of the pandemic – expected to start early next month.
The moves emerged as the total number of reported deaths in the UK rose to 578; one official said the NHS faced an “extreme surge” of seriously ill patients early next month.
The plans are part of a series of measures drawn up in recent days by senior officials from NHS England’s London region and disclosed to the Guardian.
NHS Providers, which represents hospital trusts, has warned that some hospitals in the capital are filling up so fast with people left seriously unwell from coronavirus that they will soon be full.
Last week Northwick Park hospital in north-west London had to declare a “critical incident” after it ran out of space for Covid-19 patients and doctors to intubate (insert a tube into) them so they could be put on a ventilator.
Officials involved in the NHS’s emergency preparedness effort in London have revealed that:
A lack of ventilators has forced NHS planners to explore whether one machine could be used to keep two patients alive, drastically increasing capacity at a stroke.
London will have 7,500 critical care beds by the end of next week – 27 times more than the 275 it had before the epidemic began in January.
There are fears that a lack of oxygen could hamper the drive to save lives through the massive expansion of critical care capacity – hospitals will need daily deliveries to service all the extra ventilators.
Doctors at the newly-created Nightingale hospital at London’s ExCel centre looking after thousands of patients receiving life-or-death care will work there for at least six weeks, working five days in a row before having a break – and sleep on site.
The sheer number of patients falling ill will see the usual staffing ratios in intensive care units scrapped temporarily so that one intensive care nurse is looking after six patients rather than one – in what doctors privately warned was an “unbelievable” relaxation that would hit care standards.
Chris Hopson, NHS Providers’ chief executive, said hospitals in London had expanded critical care capacity between five and seven-fold in the last few weeks, but bosses at those hospitals have been alarmed by the speed at which beds are filling up in the capital.
He said the problems had been exacerbated by medical staff being off sick with suspected coronavirus or in vulnerable groups, with 30% to 50% not at work in some trusts.
He did not name the trust where 50% of staff are currently off sick or self-isolating because someone in their household has symptoms, but it is a London trust.
NHS chiefs are concerned that the London Ambulance Service is already so stretched it will struggle to cope with the 100 extra patients a day it is expected to have to take to hospital. It plans to meet that challenge by using 20-25 vehicles usually used to take patients to non-urgent appointments, which have few medical facilities on board, and hire taxis and dial-a-ride services for people denied their usual transport.
Private hospitals in London have offered to provide 111 critical care beds to help the NHS as well as 1,300 “step-down” beds for patients leaving NHS hospitals. They will also supply staff and equipment.
In a sign of the huge number of people expected to need critical care when illness rates in the rest of England become as high as London, the NHS also plans to open “field hospitals” for Covid-19 patients in Manchester and Birmingham, modelled on the transformation underway at the ExCel centre. Officials are looking at the National Exhibition Centre beside Birmingham airport as the likely venue.
In addition, the army, which is playing a key role delivering supplies of personal protective equipment to hospitals and GP surgeries, is building a new ward for seriously unwell patients in the car park at Wigan hospital. Experts believe the north of England will start seeing rates of Covid-19 illness comparable to London’s in about two weeks.
Speaking to BBC Radio 4’s Today programme, Hopson said: “They [London trusts] are struggling with the explosion of demand in seriously ill patients. They are saying it’s the number arriving and the speed with which they are arriving and how ill they are. They talk about wave after wave after wave.
“The words that are used to me are that it’s a continuous tsunami. As one said to me, it’s much bigger and large numbers with a greater degree of stretch than you can ever have possibly imagined.
“The CEOs are concerned that all that extra capacity is now being used up very, very quickly. We’ve got the surge capacity at the ExCel centre but this is filling up very quickly.”
Concern over whether ministers could have better prepared for the pandemic will likely be heightened by remarks from Sir David King, a former chief scientific adviser to the government.
He told journalists that the government was warned of the dangers of epidemics sweeping the UK four years ago.
“In 2016 there was a report that indicated our hospitals would not be ready for an epidemic of this kind but it has not been made public,” he said.
An NHS spokesperson said: “Staff in London are at this stage responding to a larger number of patients with confirmed coranavirus than other regions of the country so as well as increasing ‘surge’ capacity across London hospitals, we’re deploying other options too, including new facilities like the NHS Nightingale London and using capacity in the private sector.
“But it remains absolutely vital that this huge mobilisation by the NHS is matched by action from the public which means following medical advice to the letter – please stay at home to save lives.”
Additional reporting: Caroline Bannock, Sarah Marsh and Fiona Harvey