How Close Were Hospitals To Collapse In Covid?

Listen to Jim publication this article

Five times Prof Kevin Fong collapsed down successful tears successful a nondescript proceeding room successful West London, while giving grounds to nan Covid inquiry.

The 53-year-old has nan benignant of CV that makes you salary attention: a advisor anaesthetist successful London who besides useful for nan aerial ambulance work and specialises successful abstraction medicine.

In 2020, arsenic Covid dispersed astir nan world, he was seconded to NHS England and sent retired to nan worst deed areas to support different medics.

We’ve agelong been told that hospitals were struggling to header during nan pandemic. In January 2021, past premier curate Boris Johnson warned nan NHS was “under unprecedented pressure”.

But now galore hours of grounds to nan Covid enquiry this autumn is offering our clearest knowing yet of what was really going connected astatine nan tallness of nan pandemic.

The enquiry restarts its unrecorded hearings this week pinch grounds from doctors and diligent groups. Health ministers and elder NHS managers are besides expected to look earlier nan extremity of nan year.

I was astatine nan enquiry nan time Prof Fong calmly talked done much than 40 visits he led to intensive attraction units, his sound cracking astatine times.

What Prof Fong discovered astatine nan hospitals he visited was thing he said could not beryllium recovered successful nan charismatic NHS information aliases nan main evening news bulletins astatine nan time.

“It really was for illustration thing other I’ve ever seen,” he said.

“These group were utilized to seeing decease but not connected that scale, and not for illustration that.”

In precocious 2020, for example, he was sent to a midsize territory infirmary location successful England that was “bursting astatine nan seams”.

This was conscionable arsenic nan 2nd activity of Covid was hitting its peak. England was days distant from its 3rd nationalist lockdown. The first vaccines were being rolled retired but not yet successful ample numbers.

In that hospital, he recovered nan intensive attraction unit, nan overflow areas and nan respiratory wards each afloat pinch Covid patients.

The erstwhile nighttime personification had died successful an ambulance extracurricular waiting to beryllium admitted. The aforesaid point had happened that morning.

The unit were “in full bits”. Some of nan nurses were wearing big nappies aliases utilizing diligent commodes because location wasn’t clip for toilet breaks.

One told him: “It was overwhelming, nan things we would usually do to thief group didn’t work. It was excessively much.”

That night, Prof Fong and his squad helped to transportation 17 critically sick patients to different NHS sites – an emergency measurement unheard of extracurricular nan pandemic.

“It is nan closest I person ever seen a infirmary to being successful a authorities of operational collapse,” he said.

“It was conscionable a segment from hell.”

In nan pandemic we heard reports of swamped hospitals successful threat of being overwhelmed though to what grade was ne'er afloat clear.

On nan look of it furniture occupancy successful England – that’s nan full number of infirmary beds taken up by each patients – did not deed much than 90% successful January 2021, nan highest of nan largest Covid wave.

That’s supra nan 85% level considered safe but not immoderate higher than a emblematic wintertime extracurricular nan pandemic.

That doesn’t show nan afloat story. At that constituent hospitals had cancelled each their accustomed planned activity – from hep replacements to hernia repairs. Strict Covid rules meant nan nationalist were told to enactment astatine location and protect nan NHS. The numbers coming successful done A&E successful England fell by almost 40% compared to nan erstwhile year, to 1.3 cardinal successful January 2021.

That was why, erstwhile anti-lockdown protestors sneaked into hospitals to film, they recovered deserted corridors and rows of quiet seats.

The unit though was often being felt elsewhere – connected nan main wards and successful intensive attraction units (ICUs), wherever thousands of nan sickest Covid patients needed thief to respire connected ventilators.

“At our highest we ran retired of beingness furniture spaces and had to edifice to putting 2 patients into 1 space,” 1 ICU caregiver astatine a different infirmary told Prof Fong.

“Patients were dying daily, bad news was being surgery complete nan telephone aliases via an iPad."

Later investigation by the Intensive Care Society recovered that successful January 2021, 6,099 ICU beds were filled crossed nan UK, good supra nan pre-Covid capacity of 3,848.

This immense spike successful demand, balanced to building different 141 full intensive attraction units, was being driven by nan magnitude of clip Covid patients needed treatment.

On average they would walk 16 days successful ICU, usually connected a ventilator, compared pinch conscionable 4 to 7 days for a diligent admitted for different reason.

As a result, hospitals had to unreserved to person operating theatres, broadside rooms aliases different wards into makeshift intensive attraction units. NHS trusts often ended up juggling shortages of equipment, medicines and oxygen.

But while it mightiness person been imaginable to cram successful much beds, uncovering nan other skilled workers to unit them was acold much difficult.

Prof Charlotte Summers, who led nan intensive attraction squad astatine Addenbrooke’s infirmary successful Cambridge, said: “We can’t conscionable magic up master attraction unit because it takes a bully mates of years, astatine least, for minimum captious attraction speciality training.”

“What we had, we had, and we had to agelong further and further.”

As a consequence staffing ratios were pushed to nan limit successful Covid, thing she said politicians, nan media and nan nationalist didn’t afloat understand astatine nan time.

Outside of a pandemic, master captious attraction nurses would beryllium responsible for conscionable a azygous patient. In Covid they were looking aft four, 5 aliases moreover six – often each connected a ventilator.

“Staff didn’t person clip to process aliases judge nan losses,” nan lead ICU matron astatine 1 ample school infirmary told Prof Fong.

“As soon arsenic 1 diligent had passed distant they had to get nan furniture cleared and fresh for nan adjacent patient."

Others successful intensive attraction and Covid wards – from doctors to pharmacists to dietitians – saw their workloads stretched good beyond normal safe levels.

This was nan main logic why impermanent Nightingale hospitals, built successful nan first Covid activity astatine a costs of much than £500m, only ever treated a fistful of patients. It was imaginable to build nan captious attraction infrastructure almost overnight, but rather different point to find trained medics to activity successful them.

To thief plug these unit shortages successful ICU, volunteers were often brought successful from different parts of nan hospital, often pinch nary acquisition of intensive attraction medicine aliases of dealing pinch that level of trauma and death.

“They were being exposed to things which they wouldn't needfully beryllium [exposed to] successful their normal jobs, group deteriorating and dying successful beforehand of them, nan affectional distress of that,” said Dr Ganesh Suntharalingam, an ICU expert and erstwhile president of nan Intensive Care Society.

Another infirmary expert said he felt immoderate inferior members of unit were “thrown successful astatine nan heavy end” pinch small training and nary prime astir wherever they were sent.

The enquiry heard that each this “inevitably” had an effect connected immoderate of nan sickest patients.

At nary constituent did nan NHS person to enforce a general ‘national triage’, wherever personification was refused curen because they could not get a infirmary bed.

But utilizing that arsenic measurement of wellness strategy illness whitethorn beryllium excessively simplistic anyway.

Prof Summers said it would beryllium correction to deliberation of “catastrophic failure” arsenic a move that goes “from everything being okay to everything not being okay nan adjacent second.”

“It is successful nan dilution of a cardinal and 1 mini small things, peculiarly successful intensive care.”

She said erstwhile nan strategy becomes truthful overstretched it feels for illustration “we are failing our patients” and not providing nan attraction “that we would want for our ain families”.

New investigation suggests those infirmary units nether nan top unit also saw nan highest mortality rates for some Covid and non-Covid cases.

Difficult decisions were having to beryllium made astir which of nan sickest patients to move up to intensive care.

Those Covid patients who needed CPAP, a shape of pressurised oxygen support, alternatively than a ventilator, often had to beryllium cared for successful wide wards instead, wherever unit whitethorn person been little utilized to nan technology.

One anonymous ICU expert successful Wales said: “We didn't person capable abstraction to ‘give group a go' who had a very distant chance of getting better. If we had had much capacity, we mightiness person been successful a position to try."

The enquiry was besides told that astatine slightest 1 NHS spot was nether truthful overmuch unit it implemented a broad “do-not-resuscitate order” astatine nan tallness of nan pandemic. If a diligent went into cardiac apprehension aliases stopped breathing, it would mean they should not beryllium fixed thorax compressions aliases defibrillation to effort to prevention their life.

In normal times, that difficult determination should only beryllium made aft an individual objective assessment, and a chat pinch nan diligent aliases their family.

But Prof Jonathan Wyllie, ex-president of nan Resuscitation Council, said he knew of 1 unnamed spot that put successful spot a broad bid based alternatively connected age, information and disability.

Groups representing bereaved families said they were horrified, adding it was “irrefutable grounds nan NHS was overwhelmed”.

At times, nan effect connected intensive attraction was truthful awesome that immoderate units had to acquisition “rapid depressurisation” pinch dozens of patients transferred out, sometimes complete agelong distances, to different hospitals.

Before nan pandemic, from December 2019 to February 2020, only 68 of these capacity transfers had taken spot successful England. Between December 2020 and February 2021, 2,152 were needed, either by roadworthy aliases aerial ambulance.

Often it was nan astir unchangeable patients successful smaller territory hospitals who would beryllium selected for transportation arsenic – bluntly – they were nan astir apt to past successful a moving conveyance for respective hours.

“But what that meant for nan smaller units is that they were near pinch a cohort of patients who were astir apt to die,” said Prof Fong.

“Those units would acquisition mortality rates successful excess of 70% successful immoderate cases.”

In normal times betwixt 15% and 20% of ICU patients dice successful hospital, according to nan Faculty of Intensive Care Medicine.

Through nan pandemic nan NHS did proceed to run and, connected a nationalist basis, patients who really needed infirmary curen were not turned away.

But Prof Charlotte Summers, successful her evidence, said unit are still “carrying nan scars” of that time.

“You cannot spot what we’ve seen, perceive what we’ve heard, and do what we’ve had to do and beryllium untouched by it,” she said.

“You cannot and beryllium human. And we are very overmuch human.”

Health services successful each 4 UK nations started nan pandemic pinch nan number of beds successful ICU and staffing levels good beneath mean compared to different rich | countries.

Five years connected and location are still almost 130,000 occupation vacancies successful nan NHS crossed nan UK. Sickness rates among nan 1.5 cardinal NHS labor successful England are moving good supra pre-pandemic levels, pinch days mislaid to stress, worry and intelligence unwellness rising from 371,000 successful May 2019 to 562,000 successful May 2024.

All this comes arsenic nan wellness work struggles to retrieve from Covid pinch waiting lists for room and different planned treatments still hovering adjacent grounds levels.

“We coped, but only just,” said Prof Summers and Dr Suntharalingam successful their grounds to nan inquiry.

“We would person grounded if nan pandemic had doubled for moreover 1 much week, aliases if a higher proportionality of nan NHS workforce had fallen sick.

“It is important to understand really very adjacent we came to a catastrophic nonaccomplishment of nan healthcare system.”

With nan enquiry ongoing nary of nan agencies are presently commenting.

Additional reporting and investigation by Yaya Egwaikhide

Top photograph credit: Getty