Temporary hospitals set up around the UK to handle the surge in coronavirus cases are almost empty, with at least one of the hastily constructed facilities expecting never to open its doors as the NHS weathers the crisis better than many had feared.
Seven Nightingale hospitals — named after the pioneering Victorian nurse — have been erected at unprecedented speed across England in recent weeks, with logistical support from members of Britain’s military. Similar facilities have also recently opened in Scotland and Wales. But the majority have only taken a handful of patients.
NHS leaders reject any suggestion that they have become “white elephants”, casting the dearth of coronavirus sufferers at the Nightingales as a mark of how well the health service prepared for the biggest public health emergency in a century. The UK has avoided the wrenching scenes in Italy where dying patients were treated in corridors after some hospitals ran out of beds.
On Sunday, Simon Stevens, NHS England chief executive, pointed to more than 30,000 beds in regular hospitals that had been released to make way for coronavirus patients, limiting the need to make “extensive use” of the Nightingales.
It would “count as a huge success for the whole country if we never need to use [the Nightingales] but with further waves of coronavirus possible it is important that we have these extra facilities in place and treating patients”, Sir Simon said.
However, medics are complaining that the London Nightingale — built in just nine days at the ExCeL conference centre in the city’s east end, lacks the staff or facilities to handle some of the more complex cases of coronavirus.
To be admitted to one of its 4,000 beds, patients must need full ventilation but no other specialist support, a rubric that excludes patients with multiple organ failure or pregnant women, for example, because they do not have the specialist staff or equipment.
One north London doctor complained that the Nightingale was “meant to exist to offload patients” when other hospitals were overwhelmed. “When you’ve got something that doesn’t do that it’s a waste of resources. It feels like they’re just cherry picking those patients less likely to die,” she added.
One critical care doctor said that, as he and his fellow medics had learned more about the disease, they realised patients were likely to need renal or surgical support, which the Nightingale was not equipped to provide.
Rejecting one report that the London facility has struggled with staffing levels and had to turn away seriously ill patients, officials said the intention had always been that staff would be drawn in from other hospitals as and when they were needed.
However, in a potential signal of staffing strains in some Nightingales, the Ministry of Defence said this week that it was sending 135 “combat medical technicians” — who provide battlefield first aid — to Harrogate and Bristol, two of the other six English Nightingales, which also include Manchester, Birmingham, Sunderland and Exeter.
A further 160 military personnel will be deployed to Harrogate and Bristol to help with porterage, equipment maintenance, stores management and distribution.
At other Nightingales, the story is of facilities largely unused because regular NHS hospitals have been able to care for coronavirus patients.
The 500-bed Harrogate Nightingale, serving Yorkshire, opened on Tuesday. Manchester, which has 36 beds but can expand to 750, started receiving patients last week. However, it is unclear how much it will be needed. Richard Leese, Greater Manchester’s deputy mayor, said on Wednesday that hospital admissions for coronavirus in the region had been falling since Easter.
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In Birmingham clinicians are examining whether the city’s so far empty Nightingale could be used for routine operations that have been postponed in order to free up beds in main hospitals. But David Rosser, chief executive of University Hospitals Birmingham NHS Foundation Trust, which runs four hospitals in the city, cautioned last week: “Is it as good as a bed in a hospital? No, not by a long stretch. It remains fundamentally a warehouse with beds in it.”
The Sunderland Nightingale has been fitted out in recent weeks as a 460-bed, 20-ward, facility at an undisclosed cost. It will be ready by the end of this month to receive patients from north-east England, should demand for beds outstrip capacity.
However, Martin Wilson, chief operating officer at Newcastle Hospitals NHS Foundation Trust, said he believed its doors might remain permanently shut: “If people can all play their part in social distancing, if a vaccine comes along, my hope is that we don’t need to open.”
In Glasgow, the Louisa Jordan hospital, which commemorates a Scottish nursing heroine who died in the first world war, opened on Monday but the government was relatively confident it would never be needed.
NHS England has not disclosed how much the English Nightingales have cost, beyond pointing out that both the London and Birmingham hospitals are occupying their expansive sites rent-free. However, the Scottish facility cost £43m to establish, officials said.
Before some have even opened, the future of the Nightingales is under consideration within government. On Wednesday Ben Wallace, defence secretary, suggested they could be pressed into service for different kinds of treatment, such as cancer or step-down care, noting that partly due to the effectiveness of the lockdown, “there’s not full utilisation of some of these Nightingales”.
There was “a discussion to be had, with the wider NHS, about do you want to use these facilities for something else, or do you want to decant Covid [patients] to there and go back to your day job elsewhere”, he told MPs.
An NHS spokesperson said: “Looking out over the coming months we expect to sustain the Nightingales and also deploy them to support recovering patients and others, as the rest of the NHS re-establishes routine services.”
Additional reporting by Mure Dickie
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