NHS hospitals likened to war zones as doctors prepare to make grim decisions

NHS hospitals are in urgent need of ventilators and are approaching full capacity because of the Covid-19 outbreak, which will increasingly force doctors to make tough decisions about which patients to treat, the British Medical Association has warned.

The comments by BMA spokesman and consultant anaesthetist Tom Dolphin come as senior staff at a London hospital told the Guardian they expect beds in its intensive care unit to be full by 30 March, with one source describing its A&E unit as “like a war zone”.

Dolphin, who works at Imperial College London, said some hospitals in London, such as Northwick Park, which was forced to declare a “critical incident” last week after running out of critical care beds, are already struggling with the number of patients.

“Like any epidemic, there are hotspots. Some hospitals have had to transfer patients out to other intensive care units,” he told PA Media, adding: “We’re going to get to the point where we are really running out of capacity and that transfer ability is going to be difficult to do anyway because nowhere else will have anywhere either.”

Dolphin said that as the number of Covid-19 patients escalated, doctors would be forced to make decisions over who would benefit the most from ventilation and intensive care.

“We’re going to find ourselves at the point where decisions are going to get harder and harder,” he said. “We’re going to have limited resource, and rather than being able to offer it to everybody who needs it, we are probably going to have to prioritise between the people who are going to benefit from it as well.”

NHS staff have expressed concern about a shortfall of ventilators and correct protective personal equipment (PPE), with photographs circulating of staff creating their own makeshift items, including with clinical waste bags. Dolphin said their concerns were real.

He said his own hospital was “struggling” with supplies of PPE. “It’s happening everywhere,” he said. “The government says it’s coming but it’s not all out there. It’s in very short supply.”

Dolphin said the government promise of more ventilators needed to happen immediately. “The surge is beginning, we are pretty much out of time for that capacity to come online,” he said.

Staff at the Royal London hospital in east London told the Guardian that the number of patients there is doubling every five days and will exhaust the current capacity in nine days’ time.

Managers at the hospital’s trust are considering developing the hospital’s 14th and 15th floors into intensive care wards, a spokesperson confirmed, and are being pushed by staff to hold talks with private developers.

A source at the Royal London said: “It already feels like a war zone. You cannot go into A&E because it is full of suspected Covid-19 patients.

“Doctors are having to take decisions about who to treat and who to abandon already. Operations are being cancelled, and we are nowhere near the height of the crisis.”

The 14th and 15th floors, which look like “a neat building site” according to one source, were never completed because the trust wanted to save cash payments on the hospital’s PFI (private finance initiative) deal.

Barts health NHS trust, which runs the hospital, is training more staff to help use equipment in the intensive care unit and redeploying staff into critical care from other areas.

Managers are looking at options to expand intensive care into theatres, recovery anaesthetic rooms and specialist wards.

Dr Ian Renfrew, the hospital’s lead interventional radiologist, has set up a WhatsApp group so that the London and Regional Properties billionaire Ian Livingstone and other developers can discuss possible sites to rapidly establish new units with the trust’s chief executive, Alwen Williams.

In a sign that the offer is being taken seriously, Williams has invited members of the group to meet the hospital’s estates director to discuss space and specification.

The Whittington hospital in north London has had to expand its 15-bed intensive treatment unit because of the leap in Covid-19 cases and now has space for 35 people.

However, there are fears about how staff will cope with the extra patients. A nurse at the hospital, who did not want to be named, said: “The problem as well is nursing staff levels. We are expanding to 35 beds but then we will be short of staff. Capacity being full means one nurse looks after three or four intubated patients in that scenario. At the moment the hospital is coping but I am not sure it will in the future when capacity grows.”

The housing minister, Robert Jenrick, told Sky News on Sunday that the government had received prototypes of new ventilators and should begin production soon. However, NHS staff have said there must be sufficient people trained to operate them too.

Jason Leitch, NHS national clinical director of healthcare quality and strategy, insisted there was sufficient supply of PPE but admitted distribution had been an issue.

He said staff had to be trained in how to fit the high-end masks, adding: “I am confident that the beginning of that supply chain is robust and now the distribution will get better over the next few days.”

On Saturday it was announced that more beds, ventilators and 20,000 qualified extra staff would be made available from next week, thanks to a deal between NHS England and private hospitals.

A spokesman for Barts health NHS trust said: “We are considering how best we can work in partnership to help our hospitals manage the continuing increase in Covid-19 cases.”