Nightingale hospitals grounded by staff shortage

Each patient so far admitted to the Nightingale hospitals has cost £1m to treat, an analysis reveals.

Caroline Wheeler and Tom Calver

Seven Nightingale hospitals were built, at a total cost of £220m, to ease pressure on the health service during the first wave of the Covid-19 pandemic, but some may never fully open because of a staff shortage. The aim was to provide critical care in the event that NHS hospitals became overwhelmed.

Only two, in London and Manchester, looked after anyone, caring for about 200 patients in total during the first wave.

Despite England being plunged into a second national lockdown amid fears the NHS was reaching breaking point, only the Nightingale in Manchester is currently taking patients. Harrogate’s and Exeter’s are reportedly being used for non-Covid diagnostic care, such as cancer screening.

Chris Hopson, chief executive of NHS Providers, said there are “not the hundreds or thousands of NHS staff waiting to be deployed into those hospitals”.

He added: “In effect, you would have to take them from existing hospitals. Clearly what you want to do is to carry on treating patients in existing hospitals for as long as you possibly can until all of the existing capacity is used and then you flip to your insurance policy of using the Nightingales.

“But as soon as you start doing that, you will start drawing staff from existing hospitals, so the patient-to-members-of-staff ratio will start dropping, which will mean more pressure on quality of care.”

He claims the makeshift hospitals were only supposed to be deployed as a “last resort insurance policy” if the capacity in existing hospitals was reached.

However, Hopson said that the NHS Nightingale hospitals, inspired by the example of Italy’s Covid response, remain on standby to be used for when the last bit of capacity in the health service has been squeezed, adding: “The idea that you don’t need a lockdown because you are not using your Nightingale capacity is not true.”

The revelation comes just days after Sir Simon Stevens, the chief executive of NHS England, revealed that about 30,000 NHS staff are self-isolating or off work because of the coronavirus. The NHS employs 1.3m people in England.

Last week a senior intensive care specialist warned that reopening Nightingale field hospitals during the second peak of the coronavirus risks poaching staff from already overburdened hospitals.

Speaking at a Royal Society of Medicine webinar on Thursday, Dr Gary Masterson, a consultant at the Royal Liverpool University Hospital, said Nightingale hospitals had been a good idea in principle, but added: “I think perhaps the thinking was done before we had any understanding of this disease process.”

He said they were likely to be of little value because it is already hard to find the numbers of multi-disciplinary staff needed for our standard hospitals.

“There was an impression that if you stick a ventilator by a bed you get an intensive care bed space — that’s simply not true,” Masterson said.

“Once you ventilate a patient, these patients are often very, very sick and require advanced therapies.

“We are struggling to staff our normal NHS hospitals with self-isolation, with staff sickness and so forth — how are we going to staff Nightingale hospitals? I really don’t understand that.”

The Birmingham Nightingale, based at the National Exhibition Centre, cost £66.4m and was the most expensive to set up. Despite a capacity of 4,000 beds, it has yet to treat a single patient.

The cost of the Exeter Nightingale, at £23m, included £113,000 in management consultant fees. It opened on July 3 — well after the worst of the first wave — and never admitted a single Covid patient. Along with Harrogate, it has been used for CT scans since the summer.

Manchester Nightingale is finally being used for patients, but not Covid ones. It reopened at the end of last month, but if trusts want to use the £23.4m facility they have to supply their own nurses.

In the first wave the hospital cared for just over 100 patients in total. However, it is not an intensive care hospital, instead it is used for those who “no longer need to be in a critical care environment”.

ExCeL London and the NEC, which had already been earmarked to be decommissioned as hospitals, were set to reopen for events from October 1 until the government delayed the restart date.

Between them the seven Nightingales had a maximum stated capacity of 10,126 beds, around half of which were intensive care. However, because patient numbers were so small or non-existent, the actual number of beds was just 1,700.

Yesterday, the Royal College of Nursing (RCN) warned that nursing shortages across the NHS could lead to staff burnout and risk patient safety this winter.

The nursing union said that a combination of staff absence due to the pandemic, and around 40,000 registered nursing vacancies in England, was putting too much strain on the remaining workforce.

Mike Adams, RCN’s England director, said: “The NHS is now at its highest level of preparedness as it faces the prospect of an extremely challenging winter.

“We already know that frontline nurses — in hospitals, communities and care homes — are under huge strain.

“Anecdotally we’re hearing that in some hospitals they [nurses] are becoming increasingly thinly spread on the ground, as staff become unwell or have to isolate, at the same time as demand on services continues to increase.”