Analysis: Can hospitals cope with a second wave of Covid-19?

Hospitals across large swathes of England are bracing themselves for the onslaught of a second wave of the coronavirus, with numbers of patients in some areas, such as Liverpool, already stretching services.

Across the country, there are now as many patients in hospital with the virus as there were back in March and numbers are rising fast.

“We know for certain we are now in the second wave of Covid-19,” Professor Andrew Goddard, the president of the Royal College of Physicians, said on Monday. He added: “It is currently centred in the northwest and northeast of England, but it is going to spread to other areas.”

The plans drawn up by hospital teams during the summer are now being activated. Across the country, emergency rotas for doctors and nurses, as well as plans to draft staff back to the Covid front line, are being put into motion.

Concerns over the longer-term impact for patients waiting for surgery and those with suspected cancer, heart disease or other illnesses prompted an effort to restart many hospital services during the summer. Many hospitals have attempted to split their hospitals in two to create Covid-free areas in an effort to maintain some normal services.

Whether these plans work will be a big test for the NHS. Already Liverpool University Hospitals Foundation Trust has said it will be scaling back some routine operations.

The hospital is currently the worst-affected in the country, with more than 250 Covid patients, and it has started talks with neighbouring trusts to activate plans for “mutual aid”. 

In a sobering presentation at Downing Street, England’s deputy chief medical officer, Professor Jonathan Van Tam, and NHS England medical director Steve Powis made clear that what was being seen in the northwest would spread to other parts of the country.

According to the latest NHS England data on hospital admissions with Covid-19, the rise in the north of England is clear to see, but this is only the start. It is now almost inevitable that cases elsewhere in the county will see a similar trend in the coming weeks and the rate of growth of the virus in the south of England and parts of London is also rising.

In London, the Barts Health NHS Trust, which runs the Royal London Hospital in Whitechapel, is making plans to open up almost 200 new intensive care beds after a new critical care unit was built on two floors of the hospital earlier this year at a cost of £24m.

A spokesperson for the hospital told The Independent: “The new critical care unit on the 14th and 15th floors of the Royal London Hospital is being prepared to receive patients with Covid-19 if there is a surge in demand. The space will allow us to treat them separately from non-Covid patients, and this, together with the zoning and infection-control procedures in place across our hospitals, will mean that we can maintain other services.”

Beds are not enough on their own, however: as was the case with the Nightingale hospital in London, which only looked after 54 patients in total when it was operation in the spring, a lack of suitably qualified staff means there are limits to what the NHS can provide. 

Susan Masters, director of nursing, policy and public affairs at the Royal College of Nursing, said: “Readying Nightingale hospitals may relieve some of the pressure on wards and intensive care units, but it will increase the demands for staff.

“If nurses are to be deployed away from their usual jobs into frontline positions, such as ICU, they should not be put into roles that are outside their skills and competencies. They must be given the right support and training for the role they’re being sent into.”

As the second wave begins to ramp up, there are real concerns over the ability of the NHS workforce to cope – this time during winter, when the NHS already experiences higher demands due to seasonal flu and illnesses.

Dr Layla McCay, a director at the NHS Confederation, said the expected surge in Covid cases in the coming weeks and months, combined with cases of seasonal illnesses such as flu, was a big worry for hospital bosses.

“What we are anticipating this year is that there will be that winter surge and on top of a Covid-19 surge.

“We don't know how much demand is going to be for either winter or Covid-19, but from the predictions and trends we have seen, there is cause to be concerned.”

She added: “Staff are exhausted. Some have been working flat out.”