Coronavirus: NHS Nightingale chief says NHS must ‘never go back’ to old bureaucratic ways

The chief executive of London’s NHS Nightingale hospital has said the health service’s agile response to the coronavirus pandemic means it “can never go back” to its previously bureaucratic ways of working.

Professor Charles Knight also revealed the NHS is now planning to double London’s permanent intensive care bed capacity from 799 to more than 1,600 beds so a future Nightingale hospital would never be needed in any future epidemic.

Prof Knight, a consultant cardiologist, confirmed staffing levels for the Nightingale hospital, which was built at London’s ExCel conference centre, had been a major challenge. Insiders at the East London site told The Independent last week that a lack of staff was why the number of patients was only around 30.

The hospital’s CEO said the future of the Nightingale could be as a “bridge” to help the NHS get back to normal operations.

“We can never go back to how we used to work”, Prof Knight told a Royal Society of Medicine webinar on Tuesday, adding: “I think we were described in a newspaper as a lumbering bureaucracy. I think we have proven, once and for all that that’s not the case. I don’t think there’s many private sector companies that could have, or indeed have, responded to the pressures of Covid in the way we did.

“One mustn’t ignore the fact that for most of one’s time in the old NHS you were talking about money and business case approvals. We haven’t had to do that. But it would be foolish to think we could go back to a world where there is a blank cheque, that’s not going to happen, but what we can do is to take pride in what’s been achieved in terms of the flexibility of the response across the whole country. And also, to learn from that, to be more agile in the future and not go back to quite the sort of level of bureaucracy that we used to deal with.”

He said video and telephone consultations with patients was likely to become permanent for many hospitals, adding: “The hospital outpatient waiting room is probably a thing of the past and we shouldn’t have it back.”

On staffing levels, Prof Knight accepted it had been a challenge, saying: “It’s much easier to build a new hospital, than to staff it. I think the honest answer is that it would have been really very very very difficult to staff all those thousands of beds.

“But we were faced with a situation where people were going to die because of a lack of a ventilator so we had to do something … because the alternative was unthinkable.”

He said nurse to patient ratios at the hospital, which are normally one to one for ventilated patients, had been stretched to at least one to four and could have reached as high as one to six.

This was possible due to the layout of the wards he said which allowed greater visibility for staff. “That model will to some extent, and forget about the actual ratios, that model will have to go back in to normal intensive care unit practice for a period of time.

“When ICU capacity is permanently established in the normal hospitals we will still not be able to have the staff to staff those either.”

Around 850 patients were still in critical care in London he said, but warned there was a need for the NHS to get back to normal operations because of deaths linked to cancer and heart disease.

The Nightingale could continue to be “an insurance policy” for London, he said, or as a “bridge to normal operation” to allow services to re-start be being “used to decant Covid positive patients out of hospitals to allow some of them to be essentially Covid free.”

He added: “London must double its intensive care capacity on a permanent basis going forward. Everyone’s agreed that [the Nightingale] must be a temporary phenomenon. We must have a system of healthcare in this country that means if this ever happened again, we wouldn’t have to build an intensive care unit in a conference centre. There is a clear plan to double ICU capacity on a permanent basis in London, and we can be the bridge to that.”

The Nightingale opened on 3 April and admitted its first patients on 7 April.

Prof Knight said he was thankful that the predicted 7,500 surge in patients in London needing critical care never happened adding: “When we first came here, and we looked at these vast halls and we saw the beginnings of the bed bays being rolled out. It was a profoundly moving, awe inspiring and horrific moment, because if you imagine all those beds being full of patients it was like the apocalypse.”