NHS does not have enough staff to man new Covid surge facilities, ministers warned

The NHS does not have enough medics to staff beds in “surge hubs” for Covid patients being set up at hospitals around England, a representative of health service managers has warned.

The chief executive of NHS Providers, Chris Hopson, said that an “emergency staffing model” will be needed, with recently retired doctors and nurses and experienced volunteers called in if the additional capacity is needed.

And a member of the committee of the Doctors Association UK, neurologist Dr David Nicholl of University Hospital Birmingham, warned that many clinicians within the NHS are “really, really anxious” about the rising pressure on staffing within the service.

“The biggest threat is staffing at every level,” Dr Nicholl told BBC Radio 4’s Today programme. “Speaking to my colleagues in critical care, they tell me they have less staff than they had 12 months ago.

“That, frankly, is because people are burned out from last winter. A lot of people are really, really anxious about what what’s going to happen next.”

Mr Hopson said ministers must be ready to introduce new restrictions on social and economic activity “at pace” if numbers of vulnerable patients rise in English hospitals.

But he warned that it will take a fortnight for the impact of any new restrictions to reduce admissions, during which time numbers on wards and in intensive care could rise sharply.

It was not possible to expect an NHS with 100,000 vacancies to man the extra surge hubs, he told Today, adding: “We’re clear that we would need extra support to staff these hubs and that’s been made very clear.”

Mr Hopson said there was no national threshold for the number of Covid patients which would require the use of surge hubs, as the trigger will vary from area to area depending on community infection rates and levels of staff absences.

He warned that emergency departments and elective surgery are far busier now than they were a year ago at the time of the Delta surge, while a lot of NHS capacity is taken up with the vaccination campaign. Some English trusts are already under “real, real pressure”, he said.

Meanwhile, Scottish deputy first minister John Swinney said there were signs from north of the border that Omicron patients may not require as extensive hospital treatment as those hit by earlier Covid waves.

“It does appear that people are perhaps staying less time in hospital than they were previously during the pandemic,” said Mr Swinney. “And our ICU (intensive care unit) admissions are not as large a proportion of hospital admissions as they have been in the past.”

Work will start this week on on a total of eight temporary “Nightingale units” at hospitals across England, each with a capacity of around 100 patients. Further sites could also be identified to add a further 4,000 “super surge” beds.

With a record 189,213 daily positive tests reported on Thursday, and 11,898 patients in NHS hospitals - including 868 on ventilation - NHS medical director Prof Stephen Powis has said the service is on a “war footing”.

Numbers in hospital remain well below the peak of around 38,000 seen at the height of the Delta wave in January last year, but Mr Hopson warned that the threshold set by ministers for new restrictions may rapidly be reached.

“The government assesses the rules and restrictions, not the NHS, and we know the government has set a high threshold on introducing extra new restrictions,” he told Today.

“So on that basis, trust leaders can see why the government’s arguing that - in the absence of a surge of seriously ill patients coming into hospitals - that threshold hasn’t yet been crossed.

“But we still don’t know if the surge will come. In terms of restrictions, I think we’re in exactly the same place we’ve been for the last fortnight, which is that the government needs to be ready to introduce tighter restrictions should they be needed.

“It’s worth remembering that it does take about a fortnight for any new restrictions to affect the levels of hospital admissions. So the pattern of admissions over the next fortnight has already been set.

“So in terms of restrictions, we should bring them in at pace if we need them. But Trust leaders understand why, the government having set a very high threshold, that threshold has not been crossed.”

Mr Hopson said that NHS trusts will make use of all existing capacity within hospitals before moving to fill beds in surge hubs located in car parks outside.

“As we saw when we expanded our surge capacity last January, we will obviously use existing facilities inside hospitals like, for example, wards that we use for elective care patients,” he said.

“If necessary, we’ll move into operating theatres and anaesthetic areas to treat patients should we see this real surge of older patients.

“The hubs are there to have super-surge capacity on top of that, so we really would be in an emergency if we were having to use them. And therefore we would have to use an emergency staffing model.

“We’re very clear in the NHS, we don’t have the existing staff to be able to staff these beds. So we would have to go into an emergency mode.

“We would be asking colleagues who’ve recently retired, we’d be asking colleagues from the voluntary sector and experienced volunteers to come in and help.

“The important thing to understand is that we wouldn’t be using these hubs for the most critically ill patients. What we would be doing is we would be using those for patients who effectively were over the worst, who were heading towards discharge to home. Their needs still would be significant needs but they clearly wouldn’t be the same needs as the most seriously ill patients. So it really is about an emergency staffing.”

The decision to locate surge hubs in car parks, rather than using conference centres and exhibition halls as was done during the first wave of Covid in 2020, meant that senior clinicians can swiftly be called in if a patient needs highly expert attention at short notice.