Trusts told sending patients and staff to almost empty Nightingale is essential to recovery

The facility in east London was built to provide intensive care to around 3600 Covid positive patients. But it has remained largely empty since it opened as London trusts have been able to absorb the demand within their own expanded critical care capacity.

A letter to senior leaders in the capital, leaked to HSJ, said that using the Nightingale’s capacity was vital in helping London’s hospitals restore some of their typical services, such as elective surgery, as well as coping with rising emergency demand as social distancing measures are relaxed. There has been a major reduction in normal hospital activity during the coronavirus outbreak.

NHS England’s regional director Sir David Sloman said that without the facility, London would face a “perfect storm of insufficient critical care capacity” as normal services are phased back in.

He wrote yesterday: “Covid will have major impacts that last for at least 18 months and will change the way we deliver health care to our patients…

“When social distancing is relaxed, our plans for the future of London’s healthcare will rely upon new models of care and treatment…and sustained reliance on the expert site for critical care that the NHS Nightingale Hospital will provide.

“Utilising the Nightingale will enable us to be well positioned to avoid a perfect storm of insufficient critical care capacity that would otherwise prove an unnecessary restraint on the recovery of elective capacity, emergency care, covid-19 and winter pressure[s].”

The design of the Nightingale has been controversial among some critical care leaders in London, who believe the “step down” model used for temporary hospitals in other parts of the country is a better option, and there has been debate about converting the capital’s site to this approach.

Sir David’s letter said that over the “next few weeks” the Nightingale would be ramped up to provide intensive care for 84 patients, with 14 “step down” beds.

The letter suggests the plan beyond this is to open 252 intensive care beds and 42 step down beds. This would still just be a fraction of the potential capacity that was outlined in the draft clinical model.

Sir David said each of the five health systems in London would be asked to provide 11 medics and 33 registered nurses to enable the increase in activity, taking account of any staff already provided. They will be asked to commit to stay at the Nightingale for a period of at least 12 weeks.

He said the Nightingale would provide “a bridge to plan for the year ahead”, by enabling “a decant of critical care beds from theatres, recovery areas and PICU”, as well as the “refurbishment and building of future critical care facilities”, and a “decompression of critical care as presently delivered”.