What the fuck was the point in the Nightingale hospital?

[QOFE]

I just don't understand

I thought it was meant to take coronavirus patients to free up normal hospitals so the NHS didn't grind to a halt?

But I've just read an article saying it's likely to be wound down as it's not taken a new patient in over a week and the most it's ever had was 35, despite having 4000 beds.

But there's thousands of people who haven't been treated or admitted to hospital when they should have been, whilst a dedicated hospital sat empty? Elderly people being sent back to care homes to spread the virus to staff and the other patients due to no space for them to stay in hospital, but an empty hospital that they could have gone to instead?

What's that about then? Like... What was the point?

MH services are still operating

Not really

Even Chris Whitty had to point people towards mental health charities if they needed help with suicidal thoughts

I have also been wondering this. And there are plenty of staff. Just look at the threads where NHS staff have posted that hospitals are empty and they have nothing to do.

There might be plenty of staff. There aren't plenty of suitably trained staff.

Imagine if there was a shortage of airline pilots but a surplus of cabin crew - would you demand that cabin crew could fly the planes?

I wonder if the NHS would move to relaxing admission criteria.

They already have. No doubt as a result of complaints that very ill people were being left at home to deteriorate. The score on the 1-10 scale being used by paramedics and 111 was revised down from 7 to 3-5 (presumably discretionary?) about 10 days ago. No doubt as soon as it is panic stations again, it'll be revised upwards. It's one way of managing the numbers.

The Nightingale Hospitals were designed to house ventilated patients - they would be intubated and ventilated before arriving, so they would all be unconscious, lying in beds, ventilators breathing for them, teams of staff managing them (an ICU nurse supervising a small team of non-specialist Nurses assigned to each patient).

In China a large number of patients were ventilated with covid. In the worse affected regions of Italy patients were put on ventilators until they ran out of ventilators. So the UK government anticipated needing a lot of ventilated beds and created the Nightingale Hospitals and tasked business with building ventilators.

What they have found out though is firstly that many patients in China and Italy did not recover on a ventilator - it is not a magic bullet. In China many patients spent weeks on a ventilator and then died anyway. Secondly, patient selection - in the UK we would not usually put a very elderly or frail person on a ventilator even in normal circumstances, because they are very unlikely to recover to leave hospital. So many of the patients ventilated unsuccessfully in China and Italy would never have been put on a ventilator in the UK, however many ventilators we had available.

The Nightingale Hospitals wouldn't be suitable for conscious patients in their current format, so if they were going to be repurposed they would need to change.

However.... covid is not over yet. We will likely see more peaks, and some of the Nightingale capacity may be needed then. And normal NHS functions will be starting up, so there won't be so many empty beds available in the normal NHS hospitals in the next peaks.

@QOFE Contraception is not impossible to get hold of at all. Condoms are available in supermarkets. I needed a repeat of my pill this week, I emailed my GP to ask for it (which they don't normally accept but are at the moment), I got a text saying it was ready in the chemist the next day. Done.

Maybe not where you live. Where I live, GPs have stopped appointments for contraception and are telling women to use the sexual health clinic. Which operates a weekly clinic on a Tuesday night (and one on a Thursday but only for under 25s) and is in a town 15 miles away. Ok so condoms can be bought in lots of places but that is not the same thing as proper contraception available on prescription and you know it.

WatcherInTheRye - that's interesting and good to know. Hopefully give a greater number of people a chance to recover as opposed to deteriorate at home. Like you say it can be flexed if things changed.

And yes, maybe some women here can get a repeat prescription for the pill over the phone - but not if they're over 35, or due a medication review, or need their blood pressure checking first, or need it for the first time etc etc.

This is from the Telegraph article linked earlier. The modelling was based on extensive use of ventilators. Figures recently released show two thirds of Covid patients on a ventilator in the UK die.

^another doctor said that the original modelling assuming seven in 10 patients over 80 would be intubated or ventilated was ‘so far from real world practice, that it’s kind of laughable’ “It appears they don't understand one of the guiding principles of intensive care, yet were happy to make predictions about it without seeking expert opinion," he added. “The more frail you are, the longer it takes to recover from an admission to ICU, and the more likely you will die from complications on the unit. Recovery can take years and is often partial.

“Most people are significantly more frail after recovering from ICU than before. There comes a tipping point where admission is not deemed to be in the patient's best interests and isn't offered.

“That was a big early problem. We didn’t look at the models because we didn’t know what they were, and we just took on faith that we needed to prepare this vast surge capacity, which is what we did^

Its been crazy. Then also reports that people have been told they basically have to be unconscious before they can be admitted to hospital, etc etc. All behaviour as if there was no surge capacity. Reports of people dying in their homes or being laid out for longer than necessary (when they could have had breathing support)....

As others have said : second wave.

Will the second, & subsequent waves, be managed in the same way as the past four months?

COVID-19 is a novel virus, so much has been learned & at such a rate, that few, if any, can reliably predict its course & the disease is managed across global populations.

What is clear is that many of the assumptions & shibboleths of the NHS have been torn up so that rapid change & collaboration can happen. This is a good thing, the smart thing is to keep the spirit, energy & goodwill of this to construct a national health service that is fit for purpose & sustainable. No longer the NHS a political bauble.

ICU treatment can be systemically brutal & even for the fitter patients who come through such intensive treatment, overcoming the trauma & recovery does take some time.

StirCrazy2020 -
Like you say it can be flexed if things changed.

Yes, that's what worries me! Unless availability of oxygen treatment is increased in the community for those who aren't deemed ill enough for admission to hospital, then I'm afraid stringent admission criteria being resumed will once again result in people having their chance of survival compromised by lack of treatment at an early enough stage.

I query this meme that it was only blue lipped patients in later stages that were admitted to hospital. My brother was admitted, not blue-lipped, not breathless, but with other symptoms that might, or might not have been Covid. So not in late stages. He was tested and had Covid.

He seemed to be getting better. Doctors were planning to reduce his oxygen levels as he was on the face of it improving. But he wasn't so they didn't. He died - because he was too ill to be saved.

I do believe that doctors, as they have admitted, are struggling to understand still about this virus and its likely course of action - the way it can be asymptomatic, mild, severe and the way patients often seem to be recovering and then suddenly go downhill and into massive organ failure. They had to be prepared for the worst.

I do wish the geniuses with 20/20 hindsight would become politicans so we could all relax knowing they would never be wrong. We need them to do that instead of being keyboard warriors.

We are in a lockdown situation so cases will always be low in a situation like that. This hospital will be full once the lockdown lifts and people go crazy packing out parks and beaches and visiting every person they possibly can.

We aren't like China. The residents there did as they were told for 11 whole weeks. They stayed inside, they did not rebel and they didn't make what they wanted of the rules (yes it was rules there and highly enforced). This virus isn't disappearing. It will sit incubating in some people then lockdown will lift and it will be rife. The government naively think they can get numbers low then do 'test, trace, isolate' but that won't happen! Do you really think after 6-7 weeks of lockdown that people in the UK will be selfless and sensible enough to actually stay at home when they show synptoms? Will they fuck. The buggers can't even refrain from doing as they please during a pandemic so they certainly aren't going to be extra careful when there's less chance to social distance

I think they are more likely for the second wave. So far we are halfway towards the aim of gov for 54k dead.
Yes, Boris did use the word "aim". I remember thinking what a poor choice of words.

Yes we are still working in MH services

We are having to work differently. We are still getting medication to patients, we are still on the wards/working in various mh units/residential settings. The support for community patients for many is via telephone appointments (of course face to face support is better) but not for all some are deemed to at risk for telephone support

access through GP’s has changed which would more often than not be putting people on a waiting list to see a therapist along with a prescription for anti depressants. GP’s are still having consultations over the phone

People who are at high risk are still being sectioned

The Samaritans have always been a provider for support for those with suicidal thoughts - having suicidal thoughts doesn’t automatically get you access to a mh team. This would be for those deemed at risk (history of mh) for many a listening ear is the support they need

Many of us are still working our arses off dealing with mh patients, caring for those with covid, supporting them by accompanying them to hospital appointments, dealing with the anxiety and restrictions this brings that in turn has created new issues

Please don’t make such blanket statements. All services have had to change in how they provide care. The NHS has not come to a standstill and is only dealing with COVID. The priority often is trying to stop the spread of COVID and many areas we have had to change how we work not stop our work

QOFE I'm a practice nurse that has done loads of telephone consultations over the phone these past few weeks to women of all ages to reissue the contraceptive pill. Surgeries have been issued national guidelines around this. WOmen don't always need a BP check, etc. There have been only a handful of occasions I have encountered a problem. The vast majority of women should be able to get a repeat prescription without a problem.
It's poor practice on the part of your GP, but certainly not the case nationwide.

Some people get it: the Nightingale hospitals aren't needed during lockdown - the infection rate is being kept low because we are barely leaving our homes, if at all.
It is not feasible to keep lockdown in place until there is vaccine for everyone in the country.
Once lockdown is relaxed, the infection rate will increase again and Nightingale hospitals will be needed. They will also be needed to keep the coronavirus patients out of normal hospitals so the backlog of standard NHS work can recommence. However, I have heard that standard NHS work is being resumed in hospitals this week, but that those hospitals have not been deep-cleaned, so expect more cases from hospital-caught infections as well in the future.

The purpose of lockdown was to keep the infection rate manageable with what the NHS was able to provide with existing facilities. Once the Nightingale hospitals were ready and in place (one only opened last week) then the government will be more confident to relax lockdown knowing that there is extra capacity available. Lockdown wasn't to get rid of the virus so that after lockdown we would be safe. Not at all.

I agree OP. The UK refused to admit covid sufferers into hospital until they were practically at death's door (I speak from anectodatal evidence from friends and family). So, many people will have suffered - and some will have died - at home without being accepted at hospital when they really should have been. This seems to me the only reason why our hospitals were not 'overwhelmed' - we refused to admit people to hospital who actually needed it. I don't see that as a success. Our massive death rate tells the true story.

I do believe that doctors, as they have admitted, are struggling to understand still about this virus and its likely course of action - the way it can be asymptomatic, mild, severe and the way patients often seem to be recovering and then suddenly go downhill and into massive organ failure. They had to be prepared for the worst.

Sorry for your loss.

I remember reading something a couple of weeks back about hidden hypoxia with covid. I think it’s got something to do with covid affecting the body’s ability to absorb oxygen but not to get rid of CO2. So the body doesn’t compensate in the way you would expect and people’s O2 SATS were a lot lower than you would expect from their symptoms.

I can believe that people were screened out but not due to incompetence. Just because they weren’t expecting a sub-group of patients with ‘mild’ symptoms to actually be seriously unwell.

The issue was always going to be staffing. Nursing vacancies are already high. Along with adult social care, nursing has the highest level of vacancies in the public sector - the office for national statistics gives the detail on this.

This combined with the particular national shortages in ITU and theatre nurses ( theatre nurses are often well placed to support/work in ITU due to their recovery skills) meant this would always be a big issue. It will only get worse as the number of registered nurses approaching retirement age is growing quicker that those under 30.

It was necessary to have the nightingale hospital as the original figures looked horrendous. It was also a useful exercise in emergency responsiveness to open it.

I think it will still be needed. Somehow it will have to be staffed. I think this winter will be horrible. I'm an ex nurse ex NHS operational manager who spent half my career in winter pressures management / emergency planning/capacity management in hospitals. The NHS always struggles in winter, usually due to the increase in respiratory related illness, so add Coronavirus to the mix and the fact that all corona viruses\influenzas increase in the winter, plus staff sickness means that the winter wave of this will not be pretty and all capacity will be needed.

Lots of work has been done to ensure there are very enclosed areas for treating patients with Covid. Also much more testing of staff. NHS needs to get going again or there is going to be a big issue with non cubisdeatj rates.

It is good news that they are not filled!
can you not see that?