What happens when the hospitals reach capacity?

[rainytreeleaves]

Just reading about NI nearly reaching bed capacity and a few places in the north as well. Hospital in Londonderry saying they are in a worse state than in the spring.

The hospital that I work in has been on black alert all week. The covid ward is full, no other wards can be repurposed as everywhere is full and (from tracing they believe) community transmission and via asymptomatic staff, there is a mass outbreak on our care of the elderly ward. Lots of staff self isolating so unsafe shifts and lots of patients infected. Also those elderly patients aren't now leaving to free beds up and no elderly patients can be admitted there for specialist input. It's a total mess.

Our local nightingale can't open as they don't have anyone to staff it. They are literally begging people throughout our region to go on the bank to staff it but there's not enough trained staff available.

I'm just not sure what will happen next....we are worse now than the spring. Slightly less covid so far but much greater bed need in general and more general transmission throughout making working really difficult.

I’m an ICU nurse. Our unit was SLAMMED during the first round. It was horrific and to be honest I’ve blanked a lot of it out. I’ve done this job for a long time and I’m top Band 7 which is relevant in the context that after this long and at this level you’re generally considered a bit of an old war horse (I’m 42 ) who can crack on with most things.

We are all dreading the next wave. We’re tired. We know what we’re probably facing. The adrenaline and novelty (if that’s the right word) if working in an on going major incident / pandemic wore off a long time ago. We saw fellow HCPs die (4 in my unit).

The daily relentless slog of PPE and fear.

Does anyone remember Megan in Casualty? When she did her big impassioned blood, shit and vomit speech? We didn’t go into this profession to get rich and with so many people facing financial ruin / food banks etc pay rises are a difficult subject. But now that the MPs are getting one I just feel fucking sick. FUCK THEM. How can they look at themselves in the mirror???

I’m in London. The Nightingale at the excel is still there, there was some discussion at the last network meeting that it might be considered as a stand alone elective hospital but obvs transport, equipment, labs, STAFF etc are an issue.

My hospital was very very nearly overwhelmed last time.

Good luck to all of you. Sorry for the massive vent. Not in the best place today but tomorrow I’ll dust myself off and go into work with a smile as always. Onward and upward. to all my fellow HCPs

@BlueBlancmange yes if they or their families need one. But of course by that point it'll be too late.

The mp pay rise at this time is a dreadful move, esp when they all seem so totally inept.

People think of the icu when hospitals are at capacity but it's all the knock on effects as well... The little things that trigger huge things that deeply concerns me.

@Xigris all best wishes to you and your team.
Could not agree more with you.

@StatisticalSense

Well if it's staffing issues it looks like it's time for the government to conscript nonworking and part time nurses and doctors of working age to work full time (or make up their hours to full time) in the nightingale hospitals at usual rates of pay.

That's incredibly short sighted and will people off training in medicine going forward. It's a carer choice, a calling, not a meat shield.

Maybe scrap tuition fees for medical professions?

@StatisticalSense do you purposely comment on nearly every thread with the sole aim to piss everybody off and wind people up with the constant chatter of bullshit just to see how many people bite?

@StatisticalSense The NHS only has so many beds to put people in, approx 101,000 of acute and general beds for a population of about 56 million in England. During an average Winter, bed occuapncy rates are often at unsafe levels.

Perhaps nursing staff and doctors could volunteer to take patients home with them ?

@StatisticalSense

Conscription shouldn't have been the first option but the reason it needs to be considered are the large number of qualified nurses, who are either happily working their part time hours and who are unwilling to work a single second of overtime or who aren't working in any capacity despite being able to do so, who chose not to volunteer for extra duties when the carrot was offered so now need to be brought into the fold using the stick. When the country pays (I realise a small number of the most recently qualified were not funded) for your education for the good of society and you refuse to use that education to your full capability when it could save lives during a global pandemic you are being extremely selfish.

I worked for 30 years as a Nurse most of that time in palliative care seeing people die horrible deaths day in and day out . For fifteen years I did this whilst juggling four kids too. I eventually left nursing a couple of years ago burnt out with my mental health in tatters. When covid struck I did rejoin the emergency register but then dh was told to shield and I'm not going to put him at risk. I also work now in a non nursing job supporting cancer patients, we are massively busy right now with hundreds of patients having had their treatment stopped during lockdown or already their cancer was so far gone when they were diagnosed that they are already palliative. Some were diagnosed in A & E. I may consider going back if I'm desperately needed.

And just to add - I'm not going to feel guilty if I don't return to Nursing ! I did 30 years !

[quote StatisticalSense]@rainytreeleaves
Of course there's a load of with 'stress' and the same people will probably develop a bad back a week after returning (which will be the week before full pay ends).
Actually I'd to see those furloughed back in their actual jobs which could happen for the vast majority if the NHS was actually stepping up to provide for society rather than expecting society to collapse to provide for it.[/quote]
You clearly have a very low opinion of NHS workers and a real disbelief for the experiences they had through the first wave.

I wish people who are moaning about being "bored of covid" on other threads would come and read this thread.

@Pomegranatespompom thank you.

@Legoandloldolls I totally agree with you about the tuition fees.

@StatisticalSense - not the greatest username as literally your posts have NO sense!! Are you an MP? You sound like one. Thank you so much for your support and insight into something you clearly know NOTHING about. Now go away and let the grown ups talk.

I've been down as a new volunteer for my local hospital for weeks now. I so want to help but they're not allowed to bring extra people in at the moment.

@Worriedmum999

As a vulnerable family this really scares me. Will it be all over the news when hospitals are reaching capacity? I’m worried that it will be hushed up like cases in schools seem to be. I want to take my children out of school and baton down the hatches but people just keep telling me I’m worrying too much.

I'm fighting this urge too.

My only saving grace right now is that our region is increasing but not my parish. If it reached our parish I'd ve pulling out.

Why does lockdown need the approval of everyone? why are we being held to ransom by the conspiracy nuts and deniers? in politics the people get what the people deserve......an inept government. We have a bunch of idiots looking to see what the other bunch of idiots desire.

I suspect that by the last week of October the feeble minded deniers will be looking to Bojo to save them.

We have elected leaders they should lead.

As for conscription, its a national crisis, yes, but I think instead we should be looking to stamp down hard on rates of transmission. Whilst I agree that the NHS should be there to support society and not the other way around, we don't have reliable treatments that will substantially make a difference to survival. Far better to not increase capacity but to decrease transmission at this time. That means putting protecting lives before protecting the economy. If it can be done in times of war it can be done now, and with no need to conscript people.

I can cope with lockdown. I'm not remotely in the vulnerable category, neither do I have friends or family who are particularly vulnerable, and I'm in the South East. But I am more than happy to sacrifice my social life to protect the lives of others. I'm not at all sympathetic to people winging about theme parks and parties, or even whining about having their own children to educate. I get sick of people saying how hard it is to work without childcare, just imagine how hard it might be for a child who loses their parent this winter, or knows their teacher got sick in school and died, or their gran died at home because the hospital was too short of beds.

Nah, we don't need the approval of deniers and nuts to have a lockdown. We just need a government of leaders who will put life above saving this bloody system that supports their own privilege. Its sickening that they have awarded themselves a pay rise, awarded contracts to their friends and ignored their own guidance, given conflicting messages, sent millions into unsafe schools, condemned thousands in care homes to death, and done absolutely nada about improving the pay of health and social care workers. I mean, who the fuck are you StatisticalSense to demand nurses work longer hours? it may well be that many are scared, some traumatised, others themselves vulnerable, or perhaps they are lone parents to children who wholly rely upon them. What are you doing and what are you sacrificing for society? or are you one of those mad keen little worker bees parroting "save the economy at all costs" just because you are not yourself vulnerable to anything much other than boredom (probably....you do post a lot on here) or redundancy?

MiniTheMinx that is the best post I've read in a long time!
I agree 100 %.
My sincerest thanks and love to all the HCPs.
Oh, and Statitistics - just shut up.

Its not about WHEN the hospitals reach capacity but what they do now to move patients.

You can't move extremely sick patients and you can't redivert serious emergencies.

And the problem is dependent on how busy the other hospitals nearby are too.

Liverpool is a particularly difficult issue geographically given the other nearby areas are also hotspots and distance to other hospitals in the area if it goes over capacity. (There are some geographical complications with this, as there isn't much hospital capacity to the North and to the East Manchester and the Leeds/Bradford area have their own problems. There is capacity to the South atm but there are logistics with the Manchester Ship Canal Crossings - which means if you had an incident with one of those being closed, you could run into serious issues if you are diverting people all over the places, so you absoluetely don't want to run into that scenario).

However, 'over capacity' is a bit of a phrase with some elasticity.

For example prior to the peak in April, Bradford Royal had 16 ICU beds. However by stopping all non-essential hospital business they were planning to have the ability to expand to up 150 ICU beds as a lower emergency capacity and up to 500 ICU beds as a higher capacity.

As it stands I believe Liverpool's ICU beds are currently at about 40% full. But this is before they have implimented measures like in April.

The local news have reported that hospitals are NOT currently planning to shut everything as they did in April and are supposed to carry on with normal services running alongside because they are now beginning run into life threatening scenarios with delayed treatments for other conditions.

In practice, you would expect other services in Liverpool to start being affected now though as they start planning and moving people to expand maximum possible capacity at peak.

So yet. Its not quite as black and white as you think (and I thought, until I had a good look at what this meant in practice).

We are nowhere near where we were in March.

Er, these guys say otherwise:

The UK is at a “tipping point” in the Covid-19 crisis and must act swiftly to avoid history “repeating itself”, the deputy chief medical officer, Jonathan Van-Tam, has said.

In a stark warning highlighting the worst is yet to come if we do not “all act now”, Van-Tam said the country was “at a tipping point similar to where we were in March”, and that the approach of winter made the situation even more grave.

“Winter in the NHS is always a difficult period, and that is why in the first wave our strategy was ‘contain, delay, research and mitigate’ to push the first wave into spring,” he said. “This time it is different as we are now are going into the colder, darker winter months. We are in the middle of a severe pandemic and the seasons are against us. Basically, we are running into a headwind.”

“I would say, actually, we are beyond the tipping point. To be perfectly honest, I think it’s perhaps being a little bit optimistic. We are clearly on the path of exponential growth,” said Martin McKee, the professor of European public health at the London School of Hygiene and Tropical Medicine.

The R number for the UK is between 1.2 and 1.5 , with every NHS region of England with an R well above 1, suggesting widespread increases in transmission continues across the country, not just in the north of England, Van-Tam said.

www.theguardian.com/world/2020/oct/11/uk-is-at-tipping-point-of-covid-crisis-says-senior-health-official

@mjmg2015 A four week half term would be too sensible. It'll never happen.

I'd like them to shut schools for a month but have a couple of weeks of home learning. A circuit break might get us through to Xmas. And again, have a month out of school for Xmas.

[quote cbt944]We are nowhere near where we were in March.

Er, these guys say otherwise:

The UK is at a “tipping point” in the Covid-19 crisis and must act swiftly to avoid history “repeating itself”, the deputy chief medical officer, Jonathan Van-Tam, has said.

In a stark warning highlighting the worst is yet to come if we do not “all act now”, Van-Tam said the country was “at a tipping point similar to where we were in March”, and that the approach of winter made the situation even more grave.

“Winter in the NHS is always a difficult period, and that is why in the first wave our strategy was ‘contain, delay, research and mitigate’ to push the first wave into spring,” he said. “This time it is different as we are now are going into the colder, darker winter months. We are in the middle of a severe pandemic and the seasons are against us. Basically, we are running into a headwind.”

“I would say, actually, we are beyond the tipping point. To be perfectly honest, I think it’s perhaps being a little bit optimistic. We are clearly on the path of exponential growth,” said Martin McKee, the professor of European public health at the London School of Hygiene and Tropical Medicine.

The R number for the UK is between 1.2 and 1.5 , with every NHS region of England with an R well above 1, suggesting widespread increases in transmission continues across the country, not just in the north of England, Van-Tam said.

www.theguardian.com/world/2020/oct/11/uk-is-at-tipping-point-of-covid-crisis-says-senior-health-official[/quote]
I don’t get it though when we had R number of 3 then and 100000 cases a day pre lockdown. Obviously we need to stop it ending up that way but it doesn’t make sense to say we are as bad as then. They need to actually explain why they are saying these things.

I guess March means different things to different people. From what I recall, Boris was still shaking hands and so on in mid-March. He didn't seem to grasp there was anything serious going on, global pandemic-wise, that could possibly apply to the UK... Meanwhile, the virus was spreading exponentially, which it is again.

“Ever since that notorious Cummings trip — and I think we could keep going on about that — because actually it is really important that it did so much damage to trust in the in England in a way that didn’t come to Scotland. There’s still high levels of trust there,” Mckee said.

From article @cbt944 posted link to

Erm, yeah. I think that has been eroded due to one Margaret Ferrier

I’d like to see all NHS staff put on emergency contracts enabling them to be transferred around the country with 48 hours’ notice.

We cannot have nurses sitting idle in Exeter who could be staffing Birmingham nightingale.

There will be no money left to fund the NHS if there’s another lockdown so we need to push NHS capacity to the max to prevent that.

Of course the government should put all childcare and accommodation in place for staff instructed to temporarily relocate.

Bless you, Ecosse. Your trolling is amateur.

@cbt944

I guess March means different things to different people. From what I recall, Boris was still shaking hands and so on in mid-March. He didn't seem to grasp there was anything serious going on, global pandemic-wise, that could possibly apply to the UK... Meanwhile, the virus was spreading exponentially, which it is again.

Yes good point.