1/24 It’s clear from London CEOs that London trusts are now in the full flow of managing explosion of covid19 related demand we were all expecting. Thought it would be helpful to share impressions of what’s happening and what others can start to learn from London’s experiences….
2/24 As ever, we are not the Government, we are not @NHSEngland, we comment from the perspective of being the membership organisation for trusts based on our real time dialogue with trust leaders. Full details of the basis of our comments here: nhsproviders.org/news-blogs/pre…
3/24 London trust CEOs incredibly proud of how much has been done, how quickly, to clear space/create capacity but they're concerned about how quickly this extra capacity is now filling up. Preparation/planning has been incredibly helpful but size of demand surge is off the scale
4/24 It's evident that a number of hospitals are on a trajectory where their critical care capacity will become full within a few days. CEOs report that the NHS London Regional team is working well, and hard, with them to agree the next steps to follow when this happens.,
5/24 In the face of this demand hospital, ambulance, mental health and community services have been adapting rapidly to do the very best they can in the circumstances. Lots of good innovative solutions to provide best possible care given the enormous challenge being faced.
6/24 Helpful to have had clear advice on what should be done in face of this demand explosion (e.g. NICE and Royal College guidelines) but in some places the pressure is already so great that these have to be a broad “sense of direction” as opposed to minutely observed reality
7/24 For example, in most places, patient / staff ratios dropping rapidly and smaller separate teams being collapsed into larger teams to allow specialists to get round as many patients as possible. Flexible workforce configurations to provide the best care are the order of day.
8/24 Such a clear sense from CEOs that we're totally dependent on efforts of our frontline staff and those who support them. CEOs full of admiration for how all staff are stepping up to the challenge in an amazing way and desperate to support them as effectively as possible
9/24 But an equal sense that all London trusts are now really struggling with workforce gaps. We started with 100,000 vacancies (England) and all report they now have very concerning numbers of staff off sick with covid19, in vulnerable groups or are self isolating…
10/24 This is why all trust CEOs are saying that access to personal protection equipment and adequacy of PPE guidance (minimise staff infection rate) and staff testing (help staff get back to work as soon as they can come) is so important. Clarity needed here very urgently.
11/24 London hospital CEOs report that, helpfully, “ordinary” A&E emergency attendances have dropped significantly compared to the normal levels of demand they would expect at this time of year. This is a help but only a very small one given the overall context.
12/24 However they are understandably concerned about “routine business” and consequences of, for example, simply having to delay all planned care work by three months (and having enough operational staff to actually do that and inform patients).
13/24 CEOs also worried about impact of issues like rehabilitation support for discharged patients given community services staff reallocation. Trust leadership teams having to make lots of difficult prioritisation decisions at real speed with imperfect information.
14/24 One advantage we have is the opportunity to learn from what is going on in London, given that London is some way ahead of most of the rest of the country, recognising there are other hotspots elsewhere. Good to see @NHSEngland setting up quick routes for this learning.
15/24 In terms of early lessons learnt, emerging view from some smaller District General Hospitals that it may make sense to concentrate their intensive care staff, resources & patients in larger units (eg Excel Centre) earlier rather than later. Best use of specialist resource?
16/24 And that the decision on when to get these new larger units up and running and divert patients to them is important. EG It’s more difficult to move patients after a few days post admission as they're a lot more ill and it uses up vital scarce patient transport capacity.
17/24 Increasingly clear from London how central ambulance service is to managing demand - being able to convey patients to right places with available capacity, using real time info on how full hospitals are. Lots of appreciation from all trust CEOs for work of @Ldn_Ambulance
18/24 Universal praise/ support for fantastic work being done by @NHSEngland London Regional Team led by David Sloman – v clear sense that, as London has moved from preparation to delivery, regional team comes centre stage and has to be level where key capacity decsions are made
19/24 Deeply impressive work, for example, to get Excel Centre ready to start receiving patients – very complex task to bring together physical space, staff and equipment at such scale in such a short space of time. Good example of NHS mobilising at v rapid pace when needed.
20/24 Good example of why the NHS has a crucial advantage over many other countries in being a genuine national health service with experienced regional teams to manage surge capacity, support local trusts and ensure they can help each other and aren't left to sink or swim...
21/24…And the NHS has a well equipped national team to purchase and secure extra ventilator capacity, mobilise extra logistics capacity for PPE delivery, buy up as much PPE as possible on the highly competitive international market etc etc
22/24 London CEOs saying they urgently want a lot more of everything – staff, ventilators, critical care capacity, PPE, testing capacity – but they recognise that their job is to do absolutely the best with what they have got and that's what they are focussed on.
23/24 It's difficult to sum up in a single tweet but talking to London CEOs I am reminded of a phrase someone used last week: this will be much bigger, in much larger numbers, with a greater degree of stretch, than you can ever have possibly imagined….
24/24 Every member of the public can play our part too – STAY
AT HOME and follow the guidance. Can’t stress how important this is and that
this is for real. Hope helpful.
AT HOME and follow the guidance. Can’t stress how important this is and that
this is for real. Hope helpful.
