The role of the Nightingale field hospitals – which have remained largely empty even at peak periods of the pandemic – should be re-examined so they can be used more for patients recovering from Covid-19, according to senior doctors.
The creation of the Nightingales in record time last spring was hailed as a rare success story in the early months of the virus. But a lack of staff and the difficulties of switching intensive care treatment to new settings has meant they have been under-used, even at the height of the crisis when the NHS has been at breaking point.
A growing number of senior doctors are now calling for the Nightingales – especially the showpiece facility in London – to be opened up to patients who are past the worst of their illness but still need care and rehabilitation, thereby freeing up beds in hospitals, particularly in pressurised intensive care units.
Alison Pittard, dean of the Faculty of Intensive Care Medicine and an intensive care consultant, said that while it was an “amazing achievement” to have set up so much extra capacity “it is difficult for some to understand why they haven’t been used as much as expected”.
The seven Nightingales were established for different purposes – with the one at the ExCel centre in the capital intended for acute Covid cases while that in Manchester was earmarked for non-Covid cases. Using the new facilities to treat seriously ill patients in settings not designed for healthcare has caused huge logistical difficulties.
“Adapting the existing facilities to make them suitable for patients, purchasing beds, medical equipment, including ventilators and consumables, took place,” Pittard said. “But you can’t just buy the highly skilled, multi-professional staff that would be required to operate the equipment and care for the patients.”
She suggested that using Nightingales for patients who were through the worst of Covid-19 should be looked at as one of several ideas. “How could these facilities be used to help the NHS recover? One could consider using the Nightingale hospitals for patients recovering from Covid-19, taking the pressure off the NHS and liberating much-needed capacity.
“However, some do not have appropriate patient facilities as they were constructed with the view that they would be used for the critically ill, who would be sedated. Maybe they could be modified? Maybe more diagnostics could be undertaken?”
Dr Nick Scriven, past president of the Society for Acute Medicine, backed the calls for the Nightingales to focus on helping Covid survivors recuperate before being discharged.
“We know that a lot of the pressure on beds is due to a much longer length of stay [by Covid survivors]. It is a byproduct of people surviving when a year ago they might not have. The disease and treatment leaves many totally debilitated and needing weeks of therapy to regain independence,” Scriven said.
But switching to that model will not be easy, he added. “The Nightingales will need specialist rehabilitation staff and links to community care providers to make sure they don’t become massive ‘hotels’ for people to linger in without any help.”
Another senior consultant at a London hospital said there was frustration because patients who were over the worst of Covid had to test negative twice for the virus before they could be released to a Nightingale. This meant that in the case of the London Nightingale, a facility that had been set up originally for acute Covid cases, now could not take any cases at all – even those on the road to recovery.
The British Medical Association also endorsed the change of role. “It has been clear since the first wave that the Nightingales cannot be utilised as well as they might have been given the chronic staffing shortages in the NHS, particularly in intensive care,” said Dr Rob Harwood, the chair of the BMA’s consultants committee.
“Where possible these field hospitals should be put to use, though. Some sites around the country are being used to care for patients who are over the acute phase of their illness but still need hospital care, so as to help free up hospital beds and relieve pressure on other parts of the system allowing them to continue to treat the very sickest patients.”
But whatever role the facilities play, they must not take doctors and nurses away from hospitals that are already struggling with too few staff, he added.
